NMS Q&A Family Medicine

138 NMS Q&A Family Medicineof the breast examination is essentially normal, butthere is a background of granularity to palpation(like small irregularities in the breast tissue). Whichof the following is the best next disposition?(A) Suggest a mammogram(B) Refer for breast biopsy(C) Draw prolactin levels(D) Draw serum calcium and alkaline phosphataselevels(E) Perform aspiration9 A 28-year-old woman presents with a single breastnodule that is nontender. There is a second-degreefamily history of breast cancer in which her aunt(mother’s sister) had breast cancer at the age of 48.Which of the following is the best diagnostic test atthis time?(A) Mammogram(B) Excisional biopsy(C) Fine-needle biopsy(D) Serum prolactin level test(E) Ultrasonic study10 Which of the following diagnostic procedures is thebest choice for the least expensive method to differentiatein situ and invasive carcinoma of the breastand to ascertain the status of estrogen receptor presencein the tumor?(A) Fine-needle aspiration (FNA) biopsy(B) Core-needle biopsy (CNB)(C) Excisional biopsy(D) Lumpectomy(E) Mammogram11 A 35-year-old woman comes to an office setting for aroutine breast examination (clinical breast examination,or CBE) by the family doctor. Which of the followingfindings on this CBE least suggests the possibilityof breast cancer in a palpable nodule?(A) Lack of liquid retrieval on aspiration(B) Location in the superolateral quadrant(C) Fixation to underlying tissues(D) Hardness measured at 60 durometers(E) Irregular shape12 Of the following age groups, in which does the largestproportion of breast cancers occur?(A) Menarche to 25 years(B) 20 to 40 years(C) 50 years of age(D) 50 to 65 years(E) 65 years13 A 26-year-woman presents to you with a complaintof a breast lump. Upon examination, the nodule isfound to be apparently 1 cm in diameter and tender.It is more tender this week than it was last week and ithas been cyclically painful during the premenstrualweek the past three months during which she notedthe nodule. What is the best course of action at thistime?(A) Suggest mammography this week(B) Refer for breast biopsy(C) Observe for 3 months, examining the patientmonthly during that time(D) Perform needle aspiration(E) Reassure the patient that she is not in the agegroup to fear cancer of the breast14 A 28-year-old complains of a breast lump sincetrauma to the area about 2 weeks ago. What is thebest action at the present time?(A) Suggest mammography this week(B) Refer for breast biopsy(C) Observe for 3 months, examining the patientmonthly during that time(D) Perform needle aspiration(E) Reassure the patient that she is not in the agegroup to fear cancer of the breast15 Each of the following may be complications of breastimplantations except which one?(A) Capsule contraction and scarring around theimplant(B) Firmness and distortion of the breast(C) Rupture of the implant(D) “Bleeding” of silicone gel through the implantcapsule(E) Precipitation of autoimmune diseases in therecipient16 In performing a CBE, which of the following is mostappropriate in advising your patient regarding thisexamination?(A) The sensitivity of the CBE is 90% in the handsof a professional.(B) Specificity of the CBE is virtually 100%.(C) If a patient avails herself of the CBE, then sheneed not perform breast self-examination.(D) When performed optimally, the CBE is about70% sensitive.(E) The patient should make a decision to undergoeither CBE or mammography starting at age40 years.