NR509 FINAL BATES QUESTIONS AND ANSWERS
44 year old female mathematician c/o mass to right breast. no family history of breast
cancer. benign cyst shown. what advice should be given about screening? - Answers -
this patient was in compliance with the U.S. Preventative Services Task Force
(USPSTF) recommendations for her age group and risk factors prior to her current
complaint.
42 year old female website developer. has questions about breast cancer screening.
concerned about radiation exposure. which of the following is true about MRI as a
screening modality for breast cancer in the general population? - Answers - sensitivity
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? - Answers - 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? -
Answers - This patient is more likely to find a fibroadenoma than a cancer on self-
examination
48 year old psychologist concerns about breast cancer risk after an age-marched
cousin recently diagnosed. patient read about testing for 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? -
Answers - 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. Which of the following is true regarding magnetic
resonance imaging (MRI) screening of this patient? - Answers - Regardless of
recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e. the ability to rule out disease in healthy breasts).
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. non tender and feels firm and rubbery. denies any localized or systemic
symptoms. has been taking estrogen for 9 years since menopause. Which of the
following is true about this presentation of lymphadenopathy? - Answers - Metastatic
breast cancer cells may spread directly into the infraclavicular and then supraclavicular
nodes without first causing notable changes in the axillary nodes.
24 year old graphic designer presents to the clinic with a concern for a breast mass.
rubbery, mobile, nontender mass is palpated in the right breast, which is consistent with
a fibroadenoma. examiner notes a 3cm mass proximal to and 3cm left of the nipple.
Which of the following would be the most appropriate way to report this finding? -
Answers - "Rubbery, mobile, nontender mass located in the right breast, in the 10:30
position from the nipple"
54 year old female dietician presents for a routine examination. reports 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? - Answers - Glandular tissue of 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 β-human 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? - Answers - 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
44 year old female mathematician c/o mass to right breast. no family history of breast
cancer. benign cyst shown. what advice should be given about screening? - Answers -
this patient was in compliance with the U.S. Preventative Services Task Force
(USPSTF) recommendations for her age group and risk factors prior to her current
complaint.
42 year old female website developer. has questions about breast cancer screening.
concerned about radiation exposure. which of the following is true about MRI as a
screening modality for breast cancer in the general population? - Answers - sensitivity
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? - Answers - 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? -
Answers - This patient is more likely to find a fibroadenoma than a cancer on self-
examination
48 year old psychologist concerns about breast cancer risk after an age-marched
cousin recently diagnosed. patient read about testing for 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? -
Answers - 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. Which of the following is true regarding magnetic
resonance imaging (MRI) screening of this patient? - Answers - Regardless of
recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e. the ability to rule out disease in healthy breasts).
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. non tender and feels firm and rubbery. denies any localized or systemic
symptoms. has been taking estrogen for 9 years since menopause. Which of the
following is true about this presentation of lymphadenopathy? - Answers - Metastatic
breast cancer cells may spread directly into the infraclavicular and then supraclavicular
nodes without first causing notable changes in the axillary nodes.
24 year old graphic designer presents to the clinic with a concern for a breast mass.
rubbery, mobile, nontender mass is palpated in the right breast, which is consistent with
a fibroadenoma. examiner notes a 3cm mass proximal to and 3cm left of the nipple.
Which of the following would be the most appropriate way to report this finding? -
Answers - "Rubbery, mobile, nontender mass located in the right breast, in the 10:30
position from the nipple"
54 year old female dietician presents for a routine examination. reports 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? - Answers - Glandular tissue of 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 β-human 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? - Answers - 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
