NR 509 - Final Exam Bate's Interactive
Question Bank
A 44-yr-vintage woman mathematician presents to hospital with a complaint of a mass inside
the proper breast. Her accomplice observed this mass 2 days in the past, and the affected
person feels responsible due to the fact she has simplest had one mammogram and does not
interact in breast self-exam (BSE) on any normal basis. She has no family history of breast most
cancers, and her earlier mammogram become ordered as a recurring screening test at age 43
years after a short dialogue along with her number one care provider. After a radical
investigation reveals a benign cyst, what recommendation ought to take delivery of to this
affected person approximately screening for breast most cancers in her age organization?
A. BSE is properly evidenced, and all recommending corporations agree that it must learn and
reinforced.
B. Clinical breast exam (CBE) is superior to BSE and need to be a habitual part of annual
examinations beginning at age 30 years.
C. This patient changed into in compliance with the U.S. Preventive Services Task F
c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF)
recommendations for her age institution and chance factors previous to her modern-day
criticism.
A forty two-yr-vintage girl website developer presents for an annual preventive examination with
questions on breast cancer screening. She is worried about the radiation publicity associated
with mammography and is interested in magnetic resonance imaging (MRI) as a probable
alternative for ordinary screening. She is otherwise healthful with no family history of breast,
ovarian, or colon cancer. Which of the subsequent is true about MRI as a screening modality for
breast cancer in the standard population?
A. Breast cancer screening by means of MRI has been well studied within the wellknown
populace.
B. Sensitivity of screening for breast cancer will increase with breast MRI on the fee of
specificity.
C. This affected person is a great candidate for screening thru breast MRI primarily based on
modern 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 c
,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
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
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 b
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).
A 66-year-old female museum curator presents for a routine annual examination. On
examination, a notably enlarged supraclavicular lymph node is appreciated on the right side.
The lymph node is nontender and feels firm and rubbery. She denies any localized or systemic
symptoms such as breast lumps, fevers, or night sweats. She has been taking conjugated
estrogen tablets for 9 years since menopause, though she has not taken progestin compounds
since she had a hysterectomy for heavy bleeding at age 45 years. Which of the following is true
about this presentation of lymphadenopathy?
A. Breast cancer always presents with axillary lymphadenopathy because the lymphatics of the
breast uniformly drain into the axilla.
B. Supraclavicular nodes are generally considered benign and require no further evaluation or
follow-up.
C. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the neck.
, D. Firm,
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A rubbery,
mobile, nontender mass is palpated in the right breast as described by the patient, which is
consistent with a firbroadenoma. In describing the location of the mass, the examiner notes that
it is 3 cm proximal to and 3 cm to the left of the nipple. Which of the following would be the most
appropriate way to report this finding?
A. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the
nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from the nipple"
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the
nipple"
A 54-year-old female dietician presents for a routine annual examination. On review of systems,
she reports that she has had many breast findings over several years, including one biopsy with
normal pathology. She feels that her breasts have become far less lumpy since she underwent
menopause 3 years ago. Which of the following is true regarding changes in the breasts with
menopause?
A. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity
and specificity of mammograms.
B. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after
menopause.
C. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the
number of lobules.
D. Breast density has no genetic component and is entirely due to estrogen dose from
endogenous and exogenous sources over the lifetime.
E. Mammography performs most poorly in the menopausal and postmenopa
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the
number of lobules.
Question Bank
A 44-yr-vintage woman mathematician presents to hospital with a complaint of a mass inside
the proper breast. Her accomplice observed this mass 2 days in the past, and the affected
person feels responsible due to the fact she has simplest had one mammogram and does not
interact in breast self-exam (BSE) on any normal basis. She has no family history of breast most
cancers, and her earlier mammogram become ordered as a recurring screening test at age 43
years after a short dialogue along with her number one care provider. After a radical
investigation reveals a benign cyst, what recommendation ought to take delivery of to this
affected person approximately screening for breast most cancers in her age organization?
A. BSE is properly evidenced, and all recommending corporations agree that it must learn and
reinforced.
B. Clinical breast exam (CBE) is superior to BSE and need to be a habitual part of annual
examinations beginning at age 30 years.
C. This patient changed into in compliance with the U.S. Preventive Services Task F
c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF)
recommendations for her age institution and chance factors previous to her modern-day
criticism.
A forty two-yr-vintage girl website developer presents for an annual preventive examination with
questions on breast cancer screening. She is worried about the radiation publicity associated
with mammography and is interested in magnetic resonance imaging (MRI) as a probable
alternative for ordinary screening. She is otherwise healthful with no family history of breast,
ovarian, or colon cancer. Which of the subsequent is true about MRI as a screening modality for
breast cancer in the standard population?
A. Breast cancer screening by means of MRI has been well studied within the wellknown
populace.
B. Sensitivity of screening for breast cancer will increase with breast MRI on the fee of
specificity.
C. This affected person is a great candidate for screening thru breast MRI primarily based on
modern 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 c
,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
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
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 b
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).
A 66-year-old female museum curator presents for a routine annual examination. On
examination, a notably enlarged supraclavicular lymph node is appreciated on the right side.
The lymph node is nontender and feels firm and rubbery. She denies any localized or systemic
symptoms such as breast lumps, fevers, or night sweats. She has been taking conjugated
estrogen tablets for 9 years since menopause, though she has not taken progestin compounds
since she had a hysterectomy for heavy bleeding at age 45 years. Which of the following is true
about this presentation of lymphadenopathy?
A. Breast cancer always presents with axillary lymphadenopathy because the lymphatics of the
breast uniformly drain into the axilla.
B. Supraclavicular nodes are generally considered benign and require no further evaluation or
follow-up.
C. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the neck.
, D. Firm,
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A rubbery,
mobile, nontender mass is palpated in the right breast as described by the patient, which is
consistent with a firbroadenoma. In describing the location of the mass, the examiner notes that
it is 3 cm proximal to and 3 cm to the left of the nipple. Which of the following would be the most
appropriate way to report this finding?
A. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the
nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from the nipple"
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the
nipple"
A 54-year-old female dietician presents for a routine annual examination. On review of systems,
she reports that she has had many breast findings over several years, including one biopsy with
normal pathology. She feels that her breasts have become far less lumpy since she underwent
menopause 3 years ago. Which of the following is true regarding changes in the breasts with
menopause?
A. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity
and specificity of mammograms.
B. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after
menopause.
C. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the
number of lobules.
D. Breast density has no genetic component and is entirely due to estrogen dose from
endogenous and exogenous sources over the lifetime.
E. Mammography performs most poorly in the menopausal and postmenopa
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the
number of lobules.
