BREAST · MEMBERSHIP SURGERY

Breast lump + bloody nipple discharge — 44F

12 decision points ~22 min Difficulty 3/5 Membership

Setting

You are the breast fellow at Korle Bu. Your clinic has a one-stop assessment room with USS and stereotactic core biopsy capacity; mammography and MRI are booked from imaging.

Patient

Mrs O, a 44-year-old teacher, presents with a two-month history of spontaneous unilateral (right) bloody nipple discharge from a single duct. She has felt a lump behind the areola for one month. No trauma, no lactation. Menarche 12, first child at 26, three children, breast-fed each. No exogenous hormones. Maternal aunt had breast cancer at 58.

Reference stack

Bailey & Love 28e Ch 55 · Sabiston 21e Ch 35 · NICE NG101 · UK Association of Breast Surgery guidelines · ASCO/CAP 2020

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.