The key points in the history and physical examination
A 6-year-old has a yellow vaginal discharge. The examination is otherwise normal.
What are the key points in the history and physical examination?
How would you approach differ if the patient were a sexually active 16-year-old?
What are the similarities and differences in the approach?
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources
Sample Solution
Let's address this sensitive scenario with a focus on appropriate history gathering, physical examination, and a comparison of approaches for different age groups.
6-Year-Old with Yellow Vaginal Discharge
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Key Points in History:
- Onset and Duration: When did the discharge begin? How long has it been present?
- Characteristics of Discharge: Color, odor, consistency, and amount.
- Associated Symptoms: Itching, burning, pain, dysuria (painful urination), abdominal pain, or fever.
- Hygiene Practices: Bathing habits, use of soaps or bubble baths, and wiping technique (front to back).
- Foreign Body Insertion: Potential for insertion of foreign objects (e.g., toilet paper, toys).
- Trauma: Any history of trauma to the genital area.
- Recent Illnesses: Any recent infections, particularly respiratory or gastrointestinal.
- Exposure to Infections: Contact with anyone with a known infection.
- Possible sexual abuse: This needs to be asked in an age appropriate way.
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Key Points in Physical Examination:
- External Genitalia: Careful inspection for erythema, edema, excoriation, or foreign bodies.
Full Answer Section
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- Perianal Area: Examination for signs of irritation or infection.
- Lymph Nodes: Palpation of inguinal lymph nodes for enlargement.
- Abdominal Examination: Assessment for tenderness or masses.
- If signs of sexual abuse are present: a thorough exam needs to be done, with proper documentation.
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Approach:
- A gentle and reassuring approach is crucial.
- Explain each step of the examination to the child in age-appropriate terms.
- Involve the parent or guardian throughout the process.
- Consider the possibility of sexual abuse, and follow local protocols.
16-Year-Old with Yellow Vaginal Discharge
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Key Points in History:
- Sexual History: Onset of sexual activity, number of partners, and use of barrier contraceptives.
- Menstrual History: Last menstrual period, regularity, and any abnormalities.
- Symptoms: Similar to the 6-year-old, but with added emphasis on symptoms of sexually transmitted infections (STIs).
- Medications: Current medications, including antibiotics.
- Drug use: IV drug use increases risk of infections.
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Key Points in Physical Examination:
- External Genitalia: Similar to the 6-year-old, but with a focus on signs of STIs (e.g., lesions, discharge from the cervix).
- Pelvic Examination: Examination of the cervix and internal pelvic organs.
- STI Testing: Collection of samples for testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and other STIs.
- Abdominal Examination: Assessment for pelvic inflammatory disease (PID).
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Approach:
- Maintain confidentiality and respect the patient's privacy.
- Provide education on safe sexual practices and STI prevention.
- Offer STI testing and counseling.
Similarities and Differences in Approach:
- Similarities:
- Both require a thorough history and physical examination.
- Both require a focus on the characteristics of the discharge and associated symptoms.
- Both require a respectful and professional approach.
- Differences:
- The 16-year-old requires a detailed sexual history and STI testing.
- The 6-year-old requires a more focused assessment for foreign bodies and potential sexual abuse.
- The 6-year-old exam will be less invasive than the 16-year-old exam.
- The 16-year-old exam requires a pelvic exam, which is not done on a 6 year old, unless there is a very strong reason.
- Confidentiality is much more important in the 16-year-old patient.
References:
- Emans, S. J., Laufer, M. R., & Goldstein, D. P. (2012). Emans, Laufer, and Goldstein's pediatric and adolescent gynecology. Lippincott Williams & Wilkins.
- Workowski, K. A., Bachmann, G., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., ... & Thorpe, P. G. (2021). Sexually transmitted infections treatment guidelines, 2021. Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports, 70(4), 1-187.
prcofwestplains.org
Object in the Vagina - MyHealth Alberta
Risk Factor Profiles among Intravenous Drug Using Young Adults: A Latent Class Analysis (LCA) Approach - PubMed Central