07-09-2008, 04:07 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
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