11-27-2006, 03:11 PM
A 34-year-old woman, gravida 3, para 3, comes to the physician for a postpartum visit. Four
weeks ago she had a normal spontaneous vaginal delivery of a healthy male infant, following
an uneventful prenatal course. Her postpartum course has also been uncomplicated. She is
breastfeeding successfully and had a postpartum tubal ligation for birth control. The infant is
doing well. The mother does, however, complain that there is an area on her left breast that is
red, swollen, and painful. She thinks she has had fevers and chills over the past 2 days but
has not taken her temperature. She has occasional migraine headaches and no other medical
problems. She takes no medications and is allergic to sulfa drugs. She has no family history of
breast cancer. On examination, her temperature is 37.9 C (100.2 F) and she has significant
tenderness in an area on her left breast. This area also exhibits erythema and edema. The
area is not fluctuant. The remainder of her physical examination is within normal limits. Which
of the following is the most appropriate next step in management?
A. Continue with expectant management
B. Prescribe dicloxacillin
C. Prescribe levofloxacin
D. Prescribe penicillin
E. Perform incision and drainage
weeks ago she had a normal spontaneous vaginal delivery of a healthy male infant, following
an uneventful prenatal course. Her postpartum course has also been uncomplicated. She is
breastfeeding successfully and had a postpartum tubal ligation for birth control. The infant is
doing well. The mother does, however, complain that there is an area on her left breast that is
red, swollen, and painful. She thinks she has had fevers and chills over the past 2 days but
has not taken her temperature. She has occasional migraine headaches and no other medical
problems. She takes no medications and is allergic to sulfa drugs. She has no family history of
breast cancer. On examination, her temperature is 37.9 C (100.2 F) and she has significant
tenderness in an area on her left breast. This area also exhibits erythema and edema. The
area is not fluctuant. The remainder of her physical examination is within normal limits. Which
of the following is the most appropriate next step in management?
A. Continue with expectant management
B. Prescribe dicloxacillin
C. Prescribe levofloxacin
D. Prescribe penicillin
E. Perform incision and drainage