NR 509 - FINAL EXAM BATE'S
INTERACTIVE QUESTION BANK
A6544-year-
old65female65mathematician65presents65to65clinic65with65a65complaint65of65a65mass65in65t
he65right65breast.65Her65partner65noticed65this65mass65265days65ago,65and65the65patient6
5feels65guilty65because65she65has65only65had65one65mammogram65and65does65not65eng
age65in65breast65self-
examination65(BSE)65on65any65regular65basis.65She65has65no65family65history65of65breas
t65cancer,65and65her65prior65mammogram65was65ordered65as65a65routine65screening65te
st65at65age654365years65after65a65brief65discussion65with65her65primary65care65provider.65
After65a65thorough65investigation65reveals65a65benign65cyst,65what65advice65should65be65
given65to65this65patient65about65screening65for65breast65cancer65in65her65age65group?
a.65BSE65is65well65evidenced,65and65all65recommending65agencies65agree65that65it65sho
uld65be65taught65and65reinforced.
b.65Clinical65breast65examination65(CBE)65is65superior65to65BSE65and65should65be65a65ro
utine65part65of65annual65examinations65starting65at65age653065years.
c.65This65patient65was65in65compliance65with65the65U.S.65Preventive65Services65Task65F
65-65answer--
c.65This65patient65was65in65compliance65with65the65U.S.65Preventive65Services65Task65F
orce65(USPSTF)65recommendations65for65her65age65group65and65risk65factors65prior65to6
5her65current65complaint.
A6542-year-
old65female65website65developer65presents65for65an65annual65preventive65examination65
with65questions65about65breast65cancer65screening.65She65is65concerned65about65the65r
adiation65exposure65associated65with65mammography65and65is65interested65in65magneti
c65resonance65imaging65(MRI)65as65a65possible65alternative65for65routine65screening.65S
he65is65otherwise65healthy65with65no65family65history65of65breast,65ovarian,65or65colon65c
ancer.65Which65of65the65following65is65true65about65MRI65as65a65screening65modality65for
65breast65cancer65in65the65general65population?
a.65Breast65cancer65screening65by65MRI65has65been65well65studied65in65the65general65p
opulation.
b.65Sensitivity65of65screening65for65breast65cancer65increases65with65breast65MRI65at65th
e65expense65of65specificity.
c.65This65patient65is65an65ideal65candidate65for65screening65via65breast65MRI65based65on
65current65evidence.
d.65Women65at65low65lifetime65risk65of65breast65cancer65(<20%)65are65recommended65to
65undergo65screening65MRI.
,e.65Known65BRCA165or65BRCA265mutation65is65insufficient65c65-65answer--
b.65Sensitivity65of65screening65for65breast65cancer65increases65with65breast65MRI65at65th
e65expense65of65specificity.
A6535-year-
old65G0P065woman65presents65to65clinic65with65a65complaint65of65bilateral65nipple65disch
arge.65This65discharge65started65several65weeks65ago65and65has65occurred65at65irregula
r65intervals65since65that65time.65She65does65not65complain65of65local65tenderness,65redn
ess,65fever,65or65any65other65systemic65symptoms65aside65from65slightly65irregular65peri
ods65over65the65last65few65months.65On65examination,65she65is65able65to65express65a65s
mall65amount65of65discharge,65which65is65sent65to65the65laboratory65and65found65to65be65
consistent65with65breast65milk65but65without65any65signs65of65blood65or65pus.65Screening
65laboratories65are65also65sent,65which65reveal65a65normal65blood65count,65metabolic65p
anel,65thyroid-
stimulating65hormone,65and65human65chorionic65gonadotropin65(HCG)65level.65Further65l
aboratories65are65still65pending.65Which65of65the65following65is65the65most65likely65diagn
osis?
a.65Mastitis
b.65Ductal65carcinoma65in65situ
c.65Paget65disease65of65the65breast
d.65Occult65pregnancy
e.65Prolactinoma65-65answer--e.65Prolactinoma
A6522-year-
old65G0P065undergraduate65student65presents65to65clinic65after65finding65a65breast65mas
s65on65breast65self-
examination65(BSE)65at65home.65The65mass65is65nontender65without65skin65changes,65e
rythema,65or65overlying65swelling.65She65has65heard65that65most65breast65cancers65are6
5found65by65patients65themselves,65and65she65is65very65concerned65that65she65may65ha
ve65breast65cancer.65Which65of65the65following65is65true65about65BSE65and65self-
detection65of65breast65cancer?
a.65Most65masses65that65women65find65at65home65and65bring65to65a65provider's65attentio
n65turn65out65to65be65malignant.
b.65This65patient65is65more65likely65to65find65a65fibroadenoma65than65a65cancer65on65self-
examination.
c.65The65most65likely65breast65mass65this65patient65is65likely65to65find65in65herself65is65an
65abscess65complicating65underlying65mastitis.
d.65Because65of65this65patient's65age,65breast65masses65should65not65be65pursued65with
65imaging65and65diagnosis65because65the65risk65of65cancer65is65so65low.
e.65BSE65is65universally65recommended65because65of65very65high65sensitivity65-
65answer--
b.65This65patient65is65more65likely65to65find65a65fibroadenoma65than65a65cancer65on65self-
examination.
,A6548-year-
old65female65psychologist65presents65to65clinic65with65concerns65about65her65breast65ca
ncer65risk65after65an65age-
matched65cousin65was65recently65diagnosed65with65this65disease.65This65cousin65is65the
65third65family65member65on65her65father's65side65in65as65many65years65to65be65diagnose
d65with65breast65cancer,65including65the65patient's65own65father,65who65had65surgery65an
d65subsequent65treatment65365years65ago65for65breast65cancer.65The65patient65has65little
65other65knowledge65of65her65family65history,65only65that65her65grandparents65independe
ntly65arrived65from65Eastern65Europe65near65the65end65of65World65War65II65and65were65a
mong65very65few65members65of65their65family65that65survived65the65war.65The65patient65
has65read65about65testing65for65the65breast65cancer65genes65(BRCA165and65BRCA2)65a
nd65desires65further65information65about65whether65this65would65be65appropriate65for65h
er.65Which65of65the65following65is65true65about65this65patient's65indications65for65BRCA65t
esting?
a.65Her65familial65lineage65is65irrelevant65to65her65risk65of65BRCA65genes65and65-
65answer--
d.65This65patient65carries65several65risk65factors65that65together65justify65BRCA65testing.
A6568-year-
old65former65paleontologist65presents65to65clinic65with65concerns65about65her65breast65c
ancer65risk.65Her65mother65developed65the65disease65in65her6550s65and65died65from65it65
in65her6560s.65A65younger65cousin65developed65the65disease65a65few65years65ago65befor
e65the65age65of655065years,65but65this65individual65was65not65tested65for65the65BRCA165a
nd65BRCA265genes.65In65addition,65the65patient65suffered65from65lymphoma65in65her6520
s65and65had65radiation65to65the65chest.65She65did65take65hormone65replacement65therap
y65for65a65few65years65before65data65emerged65that65this65may65contribute65to65breast65c
ancer65risk.65She65has65had65several65abnormal65mammograms65in65her6550s65for65per
sistently65dense65breasts65with65subtle65findings,65but65follow-
up65biopsies65never65showed65any65malignant65pathology.65Which65of65the65following65i
s65true65regarding65magnetic65resonance65imaging65(MRI)65screening65of65this65patient?
a.65No65agency65recommends65breast65MRI65for65a65patient65such65as65this65one,65who6
5has65moderately65but65not65extraordinary65risk65factors65for65b65-65answer--
c.65Regardless65of65recommendations,65the65high65sensitivity65of65breast65MRI65comes6
5at65the65expense65of65markedly65decreased65specificity65(i.e.,65the65ability65to65rule65out
65disease65in65healthy65breasts).
A6566-year-
old65female65museum65curator65presents65for65a65routine65annual65examination.65On65e
xamination,65a65notably65enlarged65supraclavicular65lymph65node65is65appreciated65on65
the65right65side.65The65lymph65node65is65nontender65and65feels65firm65and65rubbery.65Sh
e65denies65any65localized65or65systemic65symptoms65such65as65breast65lumps,65fevers,6
5or65night65sweats.65She65has65been65taking65conjugated65estrogen65tablets65for65965ye
ars65since65menopause,65though65she65has65not65taken65progestin65compounds65since6
, 5she65had65a65hysterectomy65for65heavy65bleeding65at65age654565years.65Which65of65the
65following65is65true65about65this65presentation65of65lymphadenopathy?
a.65Breast65cancer65always65presents65with65axillary65lymphadenopathy65because65the6
5lymphatics65of65the65breast65uniformly65drain65into65the65axilla.
b.65Supraclavicular65nodes65are65generally65considered65benign65and65require65no65furt
her65evaluation65or65follow-up.
c.65Supraclavicular65nodes65are65found65along65the65anterior65edge65of65the65trapezius65
muscle65in65the65neck.
d.65Firm,65-65answer--
e.65Metastatic65breast65cancer65cells65may65spread65directly65into65the65infraclavicular65
and65then65supraclavicular65nodes65without65first65causing65notable65changes65in65the65
axillary65nodes.
A6524-year-
old65graphic65designer65presents65to65clinic65with65a65concern65for65a65breast65mass.65A
65rubbery,65mobile,65nontender65mass65is65palpated65in65the65right65breast65as65describe
d65by65the65patient,65which65is65consistent65with65a65firbroadenoma.65In65describing65the
65location65of65the65mass,65the65examiner65notes65that65it65is65365cm65proximal65to65and6
5365cm65to65the65left65of65the65nipple.65Which65of65the65following65would65be65the65most6
5appropriate65way65to65report65this65finding?
a.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the6510:3065p
osition65from65the65nipple"
b.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the65lower65ou
ter65quadrant"
c.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the65upper65in
ner65quadrant"
d.65"Rubbery,65mobile,65nontender65mass65located65in65the65left65breast,65upper65outer65
quadrant"
e.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the651:3065po
sition65from65the65nipple"65-65answer--
a.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the6510:3065p
osition65from65the65nipple"
A6554-year-
old65female65dietician65presents65for65a65routine65annual65examination.65On65review65of6
5systems,65she65reports65that65she65has65had65many65breast65findings65over65several65y
ears,65including65one65biopsy65with65normal65pathology.65She65feels65that65her65breasts
65have65become65far65less65lumpy65since65she65underwent65menopause65365years65ago
.65Which65of65the65following65is65true65regarding65changes65in65the65breasts65with65men
opause?
a.65Transformation65of65breasts65to65primarily65fatty65tissue65with65menopause65decreas
es65the65sensitivity65and65specificity65of65mammograms.
INTERACTIVE QUESTION BANK
A6544-year-
old65female65mathematician65presents65to65clinic65with65a65complaint65of65a65mass65in65t
he65right65breast.65Her65partner65noticed65this65mass65265days65ago,65and65the65patient6
5feels65guilty65because65she65has65only65had65one65mammogram65and65does65not65eng
age65in65breast65self-
examination65(BSE)65on65any65regular65basis.65She65has65no65family65history65of65breas
t65cancer,65and65her65prior65mammogram65was65ordered65as65a65routine65screening65te
st65at65age654365years65after65a65brief65discussion65with65her65primary65care65provider.65
After65a65thorough65investigation65reveals65a65benign65cyst,65what65advice65should65be65
given65to65this65patient65about65screening65for65breast65cancer65in65her65age65group?
a.65BSE65is65well65evidenced,65and65all65recommending65agencies65agree65that65it65sho
uld65be65taught65and65reinforced.
b.65Clinical65breast65examination65(CBE)65is65superior65to65BSE65and65should65be65a65ro
utine65part65of65annual65examinations65starting65at65age653065years.
c.65This65patient65was65in65compliance65with65the65U.S.65Preventive65Services65Task65F
65-65answer--
c.65This65patient65was65in65compliance65with65the65U.S.65Preventive65Services65Task65F
orce65(USPSTF)65recommendations65for65her65age65group65and65risk65factors65prior65to6
5her65current65complaint.
A6542-year-
old65female65website65developer65presents65for65an65annual65preventive65examination65
with65questions65about65breast65cancer65screening.65She65is65concerned65about65the65r
adiation65exposure65associated65with65mammography65and65is65interested65in65magneti
c65resonance65imaging65(MRI)65as65a65possible65alternative65for65routine65screening.65S
he65is65otherwise65healthy65with65no65family65history65of65breast,65ovarian,65or65colon65c
ancer.65Which65of65the65following65is65true65about65MRI65as65a65screening65modality65for
65breast65cancer65in65the65general65population?
a.65Breast65cancer65screening65by65MRI65has65been65well65studied65in65the65general65p
opulation.
b.65Sensitivity65of65screening65for65breast65cancer65increases65with65breast65MRI65at65th
e65expense65of65specificity.
c.65This65patient65is65an65ideal65candidate65for65screening65via65breast65MRI65based65on
65current65evidence.
d.65Women65at65low65lifetime65risk65of65breast65cancer65(<20%)65are65recommended65to
65undergo65screening65MRI.
,e.65Known65BRCA165or65BRCA265mutation65is65insufficient65c65-65answer--
b.65Sensitivity65of65screening65for65breast65cancer65increases65with65breast65MRI65at65th
e65expense65of65specificity.
A6535-year-
old65G0P065woman65presents65to65clinic65with65a65complaint65of65bilateral65nipple65disch
arge.65This65discharge65started65several65weeks65ago65and65has65occurred65at65irregula
r65intervals65since65that65time.65She65does65not65complain65of65local65tenderness,65redn
ess,65fever,65or65any65other65systemic65symptoms65aside65from65slightly65irregular65peri
ods65over65the65last65few65months.65On65examination,65she65is65able65to65express65a65s
mall65amount65of65discharge,65which65is65sent65to65the65laboratory65and65found65to65be65
consistent65with65breast65milk65but65without65any65signs65of65blood65or65pus.65Screening
65laboratories65are65also65sent,65which65reveal65a65normal65blood65count,65metabolic65p
anel,65thyroid-
stimulating65hormone,65and65human65chorionic65gonadotropin65(HCG)65level.65Further65l
aboratories65are65still65pending.65Which65of65the65following65is65the65most65likely65diagn
osis?
a.65Mastitis
b.65Ductal65carcinoma65in65situ
c.65Paget65disease65of65the65breast
d.65Occult65pregnancy
e.65Prolactinoma65-65answer--e.65Prolactinoma
A6522-year-
old65G0P065undergraduate65student65presents65to65clinic65after65finding65a65breast65mas
s65on65breast65self-
examination65(BSE)65at65home.65The65mass65is65nontender65without65skin65changes,65e
rythema,65or65overlying65swelling.65She65has65heard65that65most65breast65cancers65are6
5found65by65patients65themselves,65and65she65is65very65concerned65that65she65may65ha
ve65breast65cancer.65Which65of65the65following65is65true65about65BSE65and65self-
detection65of65breast65cancer?
a.65Most65masses65that65women65find65at65home65and65bring65to65a65provider's65attentio
n65turn65out65to65be65malignant.
b.65This65patient65is65more65likely65to65find65a65fibroadenoma65than65a65cancer65on65self-
examination.
c.65The65most65likely65breast65mass65this65patient65is65likely65to65find65in65herself65is65an
65abscess65complicating65underlying65mastitis.
d.65Because65of65this65patient's65age,65breast65masses65should65not65be65pursued65with
65imaging65and65diagnosis65because65the65risk65of65cancer65is65so65low.
e.65BSE65is65universally65recommended65because65of65very65high65sensitivity65-
65answer--
b.65This65patient65is65more65likely65to65find65a65fibroadenoma65than65a65cancer65on65self-
examination.
,A6548-year-
old65female65psychologist65presents65to65clinic65with65concerns65about65her65breast65ca
ncer65risk65after65an65age-
matched65cousin65was65recently65diagnosed65with65this65disease.65This65cousin65is65the
65third65family65member65on65her65father's65side65in65as65many65years65to65be65diagnose
d65with65breast65cancer,65including65the65patient's65own65father,65who65had65surgery65an
d65subsequent65treatment65365years65ago65for65breast65cancer.65The65patient65has65little
65other65knowledge65of65her65family65history,65only65that65her65grandparents65independe
ntly65arrived65from65Eastern65Europe65near65the65end65of65World65War65II65and65were65a
mong65very65few65members65of65their65family65that65survived65the65war.65The65patient65
has65read65about65testing65for65the65breast65cancer65genes65(BRCA165and65BRCA2)65a
nd65desires65further65information65about65whether65this65would65be65appropriate65for65h
er.65Which65of65the65following65is65true65about65this65patient's65indications65for65BRCA65t
esting?
a.65Her65familial65lineage65is65irrelevant65to65her65risk65of65BRCA65genes65and65-
65answer--
d.65This65patient65carries65several65risk65factors65that65together65justify65BRCA65testing.
A6568-year-
old65former65paleontologist65presents65to65clinic65with65concerns65about65her65breast65c
ancer65risk.65Her65mother65developed65the65disease65in65her6550s65and65died65from65it65
in65her6560s.65A65younger65cousin65developed65the65disease65a65few65years65ago65befor
e65the65age65of655065years,65but65this65individual65was65not65tested65for65the65BRCA165a
nd65BRCA265genes.65In65addition,65the65patient65suffered65from65lymphoma65in65her6520
s65and65had65radiation65to65the65chest.65She65did65take65hormone65replacement65therap
y65for65a65few65years65before65data65emerged65that65this65may65contribute65to65breast65c
ancer65risk.65She65has65had65several65abnormal65mammograms65in65her6550s65for65per
sistently65dense65breasts65with65subtle65findings,65but65follow-
up65biopsies65never65showed65any65malignant65pathology.65Which65of65the65following65i
s65true65regarding65magnetic65resonance65imaging65(MRI)65screening65of65this65patient?
a.65No65agency65recommends65breast65MRI65for65a65patient65such65as65this65one,65who6
5has65moderately65but65not65extraordinary65risk65factors65for65b65-65answer--
c.65Regardless65of65recommendations,65the65high65sensitivity65of65breast65MRI65comes6
5at65the65expense65of65markedly65decreased65specificity65(i.e.,65the65ability65to65rule65out
65disease65in65healthy65breasts).
A6566-year-
old65female65museum65curator65presents65for65a65routine65annual65examination.65On65e
xamination,65a65notably65enlarged65supraclavicular65lymph65node65is65appreciated65on65
the65right65side.65The65lymph65node65is65nontender65and65feels65firm65and65rubbery.65Sh
e65denies65any65localized65or65systemic65symptoms65such65as65breast65lumps,65fevers,6
5or65night65sweats.65She65has65been65taking65conjugated65estrogen65tablets65for65965ye
ars65since65menopause,65though65she65has65not65taken65progestin65compounds65since6
, 5she65had65a65hysterectomy65for65heavy65bleeding65at65age654565years.65Which65of65the
65following65is65true65about65this65presentation65of65lymphadenopathy?
a.65Breast65cancer65always65presents65with65axillary65lymphadenopathy65because65the6
5lymphatics65of65the65breast65uniformly65drain65into65the65axilla.
b.65Supraclavicular65nodes65are65generally65considered65benign65and65require65no65furt
her65evaluation65or65follow-up.
c.65Supraclavicular65nodes65are65found65along65the65anterior65edge65of65the65trapezius65
muscle65in65the65neck.
d.65Firm,65-65answer--
e.65Metastatic65breast65cancer65cells65may65spread65directly65into65the65infraclavicular65
and65then65supraclavicular65nodes65without65first65causing65notable65changes65in65the65
axillary65nodes.
A6524-year-
old65graphic65designer65presents65to65clinic65with65a65concern65for65a65breast65mass.65A
65rubbery,65mobile,65nontender65mass65is65palpated65in65the65right65breast65as65describe
d65by65the65patient,65which65is65consistent65with65a65firbroadenoma.65In65describing65the
65location65of65the65mass,65the65examiner65notes65that65it65is65365cm65proximal65to65and6
5365cm65to65the65left65of65the65nipple.65Which65of65the65following65would65be65the65most6
5appropriate65way65to65report65this65finding?
a.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the6510:3065p
osition65from65the65nipple"
b.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the65lower65ou
ter65quadrant"
c.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the65upper65in
ner65quadrant"
d.65"Rubbery,65mobile,65nontender65mass65located65in65the65left65breast,65upper65outer65
quadrant"
e.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the651:3065po
sition65from65the65nipple"65-65answer--
a.65"Rubbery,65mobile,65nontender65mass65located65in65right65breast,65in65the6510:3065p
osition65from65the65nipple"
A6554-year-
old65female65dietician65presents65for65a65routine65annual65examination.65On65review65of6
5systems,65she65reports65that65she65has65had65many65breast65findings65over65several65y
ears,65including65one65biopsy65with65normal65pathology.65She65feels65that65her65breasts
65have65become65far65less65lumpy65since65she65underwent65menopause65365years65ago
.65Which65of65the65following65is65true65regarding65changes65in65the65breasts65with65men
opause?
a.65Transformation65of65breasts65to65primarily65fatty65tissue65with65menopause65decreas
es65the65sensitivity65and65specificity65of65mammograms.
