NR509 / NR 509 Final Exam (Latest
): Advanced Physical
Assessment - Chamberlain
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 F -
ANSWER 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.
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 c - ANSWER
b. 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?
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma - ANSWER e. 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?
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 -
ANSWER b. 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?
a. Her familial lineage is irrelevant to her risk of BRCA genes and - ANSWER
d. 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?
, a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not extraordinary risk factors for b - ANSWER c.
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).
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?
a. Breast cancer always presents with axillary lymphadenopathy because the
lymphatics of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle
in the neck.
d. Firm, - ANSWER e. 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?
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position
from the nipple"
): Advanced Physical
Assessment - Chamberlain
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 F -
ANSWER 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.
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 c - ANSWER
b. 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?
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma - ANSWER e. 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?
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 -
ANSWER b. 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?
a. Her familial lineage is irrelevant to her risk of BRCA genes and - ANSWER
d. 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?
, a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not extraordinary risk factors for b - ANSWER c.
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).
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?
a. Breast cancer always presents with axillary lymphadenopathy because the
lymphatics of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle
in the neck.
d. Firm, - ANSWER e. 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?
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position
from the nipple"
