Surgery MCQs Q22

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SURGERY • BREAST

A 27-year-old woman, 1 month postpartum, presents with a painful, hot, red swelling in her left breast. The lump is very tender and she feels unwell.

What is the most likely diagnosis?

A Benign mammary dysplasia

B Lactational breast abscess

C Cystic disease

D Mastitis neonatorum

E Non-lactational abscess

Lactational Breast Abscess. The combination of postpartum status, systemic illness (feeling unwell), and a localized inflammatory mass points specifically to an abscess within the context of lactation.

Decoding the Stem

1

CLUE "Postpartum + hot, red, tender breast lump + unwell"

TRANS Infection during lactation → Mastitis progressing to Abscess.

Explanation

B. Lactational breast abscess: Correct. These typically occur within the first few weeks of lactation. Milk stasis provides a medium for bacterial growth (usually S. aureus), leading to infection and abscess formation.

A. Benign mammary dysplasia: Incorrect. Now termed fibrocystic change, this presents with cyclical, hormonal pain and nodularity, not acute infection.

C. Cystic disease: Incorrect. Simple cysts are common but present as smooth, mobile lumps without signs of heat or systemic toxicity.

D. Mastitis neonatorum: Incorrect. This occurs in newborn infants due to residual maternal hormones and subsequent infection, not in the mother.

E. Non-lactational abscess: Incorrect. These occur in women who are not currently breastfeeding, often seen in association with periductal mastitis (smokers) or peripheral infections (diabetics).

🧠 High-Yield Pearls

Feature	Clinical Significance
Common Pathogen	Staphylococcus aureus
Primary Trigger	Milk stasis (Inadequate emptying)
Cardinal Sign	Fluctuation within a tender area
Lactation Advice	Continue feeding or expression (decreases stasis)

Integrated Clinical Questions

1. Most common organism in lactational breast abscess?

Answer: Staphylococcus aureus.

2. Initial stage before abscess formation?

Answer: Acute mastitis.

3. Key clinical sign of abscess?

Answer: Fluctuation.

4. Should breastfeeding be stopped in the affected breast?

Answer: No, continue feeding or expressing milk to prevent further milk stasis.

5. Definitive treatment of a confirmed fluctuant abscess?

Answer: Incision & drainage (or needle aspiration) + appropriate antibiotics.

⚡ Exam Pearls

• Mastitis vs. Abscess: Abscess is suspected when a localized area remains hard or becomes fluctuant despite antibiotics.
• Red + hot + tender = infection: Always correlate these inflammatory signs with the lactation history.
• Early treatment: Effective milk drainage and early antibiotics can prevent mastitis from progressing to an abscess.

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