USMLE-Rx Step 2 Qmax Challenge #21066

Check out today’s Step 2 CK Qmax Question Challenge.

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A 2-year-old girl is brought to the clinic by her mother, who says her daughter is experiencing vaginal discharge and discomfort. Over the past few hours, the mother noticed her daughter holding her genital area and observed bloody spotting on her underwear. The girl is otherwise healthy, lives at home with her parents, and attends day care. The mother mentions that she recently started potty training her daughter. The patient’s temperature is 37.2°C (99.0°F), blood pressure is 110/70 mm Hg, and pulse is 70/min. The girl appears well nourished. On external genital examination, the vulva appears red and irritated, and a reddish tinged, feculent discharge is noted in the introitus. The remaining results of physical examination are benign, with no evidence of bruises, contusions, fractures, or edema noted on her body.

Which of the following is the most appropriate next step in management?

A. Clean the area with soap and water and discuss proper hygiene and potty training tips with parents
B. Contact social services and separate mother from the child
C. Order follicle-stimulating and luteinizing hormone levels
D. Perform speculum examination and culture vaginal discharge
E. Start antibiotic treatment


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8 thoughts on “USMLE-Rx Step 2 Qmax Challenge #21066”

  1. D)
    I recently came across a similar case but of 35-40 yr old women in my Mom’s hospital
    I witnessed her performing PA, PS, PV(bimanual) examination along with PAP smear recommendations.

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