NR509 FINAL EXAM NEWEST 2025/ 250
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+/ 100% VERIFIED
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 Fo - 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.
The USPSTF recommends that women age <50 years discuss risks and benefits with their
provider and decide on appropriate screening for their individual preferences and needs
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 cr - ANSWER b. Sensitivity of screening for
breast cancer increases with breast MRI at the expense of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity. Increased sensitivity (in this case, higher-resolution imaging to pick up subtler
disease) is often traded for reduced specificity (in the form of discovering many small items of
no pathological significance).
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 - ANSWER e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes the
production of breast milk and can suppress menstruation.
,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 - ANSWER b. This patient is
more likely to find a fibroadenoma than a cancer on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-examination.
In this patient's age range (15-25 years), palpable masses are most likely to be benign
fibroadenomas.
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 - ANSWER d. This patient
carries several risk factors that together justify BRCA testing.
, Rationale: This patient has both a first-degree male relative with breast cancer and several
relatives in the same lineage with breast cancer. Both of these suggest risk for the BRCA genes,
but the BRCAPRO calculator can further refine the numerical risk and help decide if screening
might be helpful.
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 br - ANSWER 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).
Rationale: 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 health breasts).
Sensitivity and specificity of screening test are almost always trade-offs; that is, a test that picks
up more true cases is also very likely to then pick up more false positives, and vice versa.
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.
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+/ 100% VERIFIED
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 Fo - 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.
The USPSTF recommends that women age <50 years discuss risks and benefits with their
provider and decide on appropriate screening for their individual preferences and needs
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 cr - ANSWER b. Sensitivity of screening for
breast cancer increases with breast MRI at the expense of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity. Increased sensitivity (in this case, higher-resolution imaging to pick up subtler
disease) is often traded for reduced specificity (in the form of discovering many small items of
no pathological significance).
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 - ANSWER e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes the
production of breast milk and can suppress menstruation.
,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 - ANSWER b. This patient is
more likely to find a fibroadenoma than a cancer on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-examination.
In this patient's age range (15-25 years), palpable masses are most likely to be benign
fibroadenomas.
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 - ANSWER d. This patient
carries several risk factors that together justify BRCA testing.
, Rationale: This patient has both a first-degree male relative with breast cancer and several
relatives in the same lineage with breast cancer. Both of these suggest risk for the BRCA genes,
but the BRCAPRO calculator can further refine the numerical risk and help decide if screening
might be helpful.
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 br - ANSWER 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).
Rationale: 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 health breasts).
Sensitivity and specificity of screening test are almost always trade-offs; that is, a test that picks
up more true cases is also very likely to then pick up more false positives, and vice versa.
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.
