NR 509 - FINAL EXAM BATE'S INTERACTIVE
2025/2026 VERIFIED SOLUTIONS LATEST EDITION
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 \- \ANS-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 \- \ANS-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 \- \ANS-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 \- \ANS-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 \- \ANS-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 \- \ANS-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).
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 \trapezius \muscle \in \the \neck.
d. \Firm, \- \ANS-e. \Metastatic \breast \cancer \cells \may \spread \directly \into \the \infraclavicular \and \then \
supraclavicular \nodes \without \first \causing \notable \changes \in \the \axillary \nodes.
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" \- \
ANS-a. \"Rubbery, \mobile, \nontender \mass \located \in \right \breast, \in \the \10:30 \position \from \the \
nipple"
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 \endogenous \
and \exogenous \sources \over \the \lifetime.
e. \Mammography \performs \most \poorly \in \the \menopausal \and \postmenopa \- \ANS-c. \Glandular \tissue \
of \the \breast \atrophies \with \menopause, \primarily \due \to \decrease \in \the \number \of \lobules.
2025/2026 VERIFIED SOLUTIONS LATEST EDITION
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 \- \ANS-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 \- \ANS-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 \- \ANS-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 \- \ANS-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 \- \ANS-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 \- \ANS-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).
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 \trapezius \muscle \in \the \neck.
d. \Firm, \- \ANS-e. \Metastatic \breast \cancer \cells \may \spread \directly \into \the \infraclavicular \and \then \
supraclavicular \nodes \without \first \causing \notable \changes \in \the \axillary \nodes.
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" \- \
ANS-a. \"Rubbery, \mobile, \nontender \mass \located \in \right \breast, \in \the \10:30 \position \from \the \
nipple"
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 \endogenous \
and \exogenous \sources \over \the \lifetime.
e. \Mammography \performs \most \poorly \in \the \menopausal \and \postmenopa \- \ANS-c. \Glandular \tissue \
of \the \breast \atrophies \with \menopause, \primarily \due \to \decrease \in \the \number \of \lobules.
