Review Question - QID 105581

Non-purulent vaginal discharge and/or mammary enlargement are commonly seen in new born infant females. No tests are needed.

Non-purulent vaginal discharge and/or mammary enlargement are not a cause for concern and generally regress within a few days. These symptoms are a result of the mother's hormones being transferred to the fetus in utero, as well as via breast milk. This finding will usually resolve on its own and requires no further workup.

Langan discusses discharge proceedures for health newborns leaving the hospital. He suggests keeping a checklist to make sure that parents are informed about normal patterns for feeding and stooling, and for care of the umbilical site and genitals. He also discusses the importance of instruction on the use of cribs and car seats, as these topics are often confusing to new parents.

Smith et al. discuss the work-up of premenarchal girls with vaginal discharge. Foreign bodies were identified in 10% of girls with longstanding vaginal discharge. Although vaginal irrigation can be useful, it is unlikely to remove a foreign body with this procedure unless imaging has already shown the presence of the foreign body.

Incorrect Answers:
Answer 1: A karyotype is the definitive test to diagnose Turner syndrome, yet this patient is not showing signs of this condition (shield chest, webbing of the neck, short stature).
Answers 2, 3, and 4: These conditions are the congenital bilateral adrenal hyperplasias. A patient with 17 alpha-hydroxylase deficiency would present with hypertension and hypokalemia which this patient does not have. A patient with 21-hydroxylase deficiency would present with hypotension and hyperkalemia which this patient does not have. Finally, a patient with 11 beta-hydroxylase deficiency would present with masculinization (ambiguous genitalia) and hypertension which are not found in this patient.