NR 509 FINAL EXAM ACTUAL EXAM

NR 509 FINAL EXAM ACTUAL EXAM

CORRECT ANSWERS | GRADED A+ |

VERIFIED ANSWERS | LATEST

VERSION | BRAND NEW VERSION!

AJ44-year- oldJfemaleJmathematicianJpresentsJtoJclinicJwithJaJcomplaintJofJaJmassJinJtheJrightJbreast.JHerJpart nerJnoticedJthisJmassJ2JdaysJago,JandJtheJpatientJfeelsJguiltyJbecauseJsheJhasJonlyJhadJoneJmammo gramJandJdoesJnotJengageJinJbreastJself- examinationJ(BSE)JonJanyJregularJbasis.JSheJhasJnoJfamilyJhistoryJofJbreastJcancer,JandJherJpriorJma mmogramJwasJorderedJasJaJroutineJscreeningJtestJatJageJ43JyearsJafterJaJbriefJdiscussionJwithJherJp rimaryJcareJprovider.JAfterJaJthoroughJinvestigationJrevealsJaJbenignJcyst,JwhatJadviceJshouldJbeJgiv enJtoJthisJpatientJaboutJscreeningJforJbreastJcancerJinJherJageJgroup?a.JBSEJisJwellJevidenced,JandJallJrecommendingJagenciesJagreeJthatJitJshouldJbeJtaughtJandJreinforc ed.b.JClinicalJbreastJexaminationJ(CBE)JisJsuperiorJtoJBSEJandJshouldJbeJaJroutineJpartJofJannualJexamin ationsJstartingJatJageJ30Jyears.c.JThisJpatientJwasJinJcomplianceJwithJtheJU.S.JPreventiveJServicesJTaskJFoJ-JCORRECTJANSWER- C.JThisJpatientJwasJinJcomplianceJwithJtheJU.S.JPreventiveJServicesJTaskJForceJ(USPSTF)Jrecommen dationsJforJherJageJgroupJandJriskJfactorsJpriorJtoJherJcurrentJcomplaint.

TheJUSPSTFJrecommendsJthatJwomenJageJ<50JyearsJdiscussJrisksJandJbenefitsJwithJtheirJproviderJa ndJdecideJonJappropriateJscreeningJforJtheirJindividualJpreferencesJandJneeds AJ42-year- oldJfemaleJwebsiteJdeveloperJpresentsJforJanJannualJpreventiveJexaminationJwithJquestionsJaboutJ breastJcancerJscreening.JSheJisJconcernedJaboutJtheJradiationJexposureJassociatedJwithJmammogr aphyJandJisJinterestedJinJmagneticJresonanceJimagingJ(MRI)JasJaJpossibleJalternativeJforJroutineJscr eening.JSheJisJotherwiseJhealthyJwithJnoJfamilyJhistoryJofJbreast,Jovarian,JorJcolonJcancer.JWhichJofJ theJfollowingJisJtrueJaboutJMRIJasJaJscreeningJmodalityJforJbreastJcancerJinJtheJgeneralJpopulation?a.JBreastJcancerJscreeningJbyJMRIJhasJbeenJwellJstudiedJinJtheJgeneralJpopulation. 1 / 4

b.JSensitivityJofJscreeningJforJbreastJcancerJincreasesJwithJbreastJMRIJatJtheJexpenseJofJspecificity.c.JThisJpatientJisJanJidealJcandidateJforJscreeningJviaJbreastJMRIJbasedJonJcurrentJevidence.d.JWomenJatJlowJlifetimeJriskJofJbreastJcancerJ(<20%)JareJrecommendedJtoJundergoJscreeningJMRI.e.JKnownJBRCA1JorJBRCA2JmutationJisJinsufficientJcrJ-JCORRECTJANSWER- b.JSensitivityJofJscreeningJforJbreastJcancerJincreasesJwithJbreastJMRIJatJtheJexpenseJofJspecificity.

Rationale:JSensitivityJofJscreeningJforJbreastJcancerJincreasesJwithJbreastJMRIJatJtheJexpenseJofJspe cificity.JIncreasedJsensitivityJ(inJthisJcase,Jhigher- resolutionJimagingJtoJpickJupJsubtlerJdisease)JisJoftenJtradedJforJreducedJspecificityJ(inJtheJformJofJ discoveringJmanyJsmallJitemsJofJnoJpathologicalJsignificance).AJ35-year- oldJG0P0JwomanJpresentsJtoJclinicJwithJaJcomplaintJofJbilateralJnippleJdischarge.JThisJdischargeJsta rtedJseveralJweeksJagoJandJhasJoccurredJatJirregularJintervalsJsinceJthatJtime.JSheJdoesJnotJcomplai nJofJlocalJtenderness,Jredness,Jfever,JorJanyJotherJsystemicJsymptomsJasideJfromJslightlyJirregularJp eriodsJoverJtheJlastJfewJmonths.JOnJexamination,JsheJisJableJtoJexpressJaJsmallJamountJofJdischarge ,JwhichJisJsentJtoJtheJlaboratoryJandJfoundJtoJbeJconsistentJwithJbreastJmilkJbutJwithoutJanyJsignsJofJ bloodJorJpus.JScreeningJlaboratoriesJareJalsoJsent,JwhichJrevealJaJnormalJbloodJcount,JmetabolicJpa nel,Jthyroid- stimulatingJhormone,JandJhumanJchorionicJgonadotropinJ(HCG)Jlevel.JFurtherJlaboratoriesJareJstillJ pending.JWhichJofJtheJfollowingJisJtheJmostJlikelyJdiagnosis?a.JMastitis b.JDuctalJcarcinomaJinJsitu c.JPagetJdiseaseJofJtheJbreast d.JOccultJpregnancy e.JProlactinomaJ-JCORRECTJANSWER-e.JProlactinoma

Rationale:JProlactinomasJareJpituitaryJtumorsJthatJsecreteJprolactin,JwhichJcausesJtheJproductionJ ofJbreastJmilkJandJcanJsuppressJmenstruation.AJ22-year- oldJG0P0JundergraduateJstudentJpresentsJtoJclinicJafterJfindingJaJbreastJmassJonJbreastJself- examinationJ(BSE)JatJhome.JTheJmassJisJnontenderJwithoutJskinJchanges,Jerythema,JorJoverlyingJs 2 / 4

welling.JSheJhasJheardJthatJmostJbreastJcancersJareJfoundJbyJpatientsJthemselves,JandJsheJisJveryJc oncernedJthatJsheJmayJhaveJbreastJcancer.JWhichJofJtheJfollowingJisJtrueJaboutJBSEJandJself- detectionJofJbreastJcancer?a.JMostJmassesJthatJwomenJfindJatJhomeJandJbringJtoJaJprovider'sJattentionJturnJoutJtoJbeJmaligna nt.b.JThisJpatientJisJmoreJlikelyJtoJfindJaJfibroadenomaJthanJaJcancerJonJself-examination.c.JTheJmostJlikelyJbreastJmassJthisJpatientJisJlikelyJtoJfindJinJherselfJisJanJabscessJcomplicatingJunderl yingJmastitis.d.JBecauseJofJthisJpatient'sJage,JbreastJmassesJshouldJnotJbeJpursuedJwithJimagingJandJdiagnosisJb ecauseJtheJriskJofJcancerJisJsoJlow.e.JBSEJisJuniversallyJrecommendedJbecauseJofJveryJhighJsensitivityJ-JCORRECTJANSWER- b.JThisJpatientJisJmoreJlikelyJtoJfindJaJfibroadenomaJthanJaJcancerJonJself-examination.

Rationale:JThisJpatientJisJmoreJlikelyJtoJfindJaJfibroadenomaJthanJaJcancerJonJself- examination.JInJthisJpatient'sJageJrangeJ(15- 25Jyears),JpalpableJmassesJareJmostJlikelyJtoJbeJbenignJfibroadenomas.AJ48-year- oldJfemaleJpsychologistJpresentsJtoJclinicJwithJconcernsJaboutJherJbreastJcancerJriskJafterJanJage- matchedJcousinJwasJrecentlyJdiagnosedJwithJthisJdisease.JThisJcousinJisJtheJthirdJfamilyJmemberJon JherJfather'sJsideJinJasJmanyJyearsJtoJbeJdiagnosedJwithJbreastJcancer,JincludingJtheJpatient'sJownJfa ther,JwhoJhadJsurgeryJandJsubsequentJtreatmentJ3JyearsJagoJforJbreastJcancer.JTheJpatientJhasJlittle JotherJknowledgeJofJherJfamilyJhistory,JonlyJthatJherJgrandparentsJindependentlyJarrivedJfromJEast ernJEuropeJnearJtheJendJofJWorldJWarJIIJandJwereJamongJveryJfewJmembersJofJtheirJfamilyJthatJsur vivedJtheJwar.JTheJpatientJhasJreadJaboutJtestingJforJtheJbreastJcancerJgenesJ(BRCA1JandJBRCA2)Jan dJdesiresJfurtherJinformationJaboutJwhetherJthisJwouldJbeJappropriateJforJher.JWhichJofJtheJfollowi ngJisJtrueJaboutJthisJpatient'sJindicationsJforJBRCAJtesting?a.JHerJfamilialJlineageJisJirrelevantJtoJherJriskJofJBRCAJgenesJandJ-JCORRECTJANSWER- d.JThisJpatientJcarriesJseveralJriskJfactorsJthatJtogetherJjustifyJBRCAJtesting.

Rationale:JThisJpatientJhasJbothJaJfirst-

degreeJmaleJrelativeJwithJbreastJcancerJandJseveralJrelativesJinJtheJsameJlineageJwithJbreastJcancer .JBothJofJtheseJsuggestJriskJforJtheJBRCAJgenes,JbutJtheJBRCAPROJcalculatorJcanJfurtherJrefineJtheJn umericalJriskJandJhelpJdecideJifJscreeningJmightJbeJhelpful. 3 / 4

AJ68-year- oldJformerJpaleontologistJpresentsJtoJclinicJwithJconcernsJaboutJherJbreastJcancerJrisk.JHerJmotherJ developedJtheJdiseaseJinJherJ50sJandJdiedJfromJitJinJherJ60s.JAJyoungerJcousinJdevelopedJtheJdiseas eJaJfewJyearsJagoJbeforeJtheJageJofJ50Jyears,JbutJthisJindividualJwasJnotJtestedJforJtheJBRCA1JandJBR CA2Jgenes.JInJaddition,JtheJpatientJsufferedJfromJlymphomaJinJherJ20sJandJhadJradiationJtoJtheJche st.JSheJdidJtakeJhormoneJreplacementJtherapyJforJaJfewJyearsJbeforeJdataJemergedJthatJthisJmayJco ntributeJtoJbreastJcancerJrisk.JSheJhasJhadJseveralJabnormalJmammograms JinJherJ50sJforJpersistent lyJdenseJbreastsJwithJsubtleJfindings,JbutJfollow- upJbiopsiesJneverJshowedJanyJmalignantJpathology.JWhichJofJtheJfollowingJisJtrueJregardingJmagne ticJresonanceJimagingJ(MRI)JscreeningJofJthisJpatient?a.JNoJagencyJrecommendsJbreastJMRIJforJaJpatientJsuchJasJthisJone,JwhoJhasJmoderatelyJbutJnotJex traordinaryJriskJfactorsJforJbrJ-JCORRECTJANSWER- c.JRegardlessJofJrecommendations,JtheJhighJsensitivityJofJbreastJMRIJcomesJatJtheJexpenseJofJmark edlyJdecreasedJspecificityJ(i.e.,JtheJabilityJtoJruleJoutJdiseaseJinJhealthyJbreasts).

Rationale:JRegardlessJofJrecommendations,JtheJhighJsensitivityJofJbreastJMRIJcomesJatJtheJexpense JofJmarkedlyJdecreasedJspecificityJ(i.e.,JtheJabilityJtoJruleJoutJdiseaseJinJhealthJbreasts).JSensitivityJa ndJspecificityJofJscreeningJtestJareJalmostJalwaysJtrade- offs;JthatJis,JaJtestJthatJpicksJupJmoreJtrueJcasesJisJalsoJveryJlikelyJtoJthenJpickJupJmoreJfalseJpositives ,JandJviceJversa.AJ66-year- oldJfemaleJmuseumJcuratorJpresentsJforJaJroutineJannualJexamination.JOnJexamination,JaJnotablyJ enlargedJsupraclavicularJlymphJnodeJisJappreciatedJonJtheJrightJside.JTheJlymphJnodeJisJnontenderJ andJfeelsJfirmJandJrubbery.JSheJdeniesJanyJlocalizedJorJsystemicJsymptomsJsuchJasJbreastJlumps,Jfe vers,JorJnightJsweats.JSheJhasJbeenJtakingJconjugatedJestrogenJtabletsJforJ9JyearsJsinceJmenopause ,JthoughJsheJhasJnotJtakenJprogestinJcompoundsJsinceJsheJhadJaJhysterectomyJforJheavyJbleedingJa tJageJ45Jyears.JWhichJofJtheJfollowingJisJtrueJaboutJthisJpresentationJofJlymphadenopathy?a.JBreastJcancerJalwaysJpresentsJwithJaxillaryJlymphadenopathyJbecauseJtheJlymphaticsJofJtheJbre astJuniformlyJdrainJintoJtheJaxilla.b.JSupraclavicularJnodesJareJgenerallyJconsideredJbenignJandJrequireJnoJfurtherJevaluationJorJfollo w-up.c.JSupraclavicularJnodesJareJfoundJalongJtheJanteriorJedgeJofJtheJtrapeziusJmuscleJinJtheJneck.

• / 4