NR 509 - FINAL EXAM BATE'S
INTERACTIVE QUESTION BANK WITH
ACCURATE SOLUTIONS /PASS GUIDE
1. 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 - 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.
2. 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 -
ANSWER-b. Sensitivity of screening for breast cancer
increases with breast MRI at the expense of specificity.
3. 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 - ANSWER-e. Prolactinoma
,4. 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 - ANSWER-b. This patient is more likely to find
a fibroadenoma than a cancer on self-examination.
5. 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 - ANSWER-d. This patient carries several risk
factors that together justify BRCA testing.
6. 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 extraordinary risk
factors for b - ANSWER-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).
7. 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
INTERACTIVE QUESTION BANK WITH
ACCURATE SOLUTIONS /PASS GUIDE
1. 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 - 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.
2. 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 -
ANSWER-b. Sensitivity of screening for breast cancer
increases with breast MRI at the expense of specificity.
3. 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 - ANSWER-e. Prolactinoma
,4. 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 - ANSWER-b. This patient is more likely to find
a fibroadenoma than a cancer on self-examination.
5. 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 - ANSWER-d. This patient carries several risk
factors that together justify BRCA testing.
6. 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 extraordinary risk
factors for b - ANSWER-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).
7. 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
