Breast,
Breast, Gastrointestinal & Preventive Health
Clinical Case
Questions (Advanced Nursing/Medical MCQs with
Answers)
1. A 44-year-old female mathematician presents to clinic with a complaint of
a mass in the right breast. Her partner noticed this mass 2 days ago, and the
patient feels guilty because she has only had one mammogram and does not
engage in breast self-examination (BSE) on any regular basis. She has
no family history of breast cancer, and her prior mammogram was ordered
as a routine screening test at age 43 years after a brief discussion with her
primary care provider. After a thorough investigation reveals a benign cyst,
what advice should be given to this patient about screening for breast
cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it
should be taught and reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a
routine part of annual examinations starting at age 30 years.
c. This patient was in compliance with the U.S. Preventive Services Task
Force (USPSTF) recommendations for her age group and risk factors prior to
her current complaint.
d. Mammography is most sensitive and specific for women in their 40s,
when breast tissue is still dense enough to image accurately.
e. Breast cancer screening is extremely well studied, and no controversy
exists on the recommended norms for screening and follow-up.: c. This
patient was in compliance with the U.S. Preventive Services Task Force
(USPSTF) recommendations for her age group and risk factors prior to her
current complaint.
2. A 42-year-old female website developer presents for an annual preventive
examination with questions about breast cancer screening. She is concerned
about the radiation exposure associated with mammography and is interest-
ed in magnetic resonance imaging (MRI) as a possible alternative for routine
screening. She is otherwise healthy with no family history of breast, ovarian,
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
,Breast,
or colon cancer. Which of the following is true about MRI as a screening
modality for breast cancer in the general population?
a.Breast cancer screening by MRI has been well studied in the general popu-
lation.
b.Sensitivity of screening for breast cancer increases with breast MRI at the
expense of specificity.
c. This patient is an ideal candidate for screening via breast MRI based on
current evidence.
d.Women at low lifetime risk of breast cancer (<20%) are recommended to
undergo screening
MRI.
e.Known BRCA1 or BRCA2 mutation is insufficient criteria to justify screening
with breast MRI.: b. Sensitivity of screening for breast cancer increases
with breast MRI at the expense of specificity.
3. A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral
nipple discharge. This discharge started several weeks ago and has occurred
at irregular intervals since that time. She does not complain of local ten-
derness, redness, fever, or any other systemic symptoms aside from slightly
irregular periods over the last few months. On examination, she is able to
express a small amount of discharge, which is sent to the laboratory and
found to be consistent with breast milk but without any signs of blood
or pus. Screening laboratories are also sent, which reveal a normal blood
count, metabolic panel, thyroid-stimulating hormone, and human chorionic
gonadotropin (HCG) level. Further laboratories are still pending. Which of the
following is the most likely diagnosis? a. Mastitis
b.Ductal carcinoma in situ
c. Paget disease of the breast
d.Occult pregnancy
e.Prolactinoma: e. Prolactinoma
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
,Breast,
4. A 22-year-old G0P0 undergraduate student presents to clinic after finding
a breast mass on breast self-examination (BSE) at home. The mass is
nontender without skin changes, erythema, or overlying swelling. She has
heard that most breast cancers are found by patients themselves, and she is
very con-cerned that she may have breast cancer. Which of the following is
true about
BSE and self-detection of breast cancer?
a.Most masses that women find at home and bring to a provider's attention
turn out to be malignant.
b.This patient is more likely to find a fibroadenoma than a cancer on self-ex-
amination.
c. The most likely breast mass this patient is likely to find in herself is an
abscess complicating underlying mastitis.
d.Because of this patient's age, breast masses should not be pursued with
imaging and diagnosis because the risk of cancer is so low.
e.BSE is universally recommended because of very high sensitivity and
speci-ficity for finding cancerous lesions.: b. This patient is more likely to
find a fibroadenoma than a cancer on selfexamination.
5. A 48-year-old female psychologist presents to clinic with concerns about
her breast cancer risk after an age-matched cousin was recently diagnosed
with this disease. This cousin is the third family member on her father's side
in as many years to be diagnosed with breast cancer, including the patient's
own father, who had surgery and subsequent treatment 3 years ago for
breast cancer. The patient has little other knowledge of her family history,
only that her grandparents independently arrived from Eastern Europe near
the end of World War II and were among very few members of their family
that survived the war. The patient has read about testing for the breast
cancer genes (BRCA1 and BRCA2) and desires further information about
whether this would be appropriate for her. Which of the following is true
about this patient's indications for BRCA testing?
a.Her familial lineage is irrelevant to her risk of BRCA genes and should be
discounted in assessing her risk for these genes.
b.Breast cancer in a male relative does not add significant weight to the
decision to test for the BRCA genes in this patient.
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
, Breast,
c. The BRCAPRO calculator does not add any further clinical information to
this patient's risk for carrying the BRCA gene.
d.This patient carries several risk factors that together justify BRCA testing.
e.Even if this patient is BRCA positive, no changes in screening or treatment
are recommended for patients with this genetic mutation, so the test is not
recommended.: d. This patient carries several risk factors that together
justify BRCA testing.
6. A 68-year-old former paleontologist presents to clinic with concerns about
her breast cancer risk. Her mother developed the disease in her 50s and died
from it in her 60s. A younger cousin developed the disease a few years ago
before the age of 50 years, but this individual was not tested for the BRCA1
and BRCA2 genes. In addition, the patient suffered from lymphoma in her
20s and had radiation to the chest. She did take hormone replacement
therapy for a few years before data emerged that this may contribute to
breast cancer risk. She has had several abnormal mammograms in her 50s
for persistently dense breasts with subtle findings, but follow-up biopsies
never showed any malignant pathology. Which of the following is true
regarding magnetic resonance imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who
has moderately but not extraordinary risk factors for breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against
screening with MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI
comes at the expense of markedly decreased specificity (i.e., the ability to
rule out disease in healthy breasts).
d. Mammograms are not affected by breast density and thus density is
not a factor in choosing MRIs over mammograms in patients such as this
individ-ual.
e. History of chest radiation is not a risk factor for breast cancer and is
thus not relevant to deciding whether MRI is appropriate in this patient.: c.
Regardless of recommendations, the high sensitivity of breast MRI comes at
the expense of markedly decreased specificity (i.e., the ability to rule out
disease in healthy breasts).
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
Breast, Gastrointestinal & Preventive Health
Clinical Case
Questions (Advanced Nursing/Medical MCQs with
Answers)
1. A 44-year-old female mathematician presents to clinic with a complaint of
a mass in the right breast. Her partner noticed this mass 2 days ago, and the
patient feels guilty because she has only had one mammogram and does not
engage in breast self-examination (BSE) on any regular basis. She has
no family history of breast cancer, and her prior mammogram was ordered
as a routine screening test at age 43 years after a brief discussion with her
primary care provider. After a thorough investigation reveals a benign cyst,
what advice should be given to this patient about screening for breast
cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it
should be taught and reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a
routine part of annual examinations starting at age 30 years.
c. This patient was in compliance with the U.S. Preventive Services Task
Force (USPSTF) recommendations for her age group and risk factors prior to
her current complaint.
d. Mammography is most sensitive and specific for women in their 40s,
when breast tissue is still dense enough to image accurately.
e. Breast cancer screening is extremely well studied, and no controversy
exists on the recommended norms for screening and follow-up.: c. This
patient was in compliance with the U.S. Preventive Services Task Force
(USPSTF) recommendations for her age group and risk factors prior to her
current complaint.
2. A 42-year-old female website developer presents for an annual preventive
examination with questions about breast cancer screening. She is concerned
about the radiation exposure associated with mammography and is interest-
ed in magnetic resonance imaging (MRI) as a possible alternative for routine
screening. She is otherwise healthy with no family history of breast, ovarian,
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
,Breast,
or colon cancer. Which of the following is true about MRI as a screening
modality for breast cancer in the general population?
a.Breast cancer screening by MRI has been well studied in the general popu-
lation.
b.Sensitivity of screening for breast cancer increases with breast MRI at the
expense of specificity.
c. This patient is an ideal candidate for screening via breast MRI based on
current evidence.
d.Women at low lifetime risk of breast cancer (<20%) are recommended to
undergo screening
MRI.
e.Known BRCA1 or BRCA2 mutation is insufficient criteria to justify screening
with breast MRI.: b. Sensitivity of screening for breast cancer increases
with breast MRI at the expense of specificity.
3. A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral
nipple discharge. This discharge started several weeks ago and has occurred
at irregular intervals since that time. She does not complain of local ten-
derness, redness, fever, or any other systemic symptoms aside from slightly
irregular periods over the last few months. On examination, she is able to
express a small amount of discharge, which is sent to the laboratory and
found to be consistent with breast milk but without any signs of blood
or pus. Screening laboratories are also sent, which reveal a normal blood
count, metabolic panel, thyroid-stimulating hormone, and human chorionic
gonadotropin (HCG) level. Further laboratories are still pending. Which of the
following is the most likely diagnosis? a. Mastitis
b.Ductal carcinoma in situ
c. Paget disease of the breast
d.Occult pregnancy
e.Prolactinoma: e. Prolactinoma
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
,Breast,
4. A 22-year-old G0P0 undergraduate student presents to clinic after finding
a breast mass on breast self-examination (BSE) at home. The mass is
nontender without skin changes, erythema, or overlying swelling. She has
heard that most breast cancers are found by patients themselves, and she is
very con-cerned that she may have breast cancer. Which of the following is
true about
BSE and self-detection of breast cancer?
a.Most masses that women find at home and bring to a provider's attention
turn out to be malignant.
b.This patient is more likely to find a fibroadenoma than a cancer on self-ex-
amination.
c. The most likely breast mass this patient is likely to find in herself is an
abscess complicating underlying mastitis.
d.Because of this patient's age, breast masses should not be pursued with
imaging and diagnosis because the risk of cancer is so low.
e.BSE is universally recommended because of very high sensitivity and
speci-ficity for finding cancerous lesions.: b. This patient is more likely to
find a fibroadenoma than a cancer on selfexamination.
5. A 48-year-old female psychologist presents to clinic with concerns about
her breast cancer risk after an age-matched cousin was recently diagnosed
with this disease. This cousin is the third family member on her father's side
in as many years to be diagnosed with breast cancer, including the patient's
own father, who had surgery and subsequent treatment 3 years ago for
breast cancer. The patient has little other knowledge of her family history,
only that her grandparents independently arrived from Eastern Europe near
the end of World War II and were among very few members of their family
that survived the war. The patient has read about testing for the breast
cancer genes (BRCA1 and BRCA2) and desires further information about
whether this would be appropriate for her. Which of the following is true
about this patient's indications for BRCA testing?
a.Her familial lineage is irrelevant to her risk of BRCA genes and should be
discounted in assessing her risk for these genes.
b.Breast cancer in a male relative does not add significant weight to the
decision to test for the BRCA genes in this patient.
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
, Breast,
c. The BRCAPRO calculator does not add any further clinical information to
this patient's risk for carrying the BRCA gene.
d.This patient carries several risk factors that together justify BRCA testing.
e.Even if this patient is BRCA positive, no changes in screening or treatment
are recommended for patients with this genetic mutation, so the test is not
recommended.: d. This patient carries several risk factors that together
justify BRCA testing.
6. A 68-year-old former paleontologist presents to clinic with concerns about
her breast cancer risk. Her mother developed the disease in her 50s and died
from it in her 60s. A younger cousin developed the disease a few years ago
before the age of 50 years, but this individual was not tested for the BRCA1
and BRCA2 genes. In addition, the patient suffered from lymphoma in her
20s and had radiation to the chest. She did take hormone replacement
therapy for a few years before data emerged that this may contribute to
breast cancer risk. She has had several abnormal mammograms in her 50s
for persistently dense breasts with subtle findings, but follow-up biopsies
never showed any malignant pathology. Which of the following is true
regarding magnetic resonance imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who
has moderately but not extraordinary risk factors for breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against
screening with MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI
comes at the expense of markedly decreased specificity (i.e., the ability to
rule out disease in healthy breasts).
d. Mammograms are not affected by breast density and thus density is
not a factor in choosing MRIs over mammograms in patients such as this
individ-ual.
e. History of chest radiation is not a risk factor for breast cancer and is
thus not relevant to deciding whether MRI is appropriate in this patient.: c.
Regardless of recommendations, the high sensitivity of breast MRI comes at
the expense of markedly decreased specificity (i.e., the ability to rule out
disease in healthy breasts).
Breast, Gastrointestinal & Preventive Health Clinical Case Questions (Advanced Nursing Medical MCQs with
Answers)
