NR509 FINAL EXAM NEWEST 2024 TEST
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, 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?
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? "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?
Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the
number of lobules.
An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of
intense abdominal pain, light-headedness, and a fainting episode that finally prompted her to seek
medical attention. She has a strong family history of gallstones and is concerned about this possibility.
She has not had any vomiting or diarrhea. She had a normal bowel movement this morning. Her
βhuman chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10
weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min;
oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior
to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness.
What is the most likely diagnosis? a. Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs
are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also
measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase, alanine
aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appointment and the clinician performs an abdominal exam to
assess his liver. Which of the following findings would be most consistent with hepatomegaly? Liver
palpable 3 cm below the right costal margin, mid clavicular line, on expiration
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? 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? 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? 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? 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? 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.
