NR 509: FINAL EXAM PRACTICE
QUESTIONS AND VERIFIED
ANSWERS GRADED A+
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
,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 - 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 irrelevan - 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?
a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not e - c. Regardless of recommendations, the high sensitivity of
breast MRI comes at the expense of markedly decreased specificity (i.e., the
ability to rule out disease in healthy breasts).
, A 66-year-old female museum curator presents for a routine annual
examination. On examination, a notably enlarged supraclavicular lymph node is
appreciated on the right side. The lymph node is nontender and feels firm and
rubbery. She denies any localized or systemic symptoms such as breast lumps,
fevers, or night sweats. She has been taking conjugated estrogen tablets for 9
years since menopause, though she has not taken progestin compounds since
she had a hysterectomy for heavy bleeding at age 45 years. Which of the
following is true about this presentation of lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the
lymphatics of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapeziu - e.
Metastatic breast cancer cells may spread directly into the infraclavicular and
then supraclavicular nodes without first causing notable changes in the axillary
nodes.
A 24-year-old graphic designer presents to clinic with a concern for a breast
mass. A rubbery, mobile, nontender mass is palpated in the right breast as
described by the patient, which is consistent with a firbroadenoma. In
describing the location of the mass, the examiner notes that it is 3 cm proximal
QUESTIONS AND VERIFIED
ANSWERS GRADED A+
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
,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 - 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 irrelevan - 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?
a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not e - c. Regardless of recommendations, the high sensitivity of
breast MRI comes at the expense of markedly decreased specificity (i.e., the
ability to rule out disease in healthy breasts).
, A 66-year-old female museum curator presents for a routine annual
examination. On examination, a notably enlarged supraclavicular lymph node is
appreciated on the right side. The lymph node is nontender and feels firm and
rubbery. She denies any localized or systemic symptoms such as breast lumps,
fevers, or night sweats. She has been taking conjugated estrogen tablets for 9
years since menopause, though she has not taken progestin compounds since
she had a hysterectomy for heavy bleeding at age 45 years. Which of the
following is true about this presentation of lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the
lymphatics of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapeziu - e.
Metastatic breast cancer cells may spread directly into the infraclavicular and
then supraclavicular nodes without first causing notable changes in the axillary
nodes.
A 24-year-old graphic designer presents to clinic with a concern for a breast
mass. A rubbery, mobile, nontender mass is palpated in the right breast as
described by the patient, which is consistent with a firbroadenoma. In
describing the location of the mass, the examiner notes that it is 3 cm proximal
