This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
A six years old girl child presents with spotting, no secondary sexual characteristic present. Cause can be: 
Select and explain. 
A. Menarche, B. Foreign body, C. Gonococcal infectionGonococcal infection, D. Haemorrhagic disease
B: Foreign body
Answer: B: Foreign body 
Explanation: Because there is no signs of infection or menarche, foreign body is the best answer. Hemorrhagic disease will not appear as spotting. Causes of vaginal bleeding in children: Foreign body Genital tumors Urethral prolapse Lichen sclerosus Vulvovaginitis Condyloma acuminata Trauma Precocious pubey Exogenous hormone usage Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 14. Pediatric Gynecology. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.