Abuse

Question 1

Differentiate negative image pattern injury and positive image pattern injury.

Answer 1

• Negative injury:
  o Bruising resembles the outline of the object as the soft tissue in the centre of the impact field moves laterally
• Positive injury:
  o With slower thrust of strike, the central portion of the injury may be discoloured

Question 2

How can bite marks inflicted by an adult abuser be differentiated from that of a child sibling?

Answer 2

• Distance between the maxillary canines: Child 3cm

Question 3

What is a DDx of skeletal # child abuse?

Answer 3

· Accidental trauma
· Osteogenesis imperfecta
· Menke’s disease
· Congenital syphilis, congenital rubella
· Normal variant

Question 4

What is the differential diagnosis of retinal hemorrhages?

Answer 4

· Infection – endocarditis, CMV retinitis
· Inflammatory - ?
· Iatrogenic – post-op
· Tumor – retinoblastoma, ALL
· Toxic - CO
· Trauma – shaken baby, retinal tear
· Metabolic – diabetic retinopathy, 
· Drugs
· Degenerative / developmental - 
· Cardiac/Vascular –hypertensive retinopathy, 
· Neurologic – ICH, increased ICP
· Hematologic - DIC, other coagulation disorders

Question 5

What are the components of the skeletal survey, and when is it indicated?

Answer 5

o

Question 6

What is the age of consent in Alberta?

Answer 6

Consent
Age of consent changed from 14 to 16
MANDATORY REPORTING IF
Child  2 yrs older
14-15 if position of authority or >5 yrs
16-18 if partner in position of authority
Age