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2024 NR 509 ADVANCED HEALTH ASSESSMENT FINAL EXAM WEEK 8 WITH CORRECT ANSWERS
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2024 NR 509 ADVANCED HEALTH ASSESSMENT FINAL EXAM WEEK 8 WITH CORRECT ANSWERS
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2024 NR 509 ADVANCED HEALTHASSESSMENT FINAL EXAM WEEK 8
WITH CORRECT ANSWERS
CHAPTER 18: Breasts and Axillae
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? - CORRECT-
ANSWERSSensitivity of screening for breast cancer increases with breast MRI
at the expense of specificity.
Sensitivity of screening for breast cancer increases with breast MRI at the
expense of specificity. Increased sensitivity (in this case, higher-resolution
imaging to pick up subtler disease) is often traded for reduced specificity (in
the form of discovering many small items of no pathological significance).
This is a core concept in designing screening tests—very sensitive tests often
pick up false positives, while very specific tests often rule out disease
effectively by missing many actual cases. Balance must be sought between
these two when setting thresholds for positive and negative screens. Breast
cancer screening by MRI has been well studied in the general population is
incorrect. This screening modality has only been studied in high-risk
populations. This patient is an ideal candidate for screening via breast MRI
based on current evidence is incorrect. This patient meets no known criteria
for screening with breast MRI (known BRCA mutation, history of chest
radiation, etc.). Women at low lifetime risk of breast cancer (<20%) are
recommended to undergo screening MRI is incorrect. Only women at high
lifetime risk (>20%) are current recommended to utilize breast MRI as a
screening tool. Known BRCA1 or BRCA2 mutation is insufficient criteria to
justify screening with breast MRI is incorrect. The BRCA1 or BRCA2 mutation
confers a risk >20% of breast cancer over a lifetime, which is considered
sufficient criteria for screening with MRI rather than mammogram.
CHAPTER 18: Breasts and Axillae
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? - CORRECT-ANSWERSProlactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which
causes the production of breast milk and can suppress menstruation. Mastitis
is incorrect. Mastitis is a breast infection that is typically painful and
characterized by a focal area of redness and tenderness in one breast.
Ductal carcinoma in situ is incorrect. While nipple discharge should raise
suspicion for breast cancer, in this case the discharge is neither bloody nor
purulent, and it is notably bilateral. A prudent provider may still order a
mammogram and/or ultrasound, but the answer is unlikely to be breast
cancer. Paget disease of the breast is incorrect. This condition may present
with nipple discharge, but it is usually bloody. Occult pregnancy is incorrect.
This patient has a negative HCG test, which is the standard hormonal
laboratory examination used to determine pregnancy in both urine and
serum tests.
CHAPTER 18: Breasts and Axillae
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? - CORRECT-ANSWERSa.
Most masses that women find at home and bring to a provider's attention
turn out to be malignant.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on
self-examination. In this patient's age range (15-25 years), palpable masses
are most likely to be benign fibroadenomas. Most masses that women find at
home and bring to a provider's attention turn out to be malignant is
incorrect. About 11% of complaints of breast masses turn out to be
malignant, leaving the vast majority (89%) noncancerous. The most likely
breast mass this patient is likely to find in herself is an abscess complicating
underlying mastitis is incorrect. This patient has neither the symptoms of
mastitis (localized swelling/erythema/tenderness with generalized fever) nor
the risk factors for this condition (pregnancy and/or breastfeeding), making
mastitis a very unlikely diagnosis. Because of this patient's age, breast
masses should not be pursued with imaging and diagnosis because the risk
of cancer is so low is incorrect. Though the risk of cancer in this patient is
,low, the consequence of missing a cancer diagnosis is quite high; for that
reason, definitive diagnosis should be pursued for almost all breast masses.
Because of this patient's age, breast masses should not be pursued with
imaging and diagnosis because the risk of cancer is so low is incorrect. BSE
suffers from notoriously low sensitivity and specificity, making it a very
controversial recommendation as it tends to overestimate disease in healthy
breasts and miss cancer in breasts with subtle disease.
CHAPTER 18: Breasts and Axillae
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? - CORRECT-ANSWERSThis patient
carries several risk factors that together justify BRCA testing.
Rationale: This patient has both a first-degree male relative with breast
cancer and several relatives in the same lineage with breast cancer. Both of
these suggest risk for the BRCA genes, but the BRCAPRO calculator can
further refine the numerical risk and help decide if screening might be
helpful. Her familial lineage is irrelevant to her risk of BRCA genes, and
should be discounted in assessing her risk for these genes is incorrect.
Ashkenazi-Jewish heritage is a risk factor for carrying the BRCA genes, and
for obvious reasons, historical events in the last century obscured the family
history of many Jewish families from Europe. Though this patient does not
overtly describe Jewish heritage, her family's story certainly raises concern
that she may carry some genetic lineage that is at risk for this mutation.
Breast cancer in a male relative does not significant weight to the decision to
test for the BRCA genes in this patient is incorrect. Breast cancer is quite
rare in men, and any case of it should raise concerns for the presence of the
BRCA genes. The BRCAPRO calculator does not add any further clinical
information to this patient's risk for carrying the BRCA gene is incorrect. The
BRCAPRO calculator offers a numerical estimation of the patient's risk of
carrying a BRCA gene based on risk factors. It does not, however, analyze
risk of developing breast cancer based on those risks. Even if this patient is
BRCA positive, no changes in screening or treatment are recommended for
patients with this genetic mutation, so the test is not recommended is
incorrect. BRCA positive individuals may undergo prophylactic mastectomy,
, oophorectomy, and increased screening with magnetic resonance imaging
instead of mammography to find early cases of brea
CHAPTER 18: Breasts and Axillae
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? -
CORRECT-ANSWERSRegardless 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).
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 health breasts). Sensitivity and specificity of screening test are
almost always trade-offs; that is, a test that picks up more true cases is also
very likely to then pick up more false positives, and vice versa. With breast
MRI, the pick-up rate of true disease is almost double that of mammograms,
but at the expense of double the false positives. No agency recommends
breast MRI for a patient such as this one, who has moderately but not
extraordinary risk factors for breast cancer is incorrect. This patient presents
with an extraordinary risk profile, including strong family history of breast
cancer (suggestive of BRCA linkage to disease but without clear diagnosis),
history of chest radiation, and dense breasts requiring prior biopsies to rule
out malignancy. She meets the American Cancer Society (ACS) criteria for
annual breast MRI, though the USPSTF does not agree that the evidence
exists to support this recommendation. The USPSTF recommends against
screening with MRI for patients with such risk factors is incorrect. The
USPSTF, recognizing the limited data available on this screening test, states
that there is insufficient evidence to state one way or another whether this
test is appropriate for high-risk patients. Mammograms are not affected by
breast density and thus density is not a factor in choosing MRIs over
mammograms in patients such as this individual is incorrect. Breast density
is both a risk factor for breast cancer and a factor that hampers effective
screening wit
CHAPTER 18: Breasts and Axillae
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