AIIMS Bhopal NO - 2018 (Shift-1st)
Obstetrics & Gynaecology
Hard
Which of the following is not responsible for Bloody/Sanguineous discharge from the nipples?
Appeared in: AIIMS Bhopal NO - 2018 (Shift-1st)
Explanation
- Oral contraceptives contain hormones (estrogen and progestin) that can affect breast tissue.
- While they can cause nipple discharge, it is typically physiologic (non-pathologic) and presents as a milky (galactorrhea), clear, or sometimes greenish fluid.
- Bloody or sanguineous discharge is not a characteristic side effect of oral contraceptive use and suggests a different, underlying pathology.
Why Other Options Were Wrong
- Option B: Intra-ductal papilloma is a benign, wart-like tumor that grows inside a milk duct and is the most common cause of pathologic, bloody nipple discharge, especially when it's from a single duct.
- Option C: Duct ectasia occurs when a milk duct widens and its walls thicken, which can cause it to become blocked and lead to fluid buildup. This can result in a sticky, thick discharge that may be greenish, brown, or blood-tinged (serosanguineous).
- Option D: Intra-ductal cancer, such as Ductal Carcinoma in Situ (DCIS) or invasive ductal carcinoma, can cause bloody nipple discharge. It is a critical diagnosis to exclude when a patient presents with this symptom.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Nipple Discharge as background academic context rather than a clinical decision trigger.
- Any instance of spontaneous, unilateral, or bloody nipple discharge is a red flag that requires prompt nursing assessment and referral for medical evaluation.
- Nurses play a key role in patient education, teaching them how to perform breast self-examinations and to report any changes, including nipple discharge, to their healthcare provider immediately.
- What if? If a patient on oral contraceptives reports new-onset bloody nipple discharge, the nurse's priority is not to simply attribute it to the medication. The correct action is to facilitate a diagnostic workup (e.g., mammogram, ultrasound) because the discharge is likely due to an unrelated, potentially serious condition.
How to Approach the Question
- First, identify the core of the question: it asks for the option that does NOT cause a specific symptom (bloody nipple discharge). This is a negative-framing question.
- Next, analyze the symptom: 'Bloody/Sanguineous discharge' is a sign of pathology, not a normal physiological response.
- Review each option, recalling or looking up its association with nipple discharge.
- Evaluate Option A: Oral contraceptives are hormonal medications. Hormonal changes can cause milky discharge (galactorrhea), but bloody discharge is not a typical effect.
- Evaluate Options B, C, and D: Intra-ductal papilloma, duct ectasia, and intra-ductal cancer are all known pathological conditions of the breast ducts that can cause bleeding.
- Conclude that the option that does not fit the pattern of causing bloody discharge is Oral Contraceptives.
Concept Tested & Keywords
- Concept Tested: Etiology of Nipple Discharge
- Stem keywords: Bloody discharge, Sanguineous discharge, nipples
- Lead-in keywords: not responsible
- Negative lead-in flag: The question asks to identify the option that is NOT a cause of bloody nipple discharge.
Question ID
QM_Vk4FdcRVwpuqwYF5gEX
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1134-1136
E6 Gynecology Williams p. 303-370
Practise the full AIIMS Bhopal NO - 2018 (Shift-1st)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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