NR 509 FINAL EXAM (2025) QUESTIONS AND
ANSWERS (MULTIPLE CHOICES) WITH RATIONALES
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 Fo -
...(ANSWERS)....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.
The USPSTF recommends that women age <50 years discuss risks and benefits
with their provider and decide on appropriate screening for their individual
preferences and needs
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 cr - ...(ANSWERS)....b.
Sensitivity of screening for breast cancer increases with breast MRI at the expense
of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at
the expense of specificity. Increased sensitivity (in this case, higher-resolution
imaging to pick up subtler disease) is often traded for reduced specificity (in the
form of discovering many small items of no pathological significance).
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 - ...(ANSWERS)....e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes
the production of breast milk and can suppress menstruation.
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 -
...(ANSWERS)....b. This patient is more likely to find a fibroadenoma than a cancer
on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-
examination. In this patient's age range (15-25 years), palpable masses are most
likely to be benign fibroadenomas.
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 -
...(ANSWERS)....d. This patient carries several risk factors that together justify
BRCA testing.
Rationale: This patient has both a first-degree male relative with breast cancer
and several relatives in the same lineage with breast cancer. Both of these
suggest risk for the BRCA genes, but the BRCAPRO calculator can further refine
the numerical risk and help decide if screening might be helpful.
ANSWERS (MULTIPLE CHOICES) WITH RATIONALES
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 Fo -
...(ANSWERS)....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.
The USPSTF recommends that women age <50 years discuss risks and benefits
with their provider and decide on appropriate screening for their individual
preferences and needs
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 cr - ...(ANSWERS)....b.
Sensitivity of screening for breast cancer increases with breast MRI at the expense
of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at
the expense of specificity. Increased sensitivity (in this case, higher-resolution
imaging to pick up subtler disease) is often traded for reduced specificity (in the
form of discovering many small items of no pathological significance).
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 - ...(ANSWERS)....e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes
the production of breast milk and can suppress menstruation.
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 -
...(ANSWERS)....b. This patient is more likely to find a fibroadenoma than a cancer
on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-
examination. In this patient's age range (15-25 years), palpable masses are most
likely to be benign fibroadenomas.
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 -
...(ANSWERS)....d. This patient carries several risk factors that together justify
BRCA testing.
Rationale: This patient has both a first-degree male relative with breast cancer
and several relatives in the same lineage with breast cancer. Both of these
suggest risk for the BRCA genes, but the BRCAPRO calculator can further refine
the numerical risk and help decide if screening might be helpful.
