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  #1  
Old 03-07-2012
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Question 3 yr old with condylomata acuminata

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
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  #2  
Old 03-07-2012
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HPV can cause

1.common warts.(mother has it)
2.plantar warts.
3.genital warts.

i go for mother wart DNA testing .....
but the strain is differrent..commom warts type 2,4
and the genital is by type 6,11...
any inputs will be appreciated
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  #3  
Old 03-07-2012
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its clinical dx. so next step must be rx.
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  #4  
Old 03-07-2012
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guys mazrodin is rite...abt the strain being diff

i wud go for futher evaluation of child to rule out any chances of Abuse...sexual.

so
before DNA typing of mother's i wil go for "D"...as a physician

becuase if present not only it must be reported but child needs treatment for it as well

this followed by laser treatment...

if negative then less suspicious for abuse and i wil go for Dna typing of mother...

so ans shud be D
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Old 03-07-2012
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i tried to read about this, and from what i gathered is the following,

1) Dna typing for Hpv in children for determining sexual transmission does not work.

2) since the mother has it in her hand, that was the most likely source.

3) but i also read that, all cases of genital warts should be considered sexually transmitted unless otherwise proven.

4) there is no treatment for warts in children , it resolves spontanoeously in 2 yrs....but the child is a reservoir for hpv till then . at times it can become treatment resistant.



this is one of the sources, i dont own any rights.

http://www.childrensdayton.org/cms/r..._acuminata.pdf

but i still guess E is the answer.
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Old 03-07-2012
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Default answers to the questions???

I'm new to the forums, so it's possible that I'm missing something. I'm reading the questions thinking about them then, looking for the correct answer to check mine, but I cannot find the correct answer, everybody writes their own comments but cannot find the correct answer.
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  #7  
Old 03-07-2012
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well i think lot of real practice ans are diff from the actual ans on USMLE.... but i think D is the ans...

E is also not a bad choice though
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  #8  
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I think D is the ans. further tests should be done to rule out sexual abuse so that it does not happen again. there after treatment can follow. though the child can get this wart from the mother since her wart is on the palmer area and the child is still at the age of wearing diaper. but first thorough test to rule out sexual abuse. then treatment ie E. though in children wart can sometimes resolve without treatment.
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Old 03-07-2012
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you think or u r sure?
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Old 03-07-2012
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Am Sure Dr. Dru
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Old 11-20-2012
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Quote:
Originally Posted by achistikbenny View Post
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
the answer should be E , although would also like to treat the mother but child first . does not look like abuse as the child has no visible intravaginal condylomata or vaginal or anal tears.

anyone knows the correct ans ????
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Old 11-21-2012
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D) Vaginal, anal, and throat cultures for Chlamydia trachomatis and Neisseria gonorrhoeae in the child

There are two points in favor of sexual abuse in this child:
1. Isolated genital lesions
2. C
ondylomata acuminata

The vaginal/anal exam may be normal in sexual abuse, so "
no visible intravaginal condylomata or vaginal or anal tears" means nothing.

DNA typing of the mother's palmar wart for papillomavirus is not going to help since we already know that it is Condylomata acuminata in the child and the mother does not have it.

I am not saying that it is definitely sexual abuse but it has a strong possibility which needs to be explored further.

The most likely source is the mother's brother since abuse is most done by the close family members who the child trusts.


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  #13  
Old 11-21-2012
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E) Laser therapy of the condylomata acuminata in the child
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  #14  
Old 11-21-2012
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Quote:
Originally Posted by Novobiocin View Post
D) Vaginal, anal, and throat cultures for Chlamydia trachomatis and Neisseria gonorrhoeae in the child

There are two points in favor of sexual abuse in this child:
1. Isolated genital lesions
2. C
ondylomata acuminata

The vaginal/anal exam may be normal in sexual abuse, so "
no visible intravaginal condylomata or vaginal or anal tears" means nothing.

DNA typing of the mother's palmar wart for papillomavirus is not going to help since we already know that it is Condylomata acuminata in the child and the mother does not have it.

I am not saying that it is definitely sexual abuse but it has a strong possibility which needs to be explored further.

The most likely source is the mother's brother since abuse is most done by the close family members who the child trusts.

thank you....................
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  #15  
Old 11-22-2012
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definitely D.
r/o abuse co child is alone with uncle.
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  #16  
Old 11-23-2012
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NBME 1 Q: HPV condylomas on a toddler ?!?!


Discussed here
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Infectious-Diseases, Pediatrics-, Step-2-Questions

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