18 - 102 - PHYSICAL ABUSE Flashcards
Subconjunctival hemorrhages can be seen in 0.5% to 13.0% of typical newborns, but a large subconjunctival hemorrhage beyond _________ of life is suspicious of abuse.
A. 1 and 2 weeks
B. 2 and 3 weeks
C. 1 and 2 months
D. 2 and 3 months
A
Children younger than 3 years of age at the onset of warts are least likely to have acquired their warts from sexual contact, whereas children with onset after 5 years of age have a much greater risk of having suffered sexual abuse.
A. 1 year, 3 years
B. 2 years, 4 years
C. 3 years, 5 years
D. 4 years, 6 years
C
The most common victims of domestic abuse are ______ .
A. Children
B. Adolescents
C. Adult women
D. Elderly
C
Parents are the perpetrator in child abuse _____ of the time.
A. 50%
B. 60%
C. 70%
D. 80%
D
The most common agent involved in childhood burns is _____.
A. Electrical
B. Hot liquid
C. Acid chemicals
D. Alkaline chemicals
B
What drug causes a unique syndrome characterized by retiform purpura of the ears associated with neutropenia, perinuclear antineutrophil cytoplasmic antibody and antiMPO3 antibodies
Levamisole
defined as the recurrent use of illegal drugs, or the misuse of nonprescription or prescription drugs, that results in negative consequences
Drug abuse
most common type of elder abuse
neglect
least common type of elder abuse
sexual abuse
bruise with a yellow hue is likely older than how many hours?
18 hours
but a bruise may be red, blue, or purple/black throughout its life span, from onset to resolution
Although the head is a common target of physical abuse in children, injuries to what area are more common in domestic abuse?
centrally located injuries
- Perpetrators in any cases of abuse may choose to injure hidden areas, such as the breast or genitals, to deter detection.
- Black eyes are often seen in accidental injuries but are more suspicious if they are bilateral or are unaccompanied by evidence of trauma to the nose or superior orbital ridge.
- Accidental bruising or other injuries to the oral mucous membranes are unusual and should be considered as suspect.
accidental bruises in children more frequently occur on what sites?
distal arms and legs, knees, elbows, and forehead
- Soft, padded, posterior, and protected areas of the body are far less likely to be accidentally injured.
- Bruises on the trunk, buttocks, neck folds, palms/soles, thighs, genitalia, ear lobes, neck, and cheeks are uncommon, so marks in these areas should raise concern.
- Trauma to the oral cavity including mucosal surfaces, posterior pharynx, teeth, and lingual/labial frenula are concerning findings that warrant abuse consideration
a large subconjunctival hemorrhage beyond what age of life is suspicious of abuse?
beyond 1 and 2 weeks of life
- Subconjunctival hemorrhages can be seen in 0.5% to 13.0% of typical newborns
The American Academy of Pediatrics Committee on Child Abuse and Neglect recommends that certain findings are consistent with, but not diagnostic of, abuse
- chafing,
- abrasions, or
- bruising of the inner thighs and genitalia,
- scarring, tears or distortion of the hymen,
- a decreased amount or absent hymeneal tissue,
- scarring of the fossa navicularis,
- injury to or scarring of the posterior fourchette,
- scarring or tears of the labia minora, and
- enlargement of the hymeneal opening, even without disruption of the hymen
Children younger than what age at the onset of warts are least likely to have acquired their warts from sexual contact?
younger than 3 years of age - least likely for sexual abuse
children with onset of warts after what age have a much greater risk of having suffered sexual abuse?
onset after 5 years of age - greater risk of sexual abuse
Regarding clustered injuries, the presence of how many individual injuries in the same body region is a classic guideline for raising concern for abuse?
**3 or more individual injuries **in the same body region is a classic guideline for raising concern for abuse
- Pre-mobile children should rarely have more than one isolated bruise, whereas infants who crawl/cruise infrequently have more than 2 bruises especially in the same body region, as compared with children who walk and have commonly greater than 5 or more bruises that may or may not be clustered based on location and activity
Circumferential purpura or hemosiderin pigmentation suggests what injury
ligature injury
The most common agent involved in childhood burns (both accidental and inflicted)
hot liquid
pattern of burn in inflicted scalds
inflicted scalds tend to be symmetric, with **sharply demarcated edges and an absence or paucity of splash marks **characterized by tapered edges.
Accidents such as inadvertently stepping into a hot tub or pulling a hot liquid off a table counter or stove leave irregular or geographic burn patterns that lack symmetry
80% of perpetrator in child abuse
parents
pattern of coercive behaviors that may include repeated battering, psychological abuse, sexual abuse, social isolation, deprivation, and intimidation perpetrated by someone who is or was involved in an intimate relationship with the victim
Domestic violence
Fractures concerning for intentional trauma
- bilateral long bone acute fractures,
- metaphyseal corner fractures,
- long bone fracture in a non-ambulatory child,
- epiphyseal separations,
- rib/sternal/spinous process/scapular fractures,
- fractures of variable healing stages,
- digital fractures in children younger than 36 months, and
- vertebral subluxations/fractures without high force trauma, and
- severe skull fractures in children younger than 18 months
recommended imaging for initial workup and evaluation in all patients with suspected nonaccidental head trauma as well as all children younger than 6 months with any suspected injury
Unenhanced CT
Among cases of child abuse, in the absence of neurologic symptoms, patient age less than 1 year is the only key factor found to predict more thorough diagnostic evaluation
Pediatric patients who suffer from abuse that was not initially promptly diagnosed with the first offense have up to how many percent risk of a second event?
50%
