**Question:** A 25 year old lady presents with spontaneous nipple discharge of 3-months duration. On examination the discharge is bloody and from a single duct. The following statements about management of this patient are true except -

A. The patient should be counseled on the importance of follow-up.
B. The patient should be treated with antibiotics for bacterial infection.
C. The patient should be treated with surgery as the discharge is bloody.
D. The patient should be treated with hormonal therapy for lactation suppression.

**Correct Answer:** B. The patient should be treated with antibiotics for bacterial infection.

**Core Concept:**
The case describes a patient with a bloody spontaneous nipple discharge, which is suggestive of an underlying breast pathology. The management of such patients involves a thorough evaluation to identify the cause and appropriate treatment.

**Why the Correct Answer is Right:**
Spontaneous bloody nipple discharge is a symptom that can be caused by various conditions, including lactational abnormalities, benign breast diseases, and malignant breast diseases. In this case, treating the patient with antibiotics for bacterial infection is incorrect because the discharge is bloody, ruling out a minor infection as the primary cause. The bloody discharge indicates a more severe pathology, which necessitates further investigations and targeted therapy.

**Why Each Wrong Option is Incorrect:**

A. Counseling on follow-up is essential in monitoring the patient's condition and ensuring timely intervention. This statement is relevant and should be considered for the management plan.

B. Antibiotics are likely to be inappropriate in this case as the discharge is bloody, suggesting a more severe pathology. Appropriate treatment for a bloody discharge should focus on the underlying cause rather than treating symptoms.

C. Surgery is not the first-line management for a bloody nipple discharge, considering the severity of the symptom. A thorough evaluation is essential to identify the cause and appropriate intervention.

D. Hormonal therapy for lactation suppression is incorrect as the patient's age and the bloody discharge indicate a more severe pathology. Hormonal therapy would not address the underlying cause of the bloody discharge.

**Clinical Pearl:**
In cases of bloody spontaneous nipple discharge, the initial evaluation should focus on ruling out breast malignancy as the primary cause. A thorough examination and investigations are essential to identify the underlying cause and initiate appropriate treatment. Antibiotic therapy should be reserved for minor infections and is not a primary treatment for bloody discharge.