NR509 FINAL PRACTICE
QUESTIONS WITH COMPLETE
SOLUTION
A 44-year-old female mathematician presents to the 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? - correct answer-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.
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. - correct
answer-Sensitivity of screening for breast cancer increases with breast MRI at the
expensive of specificity.
A 35-year-old G0P0 woman presents to the 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 lab 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? - correct answer-Prolactinoma
A 22-year-old G0P0 undergraduate student presents to the clinic after finding a breast
mass on breast self-examination (BSE) at home. The mass is contender 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? -
correct answer-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? - correct answer-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? - correct answer-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? -
correct answer-Metastatic breast cancer cells may spread directly into the infraclavicular
and then supraclvaicular 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 to and 3 cm to the left of the nipple. Which of
the following would be the most appropriate way to report this finding? - correct answer-
, rubbery, mobile, contender mass located in the right breast, in the 10:30 position from
the nipple.
A 54-year-old female dietician presents for a routine annual examination. On review of
systems, she reports that she has had many breast findings over several years,
including one biopsy with normal pathology. She feels that her breasts have become far
less lumpy since she underwent menopause 3 years ago. Which of the following is true
regarding changes in the breasts with menopause? - correct answer-Glandular tissue of
the breast atrophies with menopause, primarily due to a decrease in the number of
lobules.
An overweight 26-year-old public servant presents to the Emergency Department with
12 hours of intense abdominal pain, light-headedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong family history of gallstones
and is concerned about this possibility. She has not had any vomiting or diarrhea. She
had a normal bowel movement this morning. Her β-human chorionic gonadotropin (β-
hCG) is positive at triage. She reports that her last period was 10 weeks ago. Her vital
signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen
saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal
exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary
rigidity and rebound tenderness. What is the most likely diagnosis? - correct answer-
Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well
visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia.
Electrolytes and liver enzymes were also measured. His labs are all normal expect for
moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ-
glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appointment and the clinician performs an
abdominal exam to assess his liver. Which of the following findings would be most
consistent with hepatomegaly? - correct answer-Liver palpable 3 cm below the right
costal margin, mid clavicular line, on expiration.
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history
presents with a several month history of recurrent epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation.
She reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital
signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation,
95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal
aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which
of the following is her most significant risk factor for an AAA? - correct answer-History of
Smoking
A 76-year-old retired man with a history of prostate cancer and hypertension has been
screened annually for colon cancer using high sensitivity fecal occult blood testing
(FOBT). He presents for follow-up of his hypertension, during which the clinician scans
QUESTIONS WITH COMPLETE
SOLUTION
A 44-year-old female mathematician presents to the 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? - correct answer-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.
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. - correct
answer-Sensitivity of screening for breast cancer increases with breast MRI at the
expensive of specificity.
A 35-year-old G0P0 woman presents to the 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 lab 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? - correct answer-Prolactinoma
A 22-year-old G0P0 undergraduate student presents to the clinic after finding a breast
mass on breast self-examination (BSE) at home. The mass is contender 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? -
correct answer-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? - correct answer-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? - correct answer-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? -
correct answer-Metastatic breast cancer cells may spread directly into the infraclavicular
and then supraclvaicular 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 to and 3 cm to the left of the nipple. Which of
the following would be the most appropriate way to report this finding? - correct answer-
, rubbery, mobile, contender mass located in the right breast, in the 10:30 position from
the nipple.
A 54-year-old female dietician presents for a routine annual examination. On review of
systems, she reports that she has had many breast findings over several years,
including one biopsy with normal pathology. She feels that her breasts have become far
less lumpy since she underwent menopause 3 years ago. Which of the following is true
regarding changes in the breasts with menopause? - correct answer-Glandular tissue of
the breast atrophies with menopause, primarily due to a decrease in the number of
lobules.
An overweight 26-year-old public servant presents to the Emergency Department with
12 hours of intense abdominal pain, light-headedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong family history of gallstones
and is concerned about this possibility. She has not had any vomiting or diarrhea. She
had a normal bowel movement this morning. Her β-human chorionic gonadotropin (β-
hCG) is positive at triage. She reports that her last period was 10 weeks ago. Her vital
signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen
saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal
exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary
rigidity and rebound tenderness. What is the most likely diagnosis? - correct answer-
Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well
visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia.
Electrolytes and liver enzymes were also measured. His labs are all normal expect for
moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ-
glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appointment and the clinician performs an
abdominal exam to assess his liver. Which of the following findings would be most
consistent with hepatomegaly? - correct answer-Liver palpable 3 cm below the right
costal margin, mid clavicular line, on expiration.
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history
presents with a several month history of recurrent epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation.
She reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital
signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation,
95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal
aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which
of the following is her most significant risk factor for an AAA? - correct answer-History of
Smoking
A 76-year-old retired man with a history of prostate cancer and hypertension has been
screened annually for colon cancer using high sensitivity fecal occult blood testing
(FOBT). He presents for follow-up of his hypertension, during which the clinician scans
