NR 509: FINAL
EXAM PRACTICE
QUESTIONS WITH
CORRECT
SOLUTIONS.
[Document subtitle]
,CHAPTER 18: Breasts & Axillae
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 - solutions: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.
CHAPTER 18: Breasts & Axillae
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 B - solutions:b. Sensitivity of screening for breast cancer
increases with breast MRI at the expense of specificity.
CHAPTER 18: Breasts & Axillae
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 - solutions:e. Prolactinoma
CHAPTER 18: Breasts & Axillae
, 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 b - solutions:b. This patient is more likely
to find a fibroadenoma than a cancer on self-examination.
CHAPTER 18: Breasts & Axillae
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?
EXAM PRACTICE
QUESTIONS WITH
CORRECT
SOLUTIONS.
[Document subtitle]
,CHAPTER 18: Breasts & Axillae
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 - solutions: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.
CHAPTER 18: Breasts & Axillae
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 B - solutions:b. Sensitivity of screening for breast cancer
increases with breast MRI at the expense of specificity.
CHAPTER 18: Breasts & Axillae
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 - solutions:e. Prolactinoma
CHAPTER 18: Breasts & Axillae
, 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 b - solutions:b. This patient is more likely
to find a fibroadenoma than a cancer on self-examination.
CHAPTER 18: Breasts & Axillae
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?
