NR509 / NR 509 Final Exam
Advanced Physical Assessment
Questions and Answers (Verified Answers)
1.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
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
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.
2.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 criteria to justify
screening with breast MRI.
ANS b. Sensitivity of screening for breast cancer increases with breast
MRI at the expense of specificity.
3.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 tender- ness, redness, fever, or any other systemic symptoms aside
from slightly irreg- ular 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
4.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 non-
tender 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-
ex- amination.
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.
ANS b. This patient is more likely to find a fibroadenoma than a cancer
on self-examination.
Advanced Physical Assessment
Questions and Answers (Verified Answers)
1.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
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
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.
2.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 criteria to justify
screening with breast MRI.
ANS b. Sensitivity of screening for breast cancer increases with breast
MRI at the expense of specificity.
3.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 tender- ness, redness, fever, or any other systemic symptoms aside
from slightly irreg- ular 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
4.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 non-
tender 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-
ex- amination.
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.
ANS b. This patient is more likely to find a fibroadenoma than a cancer
on self-examination.
