NR 509: Final Exam Practice Questions
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 - Correct Answers-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.
CHAPTER 18: Breasts & Axillae
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 B - Correct Answers-b. Sensitivity of screening for breast cancer increases
with breast MRI at the expense of specificity.
,CHAPTER 18: Breasts & Axillae
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 Answers-e. Prolactinoma
CHAPTER 18: Breasts & Axillae
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 b - Correct Answers-b. This patient is more likely to find a
fibroadenoma than a cancer on self-examination.
CHAPTER 18: Breasts & Axillae
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 irrelevan - Correct Answers-d. This patient carries several risk factors
that together justify BRCA testing.
CHAPTER 18: Breasts & Axillae
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 e - Correct Answers-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).
CHAPTER 18: Breasts & Axillae
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?
, a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics of the
breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further evaluation or
follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapeziu - Correct Answers-e.
Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
CHAPTER 18: Breasts & Axillae
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?
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the
nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from the
nipple" - Correct Answers-a. "Rubbery, mobile, nontender mass located in right breast, in the
10:30 position from the nipple"
CHAPTER 18: Breasts & Axillae
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?
a. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity
and specificity of mammograms.
b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after
menopause.
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the
number of lobules.
d. Breast density has no genetic component and is entirely due to estrogen dose from
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 - Correct Answers-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.
CHAPTER 18: Breasts & Axillae
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 B - Correct Answers-b. Sensitivity of screening for breast cancer increases
with breast MRI at the expense of specificity.
,CHAPTER 18: Breasts & Axillae
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 Answers-e. Prolactinoma
CHAPTER 18: Breasts & Axillae
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 b - Correct Answers-b. This patient is more likely to find a
fibroadenoma than a cancer on self-examination.
CHAPTER 18: Breasts & Axillae
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 irrelevan - Correct Answers-d. This patient carries several risk factors
that together justify BRCA testing.
CHAPTER 18: Breasts & Axillae
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 e - Correct Answers-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).
CHAPTER 18: Breasts & Axillae
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?
, a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics of the
breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further evaluation or
follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapeziu - Correct Answers-e.
Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
CHAPTER 18: Breasts & Axillae
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?
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the
nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from the
nipple" - Correct Answers-a. "Rubbery, mobile, nontender mass located in right breast, in the
10:30 position from the nipple"
CHAPTER 18: Breasts & Axillae
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?
a. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity
and specificity of mammograms.
b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after
menopause.
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the
number of lobules.
d. Breast density has no genetic component and is entirely due to estrogen dose from
