NR 509 FINAL EXAM ACTUAL EXAM 2025 | ALL QUESTIONS AND CORREC
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
A 44-year-old female mathematician pre-
sents 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 C. This patient was in compliance with
of breast cancer, and her prior mammo- the U.S. Preventive Services Task Force
gram was ordered as a routine screening (USPSTF) recommendations for her age
test at age 43 years after a brief discus- group and risk factors prior to her current
sion with her primary care provider. After complaint.
a thorough investigation reveals a benign
cyst, what advice should be given to this The USPSTF recommends that women
patient about screening for breast cancer age <50 years discuss risks and ben-
in her age group? efits with their provider and decide on
a. BSE is well evidenced, and all recom- appropriate screening for their individual
mending agencies agree that it should preferences and needs
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 Fo
A 42-year-old female website developer
presents for an annual preventive exam-
ination with questions about breast can-
cer screening. She is concerned about
b. Sensitivity of screening for breast can-
the radiation exposure associated with
cer increases with breast MRI at the ex-
mammography and is interested in mag-
pense of specificity.
netic resonance imaging (MRI) as a pos-
sible alternative for routine screening.
She is otherwise healthy with no family
history of breast, ovarian, or colon can-
cer. Which of the following is true about
, NR 509 FINAL EXAM ACTUAL EXAM 2025 | ALL QUESTIONS AND CORREC
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
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 popula-
tion. Rationale: Sensitivity of screening for
b. Sensitivity of screening for breast can- breast cancer increases with breast MRI
cer increases with breast MRI at the ex- at the expense of specificity. Increased
pense of specificity. sensitivity (in this case, higher-resolution
c. This patient is an ideal candidate for imaging to pick up subtler disease) is
screening via breast MRI based on cur- often traded for reduced specificity (in the
rent evidence. form of discovering many small items of
d. Women at low lifetime risk of breast no pathological significance).
cancer (<20%) are recommended to un-
dergo screening MRI.
e. Known BRCA1 or BRCA2 mutation is
insufficient cr
A 35-year-old G0P0 woman presents to
clinic with a complaint of bilateral nipple
discharge. This discharge started sever-
al weeks ago and has occurred at irreg-
ular intervals since that time. She does
not complain of local tenderness, red-
ness, fever, or any other systemic symp-
toms aside from slightly irregular peri- e. Prolactinoma
ods over the last few months. On exam-
ination, she is able to express a small Rationale: Prolactinomas are pituitary tu-
amount of discharge, which is sent to mors that secrete prolactin, which caus-
the laboratory and found to be consistent es the production of breast milk and can
with breast milk but without any signs of suppress menstruation.
blood or pus. Screening laboratories are
also sent, which reveal a normal blood
count, metabolic panel, thyroid-stimulat-
ing hormone, and human chorionic go-
nadotropin (HCG) level. Further labora-
tories are still pending. Which of the fol-
lowing is the most likely diagnosis?
, NR 509 FINAL EXAM ACTUAL EXAM 2025 | ALL QUESTIONS AND CORREC
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
A 22-year-old G0P0 undergraduate stu-
dent presents to clinic after finding a
breast mass on breast self-examination
(BSE) at home. The mass is nontender
without skin changes, erythema, or over-
lying 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 b. This patient is more likely to find a
of the following is true about BSE and fibroadenoma than a cancer on self-ex-
self-detection of breast cancer? amination.
a. Most masses that women find at home
and bring to a provider's attention turn Rationale: This patient is more likely to
out to be malignant. find a fibroadenoma than a cancer on
b. This patient is more likely to find a self-examination. In this patient's age
fibroadenoma than a cancer on self-ex- range (15-25 years), palpable masses
amination. are most likely to be benign fibroadeno-
c. The most likely breast mass this pa- mas.
tient is likely to find in herself is an ab-
scess 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 be-
cause of very high sensitivity
A 48-year-old female psychologist pre-
sents 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
, NR 509 FINAL EXAM ACTUAL EXAM 2025 | ALL QUESTIONS AND CORREC
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
member on her father's side in as many
years to be diagnosed with breast can-
cer, including the patient's own father,
who had surgery and subsequent treat-
ment 3 years ago for breast cancer. The d. This patient carries several risk factors
patient has little other knowledge of her that together justify BRCA testing.
family history, only that her grandparents
independently arrived from Eastern Eu- Rationale: This patient has both a
rope near the end of World War II and first-degree male relative with breast
were among very few members of their cancer and several relatives in the same
family that survived the war. The patient lineage with breast cancer. Both of these
has read about testing for the breast can- suggest risk for the BRCA genes, but
cer genes (BRCA1 and BRCA2) and de- the BRCAPRO calculator can further re-
sires further information about whether fine the numerical risk and help decide if
this would be appropriate for her. Which screening might be helpful.
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
A 68-year-old former paleontologist pre-
sents to clinic with concerns about her
breast cancer risk. Her mother devel- c. Regardless of recommendations, the
oped the disease in her 50s and died high sensitivity of breast MRI comes
from it in her 60s. A younger cousin de- at the expense of markedly decreased
veloped the disease a few years ago be- specificity (i.e., the ability to rule out dis-
fore the age of 50 years, but this individ- ease in healthy breasts).
ual was not tested for the BRCA1 and
BRCA2 genes. In addition, the patient Rationale: Regardless of recommenda-
suffered from lymphoma in her 20s and tions, the high sensitivity of breast MRI
had radiation to the chest. She did take comes at the expense of markedly de-
hormone replacement therapy for a few creased specificity (i.e., the ability to rule
years before data emerged that this may out disease in health breasts). Sensitiv-
contribute to breast cancer risk. She has ity and specificity of screening test are
had several abnormal mammograms in almost always trade-offs; that is, a test
her 50s for persistently dense breasts
with subtle findings, but follow-up biop-
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
A 44-year-old female mathematician pre-
sents 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 C. This patient was in compliance with
of breast cancer, and her prior mammo- the U.S. Preventive Services Task Force
gram was ordered as a routine screening (USPSTF) recommendations for her age
test at age 43 years after a brief discus- group and risk factors prior to her current
sion with her primary care provider. After complaint.
a thorough investigation reveals a benign
cyst, what advice should be given to this The USPSTF recommends that women
patient about screening for breast cancer age <50 years discuss risks and ben-
in her age group? efits with their provider and decide on
a. BSE is well evidenced, and all recom- appropriate screening for their individual
mending agencies agree that it should preferences and needs
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 Fo
A 42-year-old female website developer
presents for an annual preventive exam-
ination with questions about breast can-
cer screening. She is concerned about
b. Sensitivity of screening for breast can-
the radiation exposure associated with
cer increases with breast MRI at the ex-
mammography and is interested in mag-
pense of specificity.
netic resonance imaging (MRI) as a pos-
sible alternative for routine screening.
She is otherwise healthy with no family
history of breast, ovarian, or colon can-
cer. Which of the following is true about
, NR 509 FINAL EXAM ACTUAL EXAM 2025 | ALL QUESTIONS AND CORREC
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
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 popula-
tion. Rationale: Sensitivity of screening for
b. Sensitivity of screening for breast can- breast cancer increases with breast MRI
cer increases with breast MRI at the ex- at the expense of specificity. Increased
pense of specificity. sensitivity (in this case, higher-resolution
c. This patient is an ideal candidate for imaging to pick up subtler disease) is
screening via breast MRI based on cur- often traded for reduced specificity (in the
rent evidence. form of discovering many small items of
d. Women at low lifetime risk of breast no pathological significance).
cancer (<20%) are recommended to un-
dergo screening MRI.
e. Known BRCA1 or BRCA2 mutation is
insufficient cr
A 35-year-old G0P0 woman presents to
clinic with a complaint of bilateral nipple
discharge. This discharge started sever-
al weeks ago and has occurred at irreg-
ular intervals since that time. She does
not complain of local tenderness, red-
ness, fever, or any other systemic symp-
toms aside from slightly irregular peri- e. Prolactinoma
ods over the last few months. On exam-
ination, she is able to express a small Rationale: Prolactinomas are pituitary tu-
amount of discharge, which is sent to mors that secrete prolactin, which caus-
the laboratory and found to be consistent es the production of breast milk and can
with breast milk but without any signs of suppress menstruation.
blood or pus. Screening laboratories are
also sent, which reveal a normal blood
count, metabolic panel, thyroid-stimulat-
ing hormone, and human chorionic go-
nadotropin (HCG) level. Further labora-
tories are still pending. Which of the fol-
lowing is the most likely diagnosis?
, NR 509 FINAL EXAM ACTUAL EXAM 2025 | ALL QUESTIONS AND CORREC
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
A 22-year-old G0P0 undergraduate stu-
dent presents to clinic after finding a
breast mass on breast self-examination
(BSE) at home. The mass is nontender
without skin changes, erythema, or over-
lying 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 b. This patient is more likely to find a
of the following is true about BSE and fibroadenoma than a cancer on self-ex-
self-detection of breast cancer? amination.
a. Most masses that women find at home
and bring to a provider's attention turn Rationale: This patient is more likely to
out to be malignant. find a fibroadenoma than a cancer on
b. This patient is more likely to find a self-examination. In this patient's age
fibroadenoma than a cancer on self-ex- range (15-25 years), palpable masses
amination. are most likely to be benign fibroadeno-
c. The most likely breast mass this pa- mas.
tient is likely to find in herself is an ab-
scess 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 be-
cause of very high sensitivity
A 48-year-old female psychologist pre-
sents 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
, NR 509 FINAL EXAM ACTUAL EXAM 2025 | ALL QUESTIONS AND CORREC
ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION | BRAN
NEW VERSION!
member on her father's side in as many
years to be diagnosed with breast can-
cer, including the patient's own father,
who had surgery and subsequent treat-
ment 3 years ago for breast cancer. The d. This patient carries several risk factors
patient has little other knowledge of her that together justify BRCA testing.
family history, only that her grandparents
independently arrived from Eastern Eu- Rationale: This patient has both a
rope near the end of World War II and first-degree male relative with breast
were among very few members of their cancer and several relatives in the same
family that survived the war. The patient lineage with breast cancer. Both of these
has read about testing for the breast can- suggest risk for the BRCA genes, but
cer genes (BRCA1 and BRCA2) and de- the BRCAPRO calculator can further re-
sires further information about whether fine the numerical risk and help decide if
this would be appropriate for her. Which screening might be helpful.
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
A 68-year-old former paleontologist pre-
sents to clinic with concerns about her
breast cancer risk. Her mother devel- c. Regardless of recommendations, the
oped the disease in her 50s and died high sensitivity of breast MRI comes
from it in her 60s. A younger cousin de- at the expense of markedly decreased
veloped the disease a few years ago be- specificity (i.e., the ability to rule out dis-
fore the age of 50 years, but this individ- ease in healthy breasts).
ual was not tested for the BRCA1 and
BRCA2 genes. In addition, the patient Rationale: Regardless of recommenda-
suffered from lymphoma in her 20s and tions, the high sensitivity of breast MRI
had radiation to the chest. She did take comes at the expense of markedly de-
hormone replacement therapy for a few creased specificity (i.e., the ability to rule
years before data emerged that this may out disease in health breasts). Sensitiv-
contribute to breast cancer risk. She has ity and specificity of screening test are
had several abnormal mammograms in almost always trade-offs; that is, a test
her 50s for persistently dense breasts
with subtle findings, but follow-up biop-
