NR 509 FINAL CURRENTLY TESTING
EXAM WITH DETAILED QUESTIONS AND
CORRECT ANSWERS GRADED A+
1. A 48-year-old female presents to the clinic with concerns
regarding her risk for breast cancer after her father and two
paternal relatives were diagnosed with breast cancer. She
reports Eastern European Jewish lineage. Which statement
correctly addresses her indication for genetic testing?
A) Testing for BRCA1 and BRCA2 is indicated because her family
history and ethnicity significantly elevate her pre-test probability.
B) Genetic testing is unnecessary unless she develops a palpable
breast mass or abnormal mammogram.
C) BRCA testing is only recommended if first-degree maternal
relatives are affected.
D) She should undergo annual breast MRI instead of genetic
counseling and testing.
Correct Answer: A
Rationale: The presence of male breast cancer in a first-degree
relative, multiple family members with breast cancer, and
Ashkenazi Jewish ancestry significantly increase the risk for
carrying a BRCA mutation, justifying genetic evaluation.
, 2. A 44-year-old asymptomatic female with no family history of
breast cancer inquires about her current breast cancer
screening schedule after receiving a normal screening
mammogram at age 43. According to the U.S. Preventive
Services Task Force (USPSTF) guidelines, how should her
prior screening be evaluated?
A) She was over-screened and should not have received a
mammogram until age 50.
B) She was in compliance with USPSTF recommendations, which
support individualized decision-making prior to age 50.
C) She should have undergone annual screening mammograms
starting at age 30.
D) She should have received routine annual breast MRIs in
addition to mammography.
Correct Answer: B
Rationale: USPSTF guidelines emphasize shared decision-
making for average-risk women under age 50, allowing patients to
choose screening initiation based on personal values and clinician
consultation.
3. A 42-year-old healthy woman requests a screening breast
MRI instead of mammography due to concerns about
radiation exposure. What trade-off must be discussed
regarding breast MRI as a screening modality in average-
risk individuals?
A) Increased sensitivity comes at the cost of decreased
specificity, leading to a higher rate of false-positive results.
,B) Breast MRI has lower sensitivity than mammography but
higher specificity.
C) Mammography produces significantly higher false-positive
rates than MRI in young women.
D) Breast MRI completely eliminates the need for subsequent
tissue biopsy.
Correct Answer: A
Rationale: Breast MRI is highly sensitive and capable of
detecting subtle tissue variations, but its lower specificity results in
more false positives and unnecessary diagnostic biopsies in low-
risk populations.
4. A 35-year-old nulliparous woman presents with bilateral,
non-painful nipple discharge present for several weeks.
Physical exam yields milky discharge from multiple ducts
without blood or pus. Serum thyroid-stimulating hormone
and HCG levels are normal, but prolactin is elevated. What
is the most likely diagnosis?
A) Intraductal papilloma
B) Mammary duct ectasia
C) Prolactinoma
D) Paget disease of the breast
Correct Answer: C
Rationale: Bilateral galactorrhea in a non-lactating female with
normal thyroid function and elevated prolactin levels strongly
indicates a prolactin-secreting pituitary adenoma (prolactinoma).
, 5. A 22-year-old college student discovers a firm, mobile,
nontender 2 cm breast mass during self-examination. What
is the most probable diagnosis for a mass with these
characteristics in a patient of this age group?
A) Invasive ductal carcinoma
B) Fibroadenoma
C) Fat necrosis
D) Breast cyst
Correct Answer: B
Rationale: Fibroadenomas are benign, smooth, mobile, non-
tender tumors that represent the most common breast mass in
women under the age of 25.
6. A 68-year-old woman with dense breast tissue and a high
risk of hereditary breast cancer undergoes breast screening.
What is the primary diagnostic limitation of utilizing magnetic
resonance imaging (MRI) for this patient?
A) High rate of false-negative results in high-risk patients
B) Inability to visualize deep chest wall structures
C) Reduced specificity leading to additional diagnostic workups
for benign lesions
D) Complete failure to detect invasive lobular carcinoma
Correct Answer: C
EXAM WITH DETAILED QUESTIONS AND
CORRECT ANSWERS GRADED A+
1. A 48-year-old female presents to the clinic with concerns
regarding her risk for breast cancer after her father and two
paternal relatives were diagnosed with breast cancer. She
reports Eastern European Jewish lineage. Which statement
correctly addresses her indication for genetic testing?
A) Testing for BRCA1 and BRCA2 is indicated because her family
history and ethnicity significantly elevate her pre-test probability.
B) Genetic testing is unnecessary unless she develops a palpable
breast mass or abnormal mammogram.
C) BRCA testing is only recommended if first-degree maternal
relatives are affected.
D) She should undergo annual breast MRI instead of genetic
counseling and testing.
Correct Answer: A
Rationale: The presence of male breast cancer in a first-degree
relative, multiple family members with breast cancer, and
Ashkenazi Jewish ancestry significantly increase the risk for
carrying a BRCA mutation, justifying genetic evaluation.
, 2. A 44-year-old asymptomatic female with no family history of
breast cancer inquires about her current breast cancer
screening schedule after receiving a normal screening
mammogram at age 43. According to the U.S. Preventive
Services Task Force (USPSTF) guidelines, how should her
prior screening be evaluated?
A) She was over-screened and should not have received a
mammogram until age 50.
B) She was in compliance with USPSTF recommendations, which
support individualized decision-making prior to age 50.
C) She should have undergone annual screening mammograms
starting at age 30.
D) She should have received routine annual breast MRIs in
addition to mammography.
Correct Answer: B
Rationale: USPSTF guidelines emphasize shared decision-
making for average-risk women under age 50, allowing patients to
choose screening initiation based on personal values and clinician
consultation.
3. A 42-year-old healthy woman requests a screening breast
MRI instead of mammography due to concerns about
radiation exposure. What trade-off must be discussed
regarding breast MRI as a screening modality in average-
risk individuals?
A) Increased sensitivity comes at the cost of decreased
specificity, leading to a higher rate of false-positive results.
,B) Breast MRI has lower sensitivity than mammography but
higher specificity.
C) Mammography produces significantly higher false-positive
rates than MRI in young women.
D) Breast MRI completely eliminates the need for subsequent
tissue biopsy.
Correct Answer: A
Rationale: Breast MRI is highly sensitive and capable of
detecting subtle tissue variations, but its lower specificity results in
more false positives and unnecessary diagnostic biopsies in low-
risk populations.
4. A 35-year-old nulliparous woman presents with bilateral,
non-painful nipple discharge present for several weeks.
Physical exam yields milky discharge from multiple ducts
without blood or pus. Serum thyroid-stimulating hormone
and HCG levels are normal, but prolactin is elevated. What
is the most likely diagnosis?
A) Intraductal papilloma
B) Mammary duct ectasia
C) Prolactinoma
D) Paget disease of the breast
Correct Answer: C
Rationale: Bilateral galactorrhea in a non-lactating female with
normal thyroid function and elevated prolactin levels strongly
indicates a prolactin-secreting pituitary adenoma (prolactinoma).
, 5. A 22-year-old college student discovers a firm, mobile,
nontender 2 cm breast mass during self-examination. What
is the most probable diagnosis for a mass with these
characteristics in a patient of this age group?
A) Invasive ductal carcinoma
B) Fibroadenoma
C) Fat necrosis
D) Breast cyst
Correct Answer: B
Rationale: Fibroadenomas are benign, smooth, mobile, non-
tender tumors that represent the most common breast mass in
women under the age of 25.
6. A 68-year-old woman with dense breast tissue and a high
risk of hereditary breast cancer undergoes breast screening.
What is the primary diagnostic limitation of utilizing magnetic
resonance imaging (MRI) for this patient?
A) High rate of false-negative results in high-risk patients
B) Inability to visualize deep chest wall structures
C) Reduced specificity leading to additional diagnostic workups
for benign lesions
D) Complete failure to detect invasive lobular carcinoma
Correct Answer: C
