NR 509: FINAL EXAM PRACTICE QUESTIONS
AND 100% CORRECT AND WELL DETAILED
ANSWERS|LATEST 2025/2026|GRADED A+
CHAPTER 18: Breasts & Axillae B B B B
A 44-year-
B
old female mathematician presents to clinic with a complaint of a mass in the right breast. Her
B B B B B B B B B B B B B B B B
partner noticed this mass 2 days ago, and the patient feels guilty because she has only had on
B B B B B B B B B B B B B B B B B B
e mammogram and does not engage in breast self-
B B B B B B B B
examination (BSE) on any regular basis. She has no family history of breast cancer, and her pri
B B B B B B B B B B B B B B B B
or mammogram was ordered as a routine screening test at age 43 years after a brief discussio
B B B B B B B B B B B B B B B B
n with her primary care provider. After a thorough investigation reveals a benign cyst, what ad
B B B B B B B B B B B B B B B
vice should be given to this patient about screening for breast cancer in her age group?
B B B B B B B B B B B B B B B
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and rei
B B B B B B B B B B B B B B B B
nforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual e
B B B B B B B B B B B B B B B B B
xaminations starting at age 30 years. B B B B B
c. This patient was in compliance with the -
B B B B B B B B
BANSWER c. This patient was in compliance with the U.S. Preventive Services Task Force
B B B B B B B B B B B B B
(USPSTF)
recommendations for her age group and risk factors prior to her current complaint. B B B B B B B B B B B B
CHAPTER 18: Breasts & Axillae B B B B
A 42-year-
B
old female website developer presents for an annual preventive examination with questions a
B B B B B B B B B B B B
bout breast cancer screening. She is concerned about the radiation exposure associated with
B B B B B B B B B B B B B
mammography and is interested in magnetic resonance imaging (MRI) as a possible alternativ
B B B B B B B B B B B B
e for routine screening. She is otherwise healthy with no family history of breast, ovarian, or c
B B B B B B B B B B B B B B B B
olon cancer. Which of the following is true about MRI as a screening modality for breast cance
B B B B B B B B B B B B B B B B
r in the general population?
B B B B
1
,a. Breast cancer screening by MRI has been well studied in the general population.
B B B B B B B B B B B B B
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of specifi
B B B B B B B B B B B B B B B
city.
c. This patient is an ideal candidate for screening via breast MRI based on current evidence.
B B B B B B B B B B B B B B B
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo screening
B B B B B B B B B B B B B B
MRI.
B
e. Known BRCA1 or B -
B B B B B
ANSWER
B b. Sensitivity of screening for breast cancer increases with breast MRI at the e
B B B B B B B B B B B B B
xpense of specificity. B B
CHAPTER 18: Breasts & Axillae B B B B
A 35-year-
B
old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge. This discharg
B B B B B B B B B B B B B B
e started several weeks ago and has occurred at irregular intervals since that time. She does n
B B B B B B B B B B B B B B B B
ot complain of local tenderness, redness, fever, or any other systemic symptoms aside from sli
B B B B B B B B B B B B B B
ghtly irregular periods over the last few months. On examination, she is able to express a small
B B B B B B B B B B B B B B B B
Bamount of discharge, which is sent to the laboratory and found to be consistent with breast m
B B B B B B B B B B B B B B B B
ilk but without any signs of blood or pus. Screening laboratories are also sent, which reveal a n
B B B B B B B B B B B B B B B B B
ormal blood count, metabolic panel, thyroid-
B B B B B
stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories ar
B B B B B B B B B B
e still pending. Which of the following is the most likely diagnosis?
B B B B B B B B B B B
a. Mastitis
B
b. Ductal carcinoma in situ
B B B B
c. Paget disease of the breast
B B B B B
d. Occult pregnancy
B B
e. Prolactinoma - ANSWER
B B B e. Prolactinoma
B
CHAPTER 18: Breasts & Axillae B B B B
2
,A 22-year-
B
old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-
B B B B B B B B B B B B B B
examination (BSE) at home. The mass is nontender without skin changes, erythema, or overlyi
B B B B B B B B B B B B B
ng swelling. She has heard that most breast cancers are found by patients themselves, and she
B B B B B B B B B B B B B B B
is very concerned that she may have breast cancer. Which of the following is true about BSE a
B B B B B B B B B B B B B B B B B B
nd self-detection of breast cancer?
B B B B
a. Most masses that women find at home and bring to a provider's attention turn out to be ma
B B B B B B B B B B B B B B B B B B
lignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
B B B B B B B B B B B B B B
c. The most likely breast mass this patient is likely to find in herself is an abscess complicating u
B B B B B B B B B B B B B B B B B B
nderlying mastitis. B
d. Because of this patient's age, breast masses should not be pursued with imaging and diagn
B B B B B B B B B B B B B B B
osis because the risk of cancer is so low.
B B B B B B B B
e. BSE is universally recommended b -
B B B B B B
ANSWER
B b. This patient is more likely to find a fibroadenoma than a cancer on self-
B B B B B B B B B B B B B B
examination.
CHAPTER 18: Breasts & Axillae B B B B
A 48-year-
B
old female psychologist presents to clinic with concerns about her breast cancer risk after an a
B B B B B B B B B B B B B B B
ge-
matched cousin was recently diagnosed with this disease. This cousin is the third family memb
B B B B B B B B B B B B B B
er on her father's side in as many years to be diagnosed with breast cancer, including the patie
B B B B B B B B B B B B B B B B B
nt's own father, who had surgery and subsequent treatment 3 years ago for breast cancer. The
B B B B B B B B B B B B B B B
patient has little other knowledge of her family history, only that her grandparents independe
B B B B B B B B B B B B B B
ntly arrived from Eastern Europe near the end of World War II and were among very few mem
B B B B B B B B B B B B B B B B B
bers of their family that survived the war. The patient has read about testing for the breast can
B B B B B B B B B B B B B B B B B
cer genes (BRCA1 and BRCA2) and desires further information about whether this would be a
B B B B B B B B B B B B B B
ppropriate for her. Which of the following is true about this patient's indications for BRCA testi
B B B B B B B B B B B B B B B
ng?
3
, a. Her familial lineage is irrelevan -
B B B B B B
B ANSWER d. This patient carries several risk factors that together justify BRCA testing.
B B B B B B B B B B B
CHAPTER 18: Breasts & Axillae B B B B
A 68-year-
B
old former paleontologist presents to clinic with concerns about her breast cancer risk. Her m
B B B B B B B B B B B B B B
other developed the disease in her 50s and died from it in her 60s. A younger cousin develope
B B B B B B B B B B B B B B B B B
d the disease a few years ago before the age of 50 years, but this individual was not tested for
B B B B B B B B B B B B B B B B B B B B
the BRCA1 and B B
BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s and had radiation to
B B B B B B B B B B B B B B B B
the chest. She did take hormone replacement therapy for a few years before data emerged th
B B B B B B B B B B B B B B B
at this may contribute to breast cancer risk. She has had several abnormal mammograms in he
B B B B B B B B B B B B B B B
r 50s for persistently dense breasts with subtle findings, but follow-
B B B B B B B B B B
up biopsies never showed any malignant pathology. Which of the following is true regarding
B B B B B B B B B B B B B B
magnetic resonance imaging (MRI) screening of this patient?
B B B B B B B
a. No agency recommends breast MRI for a patient such as this one, who has moderately but
B B B B B B B B B B B B B B B B B
not e - B B
BANSWER c. Regardless of recommendations, the high sensitivity of breast MRI comes a B B B B B B B B B B B
t the expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy b
B B B B B B B B B B B B B B B B
reasts).
CHAPTER 18: Breasts & Axillae B B B B
A 66-year-
B
old female museum curator presents for a routine annual examination. On examination, a not
B B B B B B B B B B B B B
ably enlarged supraclavicular lymph node is appreciated on the right side. The lymph node is n
B B B B B B B B B B B B B B B
ontender and feels firm and rubbery. She denies any localized or systemic symptoms such as b
B B B B B B B B B B B B B B B
reast lumps, fevers, or night sweats. She has been taking conjugated estrogen tablets for 9 yea
B B B B B B B B B B B B B B B
rs since menopause, though she has not taken progestin compounds since she had a hysterect
B B B B B B B B B B B B B B
omy for heavy bleeding at age 45 years. Which of the following is true about this presentation
B B B B B B B B B B B B B B B B B
of lymphadenopathy?
B
4
AND 100% CORRECT AND WELL DETAILED
ANSWERS|LATEST 2025/2026|GRADED A+
CHAPTER 18: Breasts & Axillae B B B B
A 44-year-
B
old female mathematician presents to clinic with a complaint of a mass in the right breast. Her
B B B B B B B B B B B B B B B B
partner noticed this mass 2 days ago, and the patient feels guilty because she has only had on
B B B B B B B B B B B B B B B B B B
e mammogram and does not engage in breast self-
B B B B B B B B
examination (BSE) on any regular basis. She has no family history of breast cancer, and her pri
B B B B B B B B B B B B B B B B
or mammogram was ordered as a routine screening test at age 43 years after a brief discussio
B B B B B B B B B B B B B B B B
n with her primary care provider. After a thorough investigation reveals a benign cyst, what ad
B B B B B B B B B B B B B B B
vice should be given to this patient about screening for breast cancer in her age group?
B B B B B B B B B B B B B B B
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and rei
B B B B B B B B B B B B B B B B
nforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual e
B B B B B B B B B B B B B B B B B
xaminations starting at age 30 years. B B B B B
c. This patient was in compliance with the -
B B B B B B B B
BANSWER c. This patient was in compliance with the U.S. Preventive Services Task Force
B B B B B B B B B B B B B
(USPSTF)
recommendations for her age group and risk factors prior to her current complaint. B B B B B B B B B B B B
CHAPTER 18: Breasts & Axillae B B B B
A 42-year-
B
old female website developer presents for an annual preventive examination with questions a
B B B B B B B B B B B B
bout breast cancer screening. She is concerned about the radiation exposure associated with
B B B B B B B B B B B B B
mammography and is interested in magnetic resonance imaging (MRI) as a possible alternativ
B B B B B B B B B B B B
e for routine screening. She is otherwise healthy with no family history of breast, ovarian, or c
B B B B B B B B B B B B B B B B
olon cancer. Which of the following is true about MRI as a screening modality for breast cance
B B B B B B B B B B B B B B B B
r in the general population?
B B B B
1
,a. Breast cancer screening by MRI has been well studied in the general population.
B B B B B B B B B B B B B
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of specifi
B B B B B B B B B B B B B B B
city.
c. This patient is an ideal candidate for screening via breast MRI based on current evidence.
B B B B B B B B B B B B B B B
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo screening
B B B B B B B B B B B B B B
MRI.
B
e. Known BRCA1 or B -
B B B B B
ANSWER
B b. Sensitivity of screening for breast cancer increases with breast MRI at the e
B B B B B B B B B B B B B
xpense of specificity. B B
CHAPTER 18: Breasts & Axillae B B B B
A 35-year-
B
old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge. This discharg
B B B B B B B B B B B B B B
e started several weeks ago and has occurred at irregular intervals since that time. She does n
B B B B B B B B B B B B B B B B
ot complain of local tenderness, redness, fever, or any other systemic symptoms aside from sli
B B B B B B B B B B B B B B
ghtly irregular periods over the last few months. On examination, she is able to express a small
B B B B B B B B B B B B B B B B
Bamount of discharge, which is sent to the laboratory and found to be consistent with breast m
B B B B B B B B B B B B B B B B
ilk but without any signs of blood or pus. Screening laboratories are also sent, which reveal a n
B B B B B B B B B B B B B B B B B
ormal blood count, metabolic panel, thyroid-
B B B B B
stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories ar
B B B B B B B B B B
e still pending. Which of the following is the most likely diagnosis?
B B B B B B B B B B B
a. Mastitis
B
b. Ductal carcinoma in situ
B B B B
c. Paget disease of the breast
B B B B B
d. Occult pregnancy
B B
e. Prolactinoma - ANSWER
B B B e. Prolactinoma
B
CHAPTER 18: Breasts & Axillae B B B B
2
,A 22-year-
B
old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-
B B B B B B B B B B B B B B
examination (BSE) at home. The mass is nontender without skin changes, erythema, or overlyi
B B B B B B B B B B B B B
ng swelling. She has heard that most breast cancers are found by patients themselves, and she
B B B B B B B B B B B B B B B
is very concerned that she may have breast cancer. Which of the following is true about BSE a
B B B B B B B B B B B B B B B B B B
nd self-detection of breast cancer?
B B B B
a. Most masses that women find at home and bring to a provider's attention turn out to be ma
B B B B B B B B B B B B B B B B B B
lignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
B B B B B B B B B B B B B B
c. The most likely breast mass this patient is likely to find in herself is an abscess complicating u
B B B B B B B B B B B B B B B B B B
nderlying mastitis. B
d. Because of this patient's age, breast masses should not be pursued with imaging and diagn
B B B B B B B B B B B B B B B
osis because the risk of cancer is so low.
B B B B B B B B
e. BSE is universally recommended b -
B B B B B B
ANSWER
B b. This patient is more likely to find a fibroadenoma than a cancer on self-
B B B B B B B B B B B B B B
examination.
CHAPTER 18: Breasts & Axillae B B B B
A 48-year-
B
old female psychologist presents to clinic with concerns about her breast cancer risk after an a
B B B B B B B B B B B B B B B
ge-
matched cousin was recently diagnosed with this disease. This cousin is the third family memb
B B B B B B B B B B B B B B
er on her father's side in as many years to be diagnosed with breast cancer, including the patie
B B B B B B B B B B B B B B B B B
nt's own father, who had surgery and subsequent treatment 3 years ago for breast cancer. The
B B B B B B B B B B B B B B B
patient has little other knowledge of her family history, only that her grandparents independe
B B B B B B B B B B B B B B
ntly arrived from Eastern Europe near the end of World War II and were among very few mem
B B B B B B B B B B B B B B B B B
bers of their family that survived the war. The patient has read about testing for the breast can
B B B B B B B B B B B B B B B B B
cer genes (BRCA1 and BRCA2) and desires further information about whether this would be a
B B B B B B B B B B B B B B
ppropriate for her. Which of the following is true about this patient's indications for BRCA testi
B B B B B B B B B B B B B B B
ng?
3
, a. Her familial lineage is irrelevan -
B B B B B B
B ANSWER d. This patient carries several risk factors that together justify BRCA testing.
B B B B B B B B B B B
CHAPTER 18: Breasts & Axillae B B B B
A 68-year-
B
old former paleontologist presents to clinic with concerns about her breast cancer risk. Her m
B B B B B B B B B B B B B B
other developed the disease in her 50s and died from it in her 60s. A younger cousin develope
B B B B B B B B B B B B B B B B B
d the disease a few years ago before the age of 50 years, but this individual was not tested for
B B B B B B B B B B B B B B B B B B B B
the BRCA1 and B B
BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s and had radiation to
B B B B B B B B B B B B B B B B
the chest. She did take hormone replacement therapy for a few years before data emerged th
B B B B B B B B B B B B B B B
at this may contribute to breast cancer risk. She has had several abnormal mammograms in he
B B B B B B B B B B B B B B B
r 50s for persistently dense breasts with subtle findings, but follow-
B B B B B B B B B B
up biopsies never showed any malignant pathology. Which of the following is true regarding
B B B B B B B B B B B B B B
magnetic resonance imaging (MRI) screening of this patient?
B B B B B B B
a. No agency recommends breast MRI for a patient such as this one, who has moderately but
B B B B B B B B B B B B B B B B B
not e - B B
BANSWER c. Regardless of recommendations, the high sensitivity of breast MRI comes a B B B B B B B B B B B
t the expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy b
B B B B B B B B B B B B B B B B
reasts).
CHAPTER 18: Breasts & Axillae B B B B
A 66-year-
B
old female museum curator presents for a routine annual examination. On examination, a not
B B B B B B B B B B B B B
ably enlarged supraclavicular lymph node is appreciated on the right side. The lymph node is n
B B B B B B B B B B B B B B B
ontender and feels firm and rubbery. She denies any localized or systemic symptoms such as b
B B B B B B B B B B B B B B B
reast lumps, fevers, or night sweats. She has been taking conjugated estrogen tablets for 9 yea
B B B B B B B B B B B B B B B
rs since menopause, though she has not taken progestin compounds since she had a hysterect
B B B B B B B B B B B B B B
omy for heavy bleeding at age 45 years. Which of the following is true about this presentation
B B B B B B B B B B B B B B B B B
of lymphadenopathy?
B
4
