NBME 1 question

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NBME 1 question

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sheena2005
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11/12/06 - 05:23 PM

A 3-year-old girl is brought to the physician after her mother noted blood on her underpants. Examination shows genital condylomata acuminata in the perineal, peri-introital, labial, and anal areas. Some of the pedunculated condylomata appear to have caused the bleeding. She has no visible intravaginal condylomata or vaginal or anal tears. Her mother has a palmar wart on her hand but no history of condylomata acuminata. Her mother has a boyfriend who does not live with them and who has never been left alone with the girl. They live with the mother's 27-year-old brother who only baby-sits the children when they are asleep. Which of the following is the most appropriate next step in management?

A
) Psychiatric assessment of the mother

B
) DNA typing of the mother's palmar wart for papillomavirus

C
) Treatment of the mother's palmar wart

D
) Vaginal, anal, and throat cultures for Chlamydia trachomatis and Neisseria gonorrhoeae in the child

E
) Laser therapy of the condylomata acuminata in the child

yasmeen
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11/12/06 - 07:17 PM

kykie
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11/13/06 - 07:30 AM

i feel its either to type the mother's palmar wart, to see if it is the same with the childs which would rule out any likely abuse, since there are no labial or vaginal tears.
also to look for NG n chlamydia may b an alternative, but. i dont really know raised eyebrow

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sheena2005
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11/13/06 - 09:44 AM

i think D sounds more strong as the correct answer.

i was do u have to treat the child first and then look for the possible sexual transmission.or do u send chlaymydia cultures first and then treat the child.which will be choice E then.

they are asking the next step in managment.

alpha12
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11/15/06 - 05:22 PM

B is the answer. D would be true if sexual abuse was more likely. could the child be abused by her uncle? it's still a possibility...there are psychos out there...hummmm...tricky question. Anyhow, throat culture would be indicated for an adult who does "blow-job". Do you think one would abuse a baby in the mouth? Damn, I don't even wanna think about it...

Edited by alpha12 on 11/15/06 - 05:30 PM

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xwxf
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11/15/06 - 07:42 PM

DDD

jvo_md
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12/04/06 - 07:41 PM

this is not a nbme qx. It's a Usmle World QX. And they say the answer is C

webjeee
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12/26/06 - 10:12 PM

Why the answer is c.

it's sexual abuse, d is better for looking for comorbidity..

fongch
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04/19/07 - 11:13 AM

I believe palmar wart and condylomata acuminata are caused by different papilomavirus and there is not possible one causing palmar wart in the mother will cause condylomata acuminate in the child, it must have come from other source. And the mother's brother is an obvious possibility. Therefore B and C cannot be the best next step.

Also, as condylomata acuminata is not a life-threatening condition, therefore it can be managed once the other possible STDs have been ruled out.

So I will go w/ D.

Justice
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04/19/07 - 11:23 AM

#10

fongch wrote:
... mother's brother is an obvious possibility... Therefore B and C cannot be the best next step. Also, as condylomata acuminata is not a life-threatening condition, therefore it can be managed once the other possible STDs have been ruled out.

So I will go w/ D.

Well, I am kind of not convinced that the mom's brother is the abuser, but yea, they want us to be alert and cautious... (D)

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