NR 509/ NR509 Final Exam Advanced
Physical Assessment (Latest 2026/ 2027)
Questions with Verified Answers Along
Rationales - Chamberlain
Q1. A 44-year-old female mathematician presents with a mass in the right breast
noted by her partner 2 days ago. She has had only one mammogram in her life,
does not perform regular breast self-examination, has no family history of breast
cancer, and her prior mammogram was a routine screening test at age 43. What
recommendation should be given about screening for breast cancer in her age
group?
Answer:-The USPSTF recommends biennial screening mammography for
women aged 40 to 74 years. This patient is now 44 and her last mammogram
was at age 43; she should resume routine biennial screening regardless of her
lack of BSE practice.
Rationale:-The U.S. Preventive Services Task Force (USPSTF) 2024
recommendations state that all women aged 40 to 74 years should undergo
screening mammography every two years. Prior compliance with screening does
not negate the need for continued routine screening. Lack of BSE practice does not
alter screening recommendations.
Q2. A 42-year-old female website developer presents for an annual examination
with questions about breast cancer screening. She has been told that radiation
exposure is associated with mammography and asks about MRI as a possible
alternative screening method. She is otherwise healthy with no family history of
breast cancer. What is true about MRI as a screening tool for breast cancer in the
general population?
Answer:-MRI is not recommended for breast cancer screening in women of
average risk due to lack of evidence demonstrating benefit, high false-positive
rates, and high cost.
,Rationale:-Breast MRI is reserved for high-risk populations (e.g., BRCA mutation
carriers, lifetime risk >20%). In average-risk women, MRI has lower specificity,
leading to unnecessary biopsies, and no mortality benefit has been demonstrated.
Mammography remains the standard of care for average-risk screening.
Q3. A 35-year-old G0P0 woman presents with a complaint of nipple discharge that
started several weeks ago and has been intermittent. She denies other symptoms.
Examination reveals a small amount of discharge sent for laboratory analysis.
Laboratory results show no significant abnormalities in CBC, TSH, or hCG. What
is the most likely diagnosis?
Answer:-The most likely diagnosis is physiologic nipple discharge or benign
ductal ectasia.
Rationale:-In a premenopausal woman with intermittent, non-bloody, spontaneous
discharge from multiple ducts and no associated mass or skin changes, the most
common cause is physiologic discharge or benign ductal ectasia. Mastitis typically
presents with pain, erythema, and fever. DCIS and Paget disease usually present
with bloody discharge, palpable mass, or skin changes.
Q4. A 22-year-old G0P0 undergraduate student presents after finding a breast mass
on self-examination at home. The mass is tender without skin changes, erythema,
or swelling. She is concerned about breast cancer. What is true about breast self-
examination and self-detection of breast cancer in this patient?
Answer:-This patient is more likely to find a fibroadenoma than a cancer upon
examination.
Rationale:-In women under 30, the vast majority of palpable breast masses are
benign, with fibroadenoma being the most common. Breast cancer is extremely
rare in this age group without genetic predisposition. BSE is not universally
recommended due to low specificity and increased unnecessary biopsies.
Q5. A 52-year-old postmenopausal woman with dense breast tissue on her recent
mammogram asks about supplemental screening options. Her lifetime breast
cancer risk is calculated at 15%. What screening approach is most appropriate?
,Answer:-Routine biennial mammography is recommended; supplemental
ultrasound or MRI is not indicated for average-risk women with dense
breasts.
Rationale:-While dense breast tissue reduces mammography sensitivity, current
guidelines do not recommend routine supplemental screening for average-risk
women (lifetime risk <20%). Shared decision-making regarding supplemental
screening may be considered but is not standard of care. MRI is reserved for high-
risk patients.
Q6. A 38-year-old woman with a known BRCA1 mutation presents for breast
cancer screening. She has no current breast complaints. What screening regimen is
recommended?
Answer:-Annual screening mammography beginning at age 30 and annual
breast MRI with contrast, staggered every six months.
Rationale:-For BRCA mutation carriers, national guidelines recommend annual
mammography and annual breast MRI starting at age 25-30, with the two
examinations alternated every six months. This approach maximizes sensitivity for
early detection in this high-risk population.
Q7. A 45-year-old woman undergoes screening mammography and receives a BI-
RADS 0 assessment. What does this result indicate and what is the appropriate
next step?
Answer:-BI-RADS 0 indicates an incomplete assessment requiring additional
imaging evaluation, typically diagnostic mammography with or without
ultrasound.
Rationale:-BI-RADS 0 means the screening study is incomplete and needs
additional imaging views or comparison with prior studies for proper
interpretation. This is not a finding of abnormality requiring biopsy but rather a
request for more imaging. The next step is diagnostic mammography with possible
targeted ultrasound.
, Q8. A 60-year-old woman with a history of treated ductal carcinoma in situ 5 years
ago presents for routine follow-up. She reports no new breast symptoms. What
surveillance approach is recommended?
Answer:-Annual screening mammography is recommended; there is no
routine indication for MRI or advanced imaging in asymptomatic patients
with prior DCIS.
Rationale:-After treatment for DCIS, patients should continue annual
mammographic surveillance. MRI may be considered in select cases but is not
routinely indicated. Physical examination alone is insufficient for surveillance.
Q9. A 28-year-old pregnant woman at 14 weeks gestation presents with a palpable,
painless breast mass. She has no family history of breast cancer. She is concerned
about radiation from mammography. What is the most appropriate initial imaging
study?
Answer:-Breast ultrasound is the initial imaging study of choice for palpable
breast masses in pregnant women.
Rationale:-Ultrasound is safe during pregnancy, has no radiation exposure, and is
highly sensitive for distinguishing cystic from solid masses. Mammography with
abdominal shielding can be performed if ultrasound reveals concerning features,
but ultrasound is the appropriate first-line study.
Q10. A 55-year-old woman with average breast cancer risk asks about the optimal
screening interval. She has read conflicting information online. What does current
USPSTF guidance recommend regarding screening frequency?
Answer:-Biennial screening every two years is recommended for women aged
40 to 74 years with average risk.
Rationale:-The USPSTF concludes with moderate certainty that biennial
mammography has a moderate net benefit for women aged 40-74. Annual
screening has not been shown to provide additional mortality benefit compared to
biennial screening but does increase false-positive rates and unnecessary
procedures.
Physical Assessment (Latest 2026/ 2027)
Questions with Verified Answers Along
Rationales - Chamberlain
Q1. A 44-year-old female mathematician presents with a mass in the right breast
noted by her partner 2 days ago. She has had only one mammogram in her life,
does not perform regular breast self-examination, has no family history of breast
cancer, and her prior mammogram was a routine screening test at age 43. What
recommendation should be given about screening for breast cancer in her age
group?
Answer:-The USPSTF recommends biennial screening mammography for
women aged 40 to 74 years. This patient is now 44 and her last mammogram
was at age 43; she should resume routine biennial screening regardless of her
lack of BSE practice.
Rationale:-The U.S. Preventive Services Task Force (USPSTF) 2024
recommendations state that all women aged 40 to 74 years should undergo
screening mammography every two years. Prior compliance with screening does
not negate the need for continued routine screening. Lack of BSE practice does not
alter screening recommendations.
Q2. A 42-year-old female website developer presents for an annual examination
with questions about breast cancer screening. She has been told that radiation
exposure is associated with mammography and asks about MRI as a possible
alternative screening method. She is otherwise healthy with no family history of
breast cancer. What is true about MRI as a screening tool for breast cancer in the
general population?
Answer:-MRI is not recommended for breast cancer screening in women of
average risk due to lack of evidence demonstrating benefit, high false-positive
rates, and high cost.
,Rationale:-Breast MRI is reserved for high-risk populations (e.g., BRCA mutation
carriers, lifetime risk >20%). In average-risk women, MRI has lower specificity,
leading to unnecessary biopsies, and no mortality benefit has been demonstrated.
Mammography remains the standard of care for average-risk screening.
Q3. A 35-year-old G0P0 woman presents with a complaint of nipple discharge that
started several weeks ago and has been intermittent. She denies other symptoms.
Examination reveals a small amount of discharge sent for laboratory analysis.
Laboratory results show no significant abnormalities in CBC, TSH, or hCG. What
is the most likely diagnosis?
Answer:-The most likely diagnosis is physiologic nipple discharge or benign
ductal ectasia.
Rationale:-In a premenopausal woman with intermittent, non-bloody, spontaneous
discharge from multiple ducts and no associated mass or skin changes, the most
common cause is physiologic discharge or benign ductal ectasia. Mastitis typically
presents with pain, erythema, and fever. DCIS and Paget disease usually present
with bloody discharge, palpable mass, or skin changes.
Q4. A 22-year-old G0P0 undergraduate student presents after finding a breast mass
on self-examination at home. The mass is tender without skin changes, erythema,
or swelling. She is concerned about breast cancer. What is true about breast self-
examination and self-detection of breast cancer in this patient?
Answer:-This patient is more likely to find a fibroadenoma than a cancer upon
examination.
Rationale:-In women under 30, the vast majority of palpable breast masses are
benign, with fibroadenoma being the most common. Breast cancer is extremely
rare in this age group without genetic predisposition. BSE is not universally
recommended due to low specificity and increased unnecessary biopsies.
Q5. A 52-year-old postmenopausal woman with dense breast tissue on her recent
mammogram asks about supplemental screening options. Her lifetime breast
cancer risk is calculated at 15%. What screening approach is most appropriate?
,Answer:-Routine biennial mammography is recommended; supplemental
ultrasound or MRI is not indicated for average-risk women with dense
breasts.
Rationale:-While dense breast tissue reduces mammography sensitivity, current
guidelines do not recommend routine supplemental screening for average-risk
women (lifetime risk <20%). Shared decision-making regarding supplemental
screening may be considered but is not standard of care. MRI is reserved for high-
risk patients.
Q6. A 38-year-old woman with a known BRCA1 mutation presents for breast
cancer screening. She has no current breast complaints. What screening regimen is
recommended?
Answer:-Annual screening mammography beginning at age 30 and annual
breast MRI with contrast, staggered every six months.
Rationale:-For BRCA mutation carriers, national guidelines recommend annual
mammography and annual breast MRI starting at age 25-30, with the two
examinations alternated every six months. This approach maximizes sensitivity for
early detection in this high-risk population.
Q7. A 45-year-old woman undergoes screening mammography and receives a BI-
RADS 0 assessment. What does this result indicate and what is the appropriate
next step?
Answer:-BI-RADS 0 indicates an incomplete assessment requiring additional
imaging evaluation, typically diagnostic mammography with or without
ultrasound.
Rationale:-BI-RADS 0 means the screening study is incomplete and needs
additional imaging views or comparison with prior studies for proper
interpretation. This is not a finding of abnormality requiring biopsy but rather a
request for more imaging. The next step is diagnostic mammography with possible
targeted ultrasound.
, Q8. A 60-year-old woman with a history of treated ductal carcinoma in situ 5 years
ago presents for routine follow-up. She reports no new breast symptoms. What
surveillance approach is recommended?
Answer:-Annual screening mammography is recommended; there is no
routine indication for MRI or advanced imaging in asymptomatic patients
with prior DCIS.
Rationale:-After treatment for DCIS, patients should continue annual
mammographic surveillance. MRI may be considered in select cases but is not
routinely indicated. Physical examination alone is insufficient for surveillance.
Q9. A 28-year-old pregnant woman at 14 weeks gestation presents with a palpable,
painless breast mass. She has no family history of breast cancer. She is concerned
about radiation from mammography. What is the most appropriate initial imaging
study?
Answer:-Breast ultrasound is the initial imaging study of choice for palpable
breast masses in pregnant women.
Rationale:-Ultrasound is safe during pregnancy, has no radiation exposure, and is
highly sensitive for distinguishing cystic from solid masses. Mammography with
abdominal shielding can be performed if ultrasound reveals concerning features,
but ultrasound is the appropriate first-line study.
Q10. A 55-year-old woman with average breast cancer risk asks about the optimal
screening interval. She has read conflicting information online. What does current
USPSTF guidance recommend regarding screening frequency?
Answer:-Biennial screening every two years is recommended for women aged
40 to 74 years with average risk.
Rationale:-The USPSTF concludes with moderate certainty that biennial
mammography has a moderate net benefit for women aged 40-74. Annual
screening has not been shown to provide additional mortality benefit compared to
biennial screening but does increase false-positive rates and unnecessary
procedures.
