NR 509 - Final Exam B ate's |! |! |! |! |! |!
Inter active Question B ank (Qs & |! |! |! |! |!
As)
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 -
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
Correct answer ✔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 - Correct answer ✔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 - Correct answer ✔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 - Correct
|! |! |! |! |! |! |! |! |! |! |! |!
answer ✔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 - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔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?
|! |! |! |! |! |! |!
Inter active Question B ank (Qs & |! |! |! |! |!
As)
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 -
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
Correct answer ✔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 - Correct answer ✔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 - Correct answer ✔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 - Correct
|! |! |! |! |! |! |! |! |! |! |! |!
answer ✔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 - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔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?
|! |! |! |! |! |! |!
