Benign gynaecology: prepubertal vaginal bleeding: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Benign gynaecology: prepubertal vaginal bleeding

Sample item

A 5-year-old girl has persistent blood-stained foul-smelling vaginal discharge without a history of trauma. What is the commonest cause and best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Vaginal foreign body (such as tissue paper); examination under anaesthesia with vaginoscopy

A retained foreign body, often toilet tissue, is the commonest cause of persistent bloody, offensive vaginal discharge in a young girl. Examination under anaesthesia with vaginoscopy and removal, often by irrigation, is the best step, after considering abuse. Other causes include vulvovaginitis, urethral prolapse and sarcoma botryoides.

Option by option

  • A. Precocious puberty; start GnRH analogue

    Precocious puberty would have breast and growth changes, not offensive discharge.

  • B. Vaginal foreign body (such as tissue paper); examination under anaesthesia with vaginoscopy (correct)

    Correct. A retained foreign body is common and is removed under vaginoscopy.

  • C. Vaginal carcinoma; urgent hysterectomy

    Vaginal carcinoma is extremely rare in a child.

  • D. Sexual maturity; reassure

    Reassurance misses a treatable cause.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Vaginal foreign body (such as tissue paper); examination under anaesthesia with vaginoscopy. A retained foreign body, often toilet tissue, is the commonest cause of persistent bloody, offensive vaginal discharge in a young girl.

Why is "Precocious puberty; start GnRH analogue" not the answer?

Precocious puberty would have breast and growth changes, not offensive discharge.

Why is "Vaginal carcinoma; urgent hysterectomy" not the answer?

Vaginal carcinoma is extremely rare in a child.

Why is "Sexual maturity; reassure" not the answer?

Reassurance misses a treatable cause.

What concept does this question test?

It tests Benign gynaecology: prepubertal vaginal bleeding in OBG. Examination under anaesthesia with vaginoscopy and removal, often by irrigation, is the best step, after considering abuse. Other causes include vulvovaginitis, urethral prolapse and sarcoma botryoides.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Benign gynaecology: prepubertal vaginal bleeding?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.