102: Physical Abuse Flashcards
What are the common indicators of physical abuse in children?
Common indicators include bruising on soft padded areas, patterned bruising in different stages of healing, bilateral and uniform burns, injuries inconsistent with explanations, and suspicious black eyes without trauma to the nose or superior orbital ridge.
What are the key features to consider in the clinical assessment of suspected abuse?
Key features include comprehensible explanations for injuries, congruence between history and physical examination findings, morphology of injuries, and localization of injuries in hidden areas.
What are the common locations for injuries in child abuse cases?
Common locations include the head, trunk, extremities, face, and genitalia.
What are the common forms of abuse?
Child abuse, elder abuse, and domestic violence.
What is a key indicator of physical abuse in children?
Bruising on soft padded areas of the body and patterned bruising in different stages of healing.
What is the lifetime risk of sexual abuse for girls?
Approximately 25% to 40%.
What are the key features in the forensic classification of abuse?
Morphology and localization of injuries.
What does a yellow bruise indicate about its age?
It is likely older than 18 hours.
What areas are commonly injured in child abuse cases?
Trunk, buttocks, neck folds, palms/soles, thighs, genitalia, ear lobes, neck, and cheeks.
What is the significance of multiple bruises of differing colors?
They may indicate repeated trauma rather than one isolated incident.
What should providers seek to identify when assessing injuries?
Congruence between history provided and physical examination findings.
Describe the epidemiology of elder abuse in terms of prevalence and risk factors.
Elder abuse affects 1 to 2 million Americans aged 65 or older annually, with individuals older than 80 being 2 to 3 times more likely to suffer abuse.
True of False: Child abuse, elder abuse, and domestic violence affect patients across all socioeconomic classes and races.
True.
What is the lifetime risk of sexual abuse for boys?
Approximately 10%.
What is the fastest-growing form of abuse in the United States?
Elder abuse.
What percentage of domestic abuse victims are women?
Approximately 90% to 95%.
Child abuse, elder abuse, and domestic violence
Morphology and localization of injuries.
What findings may suggest sexual abuse in children?
Acute genital or anal injuries, marked hymeneal opening enlargement, chafing, abrasions, or bruising of the inner thighs and genitalia.
What are the characteristics of injuries that raise concern for intentional abuse in children?
Characteristics include repeated, clustered, and/or patterned injuries, rule of 3, slap injuries, grab or pinch marks, ligature injuries, tramline bruising, bite marks, and inflicted burns.
What are some risk factors associated with child abuse?
Emotional or behavioral issues, chronic illnesses, premature birth, multiple siblings, unwanted pregnancy, single-parent households, living at or below poverty level, and gender.
What are the common red flags that may indicate child abuse?
Common red flags include unexplained delay in presentation, inconsistent caregiver history, denial of trauma, severe injuries blamed on pets or young children, and observation of child’s behavior.
What are the risk factors for elder abuse?
Risk factors include older age, lack of access to resources, low income, social isolation, minority status, low education, functional impairment, and caregiver stress.
What is the rule of 3 in relation to child abuse?
Three or more individual injuries in the same body region raises concern for abuse.
What does tramline bruising indicate?
It indicates trauma usually from a rectangular or round object, showing preserved normal skin within the lines.
What are common characteristics of inflicted burns in children?
Inflicted burns tend to be symmetric with sharply demarcated edges and an absence of splash marks.
What are some risk factors for child abuse?
Emotional or behavioral issues, chronic illnesses, living in single-parent households, and being at or below the poverty level.
What percentage of child abuse is estimated to be inflicted by parents?
80%.
What are some red flags that may trigger suspicion for child abuse?
Unexplained delay in presentation, inconsistent caregiver history, and severe injury blamed on pets or young children.
What demographic is most commonly affected by domestic abuse?
Women ages 19-29 years.
What environmental factors contribute to the risk of abuse?
Poverty, social isolation, and significant family stressors.
What are the key characteristics of injuries that raise concern for intentional abuse in children?
Key characteristics include repeated, clustered, and/or patterned injuries, rule of 3, slap injuries, grab or pinch marks, ligature injuries, tramline bruising, bite marks, and inflicted burns.
What are the risk factors associated with child abuse?
Risk factors include emotional, behavioral, or learning disabilities, chronic illnesses, unwanted pregnancy, and living at or below poverty level.
A woman presents with bilateral black eyes but no trauma to the nose or superior orbital ridge. What should you consider?
Bilateral black eyes without trauma to the nose or superior orbital ridge are suspicious for domestic abuse.
A child has a burn injury with sharply demarcated edges and no splash marks. What does this indicate?
Sharply demarcated edges and the absence of splash marks are characteristic of inflicted burns, which are suspicious for child abuse.
A patient presents with linear purpura and a small triangle at the base of the injury. What type of injury is this, and what does it suggest?
This is a slap injury, characterized by linear purpura with a small triangle at the base, concerning for physical abuse.
A child has retinal hemorrhages and large subconjunctival hemorrhages. What should you suspect?
Retinal and large subconjunctival hemorrhages are suspicious for child abuse, particularly head trauma.
A caregiver provides conflicting explanations for a child’s injury. What should you do?
Conflicting explanations are a red flag for child abuse. Perform a thorough examination and document findings clearly.
A 3-year-old child has genital warts. What should you consider, and how does the child’s age affect your suspicion?
Genital warts in a child younger than 3 years are less likely to be from sexual contact and may be acquired perinatally or through nonsexual caretaker contact.
A patient presents with circumferential purpura around the wrist. What type of injury is this, and what does it suggest?
Circumferential purpura around the wrist is a ligature injury, which is concerning for physical abuse.
A child has bruises on the neck folds and genitalia. What should you suspect?
Bruises on the neck folds and genitalia are suspicious for child abuse, particularly physical or sexual abuse.
A child has a hymeneal disruption and scarring of the posterior fourchette. What does this indicate?
Hymeneal disruption and scarring of the posterior fourchette are indicative of sexual abuse.
A caregiver denies trauma despite a child presenting with concerning injuries. What should you do?
Denial of trauma despite concerning injuries is a red flag for child abuse. Conduct a thorough examination and document findings.
A child presents with a scald injury that is symmetric and has sharply demarcated edges. What does this suggest?
Symmetric scald injuries with sharply demarcated edges are characteristic of inflicted burns, suggesting child abuse.
A child has multiple injuries in the same body region. What guideline can help raise concern for abuse?
The rule of 3 or more individual injuries in the same body region is a classic guideline for raising concern for abuse.
A child has a bite mark on the arm. What should you consider?
Bite marks are always inflicted and can be from children or pets.
What should you consider if a child has a bite mark on the arm?
Bite marks are always inflicted and are concerning for physical abuse.
What does hymeneal opening enlargement with associated scarring suggest?
It is indicative of sexual abuse.
What does scarring on the labia minora indicate?
It is indicative of sexual abuse.
What does scarring on the fossa navicularis suggest?
It is indicative of sexual abuse.
What does scarring on the posterior fourchette indicate?
It is indicative of sexual abuse.
What type of injury is characterized by linear purpura with a small triangle at the base?
A slap injury, which represents the interdigital and finger web spaces.
How can grab or pinch marks be identified in suspected abuse cases?
They can be recognized by their location on soft padded areas and their unusual patterning.
What role does a child’s spoken word play in establishing sexual abuse?
It is a valuable piece of evidence in establishing sexual abuse.
What are concerning signs of Elderly Abuse?
Unexplained repetitive injuries or explanations by caretakers that do not match the pattern of injury.
What should be done when interviewing a patient suspected of Domestic Abuse?
The patient should be interviewed alone in the absence of their partner.
What laboratory tests are recommended for assessing potential abuse in patients?
Coagulation studies, liver function tests, serum electrolytes and osmolality, serum phosphate, calcium, alkaline phosphatase, urinalysis, and toxicology based on patient presentation.
What imaging studies are suggested for evaluating potential abuse cases?
X-ray and skeletal survey for fractures, unenhanced CT of the head and fundoscopy for head injury, and tailored imaging for visceral trauma.
What is the composition of the abuse team recommended for managing cases of abuse?
The abuse team should consist of a dermatologist, pediatrician, social worker, medical photographer, and pediatric subspecialists as needed.
What are the two types of actions that can constitute elderly abuse according to the definition provided?
- Commission: Intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or trusted person.
- Omission: Failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.
What signs may indicate potential domestic abuse during a patient interview?
- Implausible explanations for an injury or a delay in seeking medical attention.
- Signs of depression or excessive use of sedatives.
- Chronic pain disorders or vague stress-related symptoms.
What is the importance of repeat visits in the context of suspected domestic abuse?
They may be used to document new or progressing skin findings and to build trust with the patient.
What should be done if a patient presents with unexplained repetitive injuries?
Investigate further as these may indicate abuse, especially if explanations do not match the pattern of injury.
Why is it important to interview a patient alone in cases of suspected domestic abuse?
To ensure the patient feels safe to disclose information without the presence of their partner, which may influence their responses.
What are some behavioral signs of caregivers that may indicate potential abuse?
Caregivers who act withdrawn, infantilize the patient, or insist on providing the medical history instead of allowing the patient to speak.
