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?

a. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity 

and specificity of mammograms.

b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after 

menopause.

c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the 

number of lobules.

d. Breast density has no genetic component and is entirely due to estrogen dose from endogenous 

and exogenous sources over the lifetime.

e. Mammography performs most poorly in the menopausal and postmenopa

c. 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?

a. Ruptured tubal (or ectopic) pregnancy

b. Acute cholecystitis

c. Ruptured appendix

d. P

a. Ruptured tubal (or ectopic) pregnancy

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

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>

MRI.

e. Known BRCA1 or BRCA2 mutation is insufficient cr

b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of 

specificity.