NR509 FINAL EXAM | QUESTIONS AND ANSWERS 2025/2026 UPDATE || 100% GUARANTEED PASS
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 F ✔️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 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.
An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of intense abdominal pain,
light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has a strong family history of
gallstones and is concerned about this possibility. She has not had any vomiting or diarrhea. She had a normal bowel movement
this morning. Her β-human chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10 weeks
ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her pelvic exam and, on palpation of her
abdomen, finds involuntary rigidity and rebound tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Per ✔️a. Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs are performed to screen
for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all normal expect for
moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, and alkaline
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 F ✔️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 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.
An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of intense abdominal pain,
light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has a strong family history of
gallstones and is concerned about this possibility. She has not had any vomiting or diarrhea. She had a normal bowel movement
this morning. Her β-human chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10 weeks
ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her pelvic exam and, on palpation of her
abdomen, finds involuntary rigidity and rebound tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Per ✔️a. Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs are performed to screen
for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all normal expect for
moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, and alkaline
