NR 509 - Final Exam Bate's Interactive Question
Bank with complete solution
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
~CORRECT 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.
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 ~CORRECT
ANSWER~b. Sensitivity of screening for breast cancer increases with breast
MRI at the expense of specificity.
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 ~CORRECT ANSWER~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 because of very high sensitivity
~CORRECT ANSWER~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 irrelevant to her risk of BRCA genes and
~CORRECT ANSWER~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 extraordinary risk factors for b ~CORRECT
Bank with complete solution
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
~CORRECT 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.
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 ~CORRECT
ANSWER~b. Sensitivity of screening for breast cancer increases with breast
MRI at the expense of specificity.
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 ~CORRECT ANSWER~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 because of very high sensitivity
~CORRECT ANSWER~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 irrelevant to her risk of BRCA genes and
~CORRECT ANSWER~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 extraordinary risk factors for b ~CORRECT
