NR 509 - Final Exam Bate's Interactive Question Bank
Study online at https://quizlet.com/_cgw5bb
1. A 44-year-old female mathematician presents to clinic c. This patient was in
with a complaint of a mass in the right breast. Her compliance with the U.S.
partner noticed this mass 2 days ago, and the patient Preventive Services Task
feels guilty because she has only had one mammo- Force (USPSTF) recom-
gram and does not engage in breast self-examination mendations for her age
(BSE) on any regular basis. She has no family history group and risk factors pri-
of breast cancer, and her prior mammogram was or- or to her current com-
dered as a routine screening test at age 43 years after plaint.
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 agen-
cies 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. Preven-
tive Services Task Force (USPSTF) recommendations
for her age group and risk factors prior to her current
complaint.
d. Mammography is most sensitive and specific for
women in their 40s, when breast tissue is still dense
enough to image accurately.
e. Breast cancer screening is extremely well stud-
ied, and no controversy exists on the recommended
norms for screening and follow-up.
2. A 42-year-old female website developer presents for b. Sensitivity of screening
an annual preventive examination with questions for breast cancer increas-
about breast cancer screening. She is concerned
, NR 509 - Final Exam Bate's Interactive Question Bank
Study online at https://quizlet.com/_cgw5bb
about the radiation exposure associated with mam- es with breast MRI at the
mography and is interested in magnetic resonance expense of specificity.
imaging (MRI) as a possible alternative for routine
screening. She is otherwise healthy with no family his-
tory 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 stud-
ied 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
criteria to justify screening with breast MRI.
3. A 35-year-old G0P0 woman presents to clinic with a e. Prolactinoma
complaint of bilateral nipple discharge. This discharge
started several weeks ago and has occurred at irregu-
lar 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. Screen-
ing laboratories are also sent, which reveal a nor-
mal blood count, metabolic panel, thyroid-stimulating
hormone, and human chorionic gonadotropin (HCG)
, NR 509 - Final Exam Bate's Interactive Question Bank
Study online at https://quizlet.com/_cgw5bb
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
4. A 22-year-old G0P0 undergraduate student presents b. This patient is more
to clinic after finding a breast mass on breast self-ex- likely to find a fibroade-
amination (BSE) at home. The mass is nontender with- noma than a cancer on
out skin changes, erythema, or overlying swelling. She self-examination.
has heard that most breast cancers are found by pa-
tients 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 and specificity for finding cancerous
lesions.
, NR 509 - Final Exam Bate's Interactive Question Bank
Study online at https://quizlet.com/_cgw5bb
5. A 48-year-old female psychologist presents to clinic d. This patient carries sev-
with concerns about her breast cancer risk after an eral risk factors that to-
age-matched cousin was recently diagnosed with this gether justify BRCA test-
disease. This cousin is the third family member on her ing.
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 knowl-
edge of her family history, only that her grandpar-
ents 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 infor-
mation 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 should be discounted in assessing her risk
for these genes.
b. Breast cancer in a male relative does not add signifi-
cant weight to the decision to test for the BRCA genes
in this patient.
c. The BRCAPRO calculator does not add any further
clinical information to this patient's risk for carrying
the BRCA gene.
d. This patient carries several risk factors that together
justify BRCA testing.
e. Even if this patient is BRCA positive, no changes
in screening or treatment are recommended for pa-
Study online at https://quizlet.com/_cgw5bb
1. A 44-year-old female mathematician presents to clinic c. This patient was in
with a complaint of a mass in the right breast. Her compliance with the U.S.
partner noticed this mass 2 days ago, and the patient Preventive Services Task
feels guilty because she has only had one mammo- Force (USPSTF) recom-
gram and does not engage in breast self-examination mendations for her age
(BSE) on any regular basis. She has no family history group and risk factors pri-
of breast cancer, and her prior mammogram was or- or to her current com-
dered as a routine screening test at age 43 years after plaint.
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 agen-
cies 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. Preven-
tive Services Task Force (USPSTF) recommendations
for her age group and risk factors prior to her current
complaint.
d. Mammography is most sensitive and specific for
women in their 40s, when breast tissue is still dense
enough to image accurately.
e. Breast cancer screening is extremely well stud-
ied, and no controversy exists on the recommended
norms for screening and follow-up.
2. A 42-year-old female website developer presents for b. Sensitivity of screening
an annual preventive examination with questions for breast cancer increas-
about breast cancer screening. She is concerned
, NR 509 - Final Exam Bate's Interactive Question Bank
Study online at https://quizlet.com/_cgw5bb
about the radiation exposure associated with mam- es with breast MRI at the
mography and is interested in magnetic resonance expense of specificity.
imaging (MRI) as a possible alternative for routine
screening. She is otherwise healthy with no family his-
tory 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 stud-
ied 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
criteria to justify screening with breast MRI.
3. A 35-year-old G0P0 woman presents to clinic with a e. Prolactinoma
complaint of bilateral nipple discharge. This discharge
started several weeks ago and has occurred at irregu-
lar 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. Screen-
ing laboratories are also sent, which reveal a nor-
mal blood count, metabolic panel, thyroid-stimulating
hormone, and human chorionic gonadotropin (HCG)
, NR 509 - Final Exam Bate's Interactive Question Bank
Study online at https://quizlet.com/_cgw5bb
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
4. A 22-year-old G0P0 undergraduate student presents b. This patient is more
to clinic after finding a breast mass on breast self-ex- likely to find a fibroade-
amination (BSE) at home. The mass is nontender with- noma than a cancer on
out skin changes, erythema, or overlying swelling. She self-examination.
has heard that most breast cancers are found by pa-
tients 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 and specificity for finding cancerous
lesions.
, NR 509 - Final Exam Bate's Interactive Question Bank
Study online at https://quizlet.com/_cgw5bb
5. A 48-year-old female psychologist presents to clinic d. This patient carries sev-
with concerns about her breast cancer risk after an eral risk factors that to-
age-matched cousin was recently diagnosed with this gether justify BRCA test-
disease. This cousin is the third family member on her ing.
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 knowl-
edge of her family history, only that her grandpar-
ents 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 infor-
mation 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 should be discounted in assessing her risk
for these genes.
b. Breast cancer in a male relative does not add signifi-
cant weight to the decision to test for the BRCA genes
in this patient.
c. The BRCAPRO calculator does not add any further
clinical information to this patient's risk for carrying
the BRCA gene.
d. This patient carries several risk factors that together
justify BRCA testing.
e. Even if this patient is BRCA positive, no changes
in screening or treatment are recommended for pa-
