NR 509 - FINAL EXAM BATE'S INTERACTIVE
QUESTION BANK QUESTIONS AND ANSWERS
LATEST UPDATE
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.
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 interested in magnetic resonance
imaging (MRI) as a possible alternative for routine screening. She is otherwise healthy
with no family history of breast, ovarian, 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 population.
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.
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 tenderness, 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
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 concerned 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-examination.
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 specificity for
finding cancerous lesions.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
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.
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.
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 individual.
QUESTION BANK QUESTIONS AND ANSWERS
LATEST UPDATE
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.
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 interested in magnetic resonance
imaging (MRI) as a possible alternative for routine screening. She is otherwise healthy
with no family history of breast, ovarian, 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 population.
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.
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 tenderness, 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
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 concerned 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-examination.
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 specificity for
finding cancerous lesions.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
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.
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.
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 individual.
