2026 NR509 FINAL EXAM |REAL 100Qs&As WITH
RATIONALES|A+GRADE ASSURED
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 Force
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
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
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
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?
d. This patient carries several risk factors that together justify BRCA testing.
RATIONALES|A+GRADE ASSURED
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 Force
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
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
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
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?
d. This patient carries several risk factors that together justify BRCA testing.
