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NR 509 FINAL EXAM 2 VERSIONS.pdf
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NR 509 FINAL EXAM 2024 NEWEST 2 VERSIONS WITH 150 QUESTIONS WITHDETAILED VERIFIED SOLUTIONS /A+ GRAND ASSURED
1. A 44-year-old female mathematician presents to clinic c. This patient was
with a complaint of a mass in the right breast. Her part- in compliance with
ner noticed this mass 2 days ago, and the patient feels the U.S. Preven-
guilty because she has only had one mammogram tive Services Task
and does not engage in breast self-examination (BSE) Force (USPSTF)
on any regular basis. She has no family history of recommendations
breast cancer, and her prior mammogram was ordered for her age group
as a routine screening test at age 43 years after a and risk factors
brief discussion with her primary care provider. After prior to her current
a thorough investigation reveals a benign cyst, what complaint.
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 examina-
tions 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 st
2. A 42-year-old female website developer presents for b. Sensitivity of
an annual preventive examination with questions screening for
about breast cancer screening. She is concerned breast cancer
about the radiation exposure associated with mam- increases with
mography and is interested in magnetic resonance breast MRI at the
imaging (MRI) as a possible alternative for routine expense of speci-
screening. She is otherwise healthy with no family his- ficity.
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-
,NR 509 FINAL EXAM 2024 NEWEST 2 VERSIONS WITH 150 QUESTIONS WITH
DETAILED VERIFIED SOLUTIONS /A+ GRAND ASSURED
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 e. Prolactinoma
a complaint of bilateral nipple discharge. This dis-
charge 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-stimu-
lating 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
4. A 22-year-old G0P0 undergraduate student presents b. This patient
to clinic after finding a breast mass on breast self-ex- is more likely to
amination (BSE) at home. The mass is nontender with- find a fibroadeno-
out skin changes, erythema, or overlying swelling. ma than a can-
She has heard that most breast cancers are found by cer on self-exami-
patients themselves, and she is very concerned that nation.
she may have breast cancer. Which of the following is
,NR 509 FINAL EXAM 2024 NEWEST 2 VERSIONS WITH 150 QUESTIONS WITH
DETAILED VERIFIED SOLUTIONS /A+ GRAND ASSURED
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.
5. A 48-year-old female psychologist presents to clinic d. This patient car-
with concerns about her breast cancer risk after an ries several risk
age-matched cousin was recently diagnosed with this factors that togeth-
disease. This cousin is the third family member on her er justify BRCA
father's side in as many years to be diagnosed with testing.
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 inde-
pendently 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 should be discounted in assessing her risk
for these genes.
b. Breast cancer in a male relative does not add sig-
nificant weight to the decision to test for the BRCA
, NR 509 FINAL EXAM 2024 NEWEST 2 VERSIONS WITH 150 QUESTIONS WITH
DETAILED VERIFIED SOLUTIONS /A+ GRAND ASSURED
genes in this patient.
c. The BRCAPRO calculator does not add any further
clinical information to this patient
6. A 68-year-old former paleontologist presents to clinic c. Regardless
with concerns about her breast cancer risk. Her moth- of recommenda-
er developed the disease in her 50s and died from it tions, the high
in her 60s. A younger cousin developed the disease sensitivity of
a few years ago before the age of 50 years, but this breast MRI comes
individual was not tested for the BRCA1 and at the expense
BRCA2 genes. In addition, the patient suffered from of markedlyde-
lymphoma in her 20s and had radiation to the chest. creased specificity
She did take hormone replacement therapy for a few (i.e., the ability to
years before data emerged that this may contribute rule out disease in
to breast cancer risk. She has had several abnor- healthy breasts).
mal 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 imag-
ing (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient
such as this one, who has moderately but not extra-
ordinary risk factors for breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF)
recommends against screening with MRI for patients
with such risk factors.
c. Regardless of recommendations, the high sensitiv-
ity of breast MRI comes at the expense of markedly-
decreased specificity (i.e., the a
7. A 66-year-old female museum curator presents for e. Metastatic
a routine annual examination. On examination, a no- breast cancer cells
tably enlarged supraclavicular lymph node is appreci- may spread di-
ated on the right side. The lymph node is nontender rectly into the in-
and feels firm and rubbery. She denies any localized fraclavicular and
or systemic symptoms such as breast lumps, fevers, then supraclavicu-
or night sweats. She has been taking conjugated es- lar nodes without
trogen tablets for 9 years since menopause, though first causing no-
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