GOGETA
Trying to get in PGY1
Topics: 381
Posts: 3,072
|
A 4-year-old girl is brought to the physician by her mother because of a bloody, greenish, malodorous vaginal discharge. The discharge was first noted 3 days ago and has worsened since then. The girl has no other symptoms. The mother reports no concerns regarding abuse of the child. Examination is attempted but impossible because of the child's absolute refusal to be examined. Several efforts at persuasion are made but are unsuccessful. Which of the following is the most appropriate next step in management?
A. Reassurance and expectant management
B. Antibiotic administration
C. Police notification
D. Examination under anesthesia
E. Pelvic examination with physical restraint
___________________
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
I think it is D
Foreign body in the vagina most common cause of this scenario in children
|
| yarab99
Forum Guru
Topics: 32
Posts: 512
|
D
|
| docnit
Forum Senior
Topics: 8
Posts: 193
|
C
sexual abuse.
case of STD.
|
| docnit
Forum Senior
Topics: 8
Posts: 193
|
moreover i think if it was foreign body left for 3 days there would be some signs of infection like fever, leukocytosis along with the discharge.
greenish discharge sounds more like trichomonal infection.
|
| docnit
Forum Senior
Topics: 8
Posts: 193
|
whats the answer please?
|
| kpmle2
Forum Guru
Topics: 95
Posts: 512
|
Examination is attempted but impossible because of the child's absolute refusal to be examined---D. Examination under anesthesia
|
| GOGETA
Trying to get in PGY1
Topics: 381
Posts: 3,072
|
This is a copy paste not me talking:
. A discharge such as that described above requires a full evaluation. The differential diagnosis includes infection, tumor, trauma, and vaginal foreign body. In a 4-year-old girl, a vaginal foreign body is a common cause of a greenish, bloody, foul-smelling vaginal discharge. The most common foreign body found is toilet paper or stool. It can often be difficult to perform any type of examination on a young child. Vaginal foreign bodies are typically seen in girls between 3 and 7 years of age, and, at these ages, many will refuse examination. However, it is absolutely essential to determine the etiology of the discharge. Failure to remove a vaginal foreign body can lead to damage to the vagina, severe pelvic inflammatory disease, or peritonitis. Thus, this child needs to have an examination. Because she refuses to be voluntarily examined, the examination should be performed under anesthesia, at which time vaginoscopy can be performed. Reassurance and expectant management (choice A) would not be appropriate for this child. There is nothing reassuring about having a bloody, malodorous vaginal discharge. This discharge could, for example, represent a malignancy or lead to severe infection. Therefore, expectant management would not be appropriate. Antibiotic administration (choice B) would not be the correct next step. It is unclear what is causing the discharge and to simply assume that the etiology is infectious, and to send the patient home with antibiotics would not be correct. Police notification (choice C) would not be the most appropriate next step. 4-year-old children can develop vaginal foreign bodies without abuse taking place. A thorough evaluation should be conducted, including cultures for sexually transmitted diseases, but police notification would not be the next step. Pelvic examination with physical restraint (choice E) should not be performed on a child. Doing so risks psychological distress and possible future sexual dysfunction
___________________
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
|
| GOGETA
Trying to get in PGY1
Topics: 381
Posts: 3,072
|
kpmle2 wrote:
Examination is attempted but impossible because of the child's absolute refusal to be examined---D. Examination under anesthesia
___________________
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
|
|
| |
| | | | | | | | | |
Similar forum topics