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General Surgery · Breast and endocrine surgery: cyclical mastalgia
Sample itemA 32-year-old woman has bilateral breast pain and lumpiness that worsen before menstruation. Examination, ultrasound and mammography are normal. What is the most appropriate first-line management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Reassurance, a well-fitting bra and simple analgesia
Cyclical mastalgia with normal triple assessment is benign, hormone-related and usually self-limiting. Reassurance, a supportive bra, simple analgesia or topical NSAIDs are first line. Hormonal agents such as tamoxifen or danazol are reserved for severe, refractory pain because of side effects.
Option by option
A. Long-term tamoxifen
Tamoxifen is used off-label only for severe refractory cases.
B. Bilateral subcutaneous mastectomy
Surgery is not indicated for benign cyclical pain.
C. Reassurance, a well-fitting bra and simple analgesia (correct)
Correct. Conservative measures are first-line once cancer is excluded.
D. Danazol
Danazol is effective but reserved for severe pain because of androgenic side effects.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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