NR509 /NR509 FINAL EXAM LATEST 2024/2025 COMPLETE
250+ QUESTIONS AND CORRECT DETAILED ASNWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+
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?
✓ 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?
✓ 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?
✓ 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?
✓ 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?
✓ "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from
the nipple"
A 54-year-old female dietician presents for a routine annual examination. On review of
systems, she reports that she 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?
✓ Glandular tissue of the 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 βhuman 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?
✓ 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 abdominal exam to
assess his liver. Which of the following findings would be most consistent with
hepatomegaly?
✓ Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history
presents with a several month history of recurrent epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation. She
reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital signs
are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; and
temperature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal aorta is
prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of the
following is her most significant risk factor for an AAA?
✓ History of smoking
, A 76-year-old retired man with a history of prostate cancer and hypertension has been
screened annually for colon cancer using high sensitivity fecal occult blood testing (FOBT).
He presents for followup of his hypertension, during which the clinician scans his chart to
ensure he is up to date with his preventive health care. He has a positive FOBT on one
occasion at age 66 years and subsequently went for a colonoscopy. Internal hemorrhoids
and sigmoid diverticuli were found on colonoscopy. He has no first-degree relatives with a
history of colorectal cancer or adenomatous polyps. What are the U.S. Preventive Services
Task Force (USPSTF) screening recommendations for this patient?
✓ Do not screen routinely
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-
year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks each
episode and is associated with onset of constipation. She describes infrequent, small hard
stool that she finds very difficult to pass. She has tried to increase dietary fiber and water
intake, but usually this is not sufficient and she resorts to over-the-counter laxatives,
which she finds upset her stomach but do resolve the constipation. Symptoms typically
gradually resolve with bowel movements. Which of the following is the most likely
physiological mechanism for her constipation?
✓ Functional change in bowel movement
A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis
and bronchiectasis that is associated with a rare congenital condition called Kartagener
syndrome. The preceptor notes that she has situs inversus and asks for a physical exam.
Which of the following descriptions best fits with findings on the abdominal exam?
✓ to percussion in the right upper quadrant, dullness to percussion of the left upper
quadrant Tympany
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-
day history of severe abdominal pain. The emergency physician suspects appendicitis and
general surgery is consulted. The resident believes the patient has signs of peritonitis on
exam. Which of the following physical exam findings supports peritonitis?
