Chapter 34

Question 1

What physical exam findings may lead you to Blount Thoracic injury secondary to child abuse?

Answer 1

Withdrawn/apprehensive child with bruises in different stages of healing, History of mother’s boyfriend babysitting and focal tenderness of the right chest wall. Avoid eye contact

Question 2

We should be considered in this patient’s work up?

Answer 2

Bleeding disorders and unintentional injuries?

Question 3

What is included in the coagulation profile?

Answer 3

PT, PTT/INR, bleeding time, platelet count

Question 4

What are the diagnostic test they should be ran for this patient?

Answer 4

Pulse ox, CXR, CBC, coagulation profile

Question 5

What are some red flags in child abuse patients?

Answer 5

Delay in seeking treatment. Inconsistent history with different healthcare staff. Injury parents not matching story or developmental stage. Multiple injuries at various healing stages. Infected injuries. Behavior disturbances. Acute mental status change

Question 6

For child abuse patients when should CT head performed? CT chest? Toxicology screening?

Answer 6

Neurologic symptoms or if her drummer is present. Intrathoracic injuries. Both serum and you’re in toxicology screening is necessary if poisoning or do you have exposure is suspected

Question 7

For child abuse cases when she coagulation profile be performed? Skeletal survey? Plain x-rays?

Answer 7

If bruising is present. Bone tenderness, limited range of motion, deformity. Mandatory if younger than two years.

Question 8

We should be done if patient is dehydrated, malnourished, or intoxicated?

Answer 8

BMP and UA

Question 9

What should be ordered if abdominal injuries are suspected?

Answer 9

LFTs, pancreatic enzymes, UA, abdominal CT

Question 10

What is necessary and all suspected child abuse cases?

Answer 10

Child protective service consultation and psychiatric consultation

Question 11

When hospitalization required for child abuse patients?

Answer 11

When no safe places are available or if condition requires inpatient management such as (burns multiple rib fractures, etc.)

Question 12

What is indicated If retinal hemorrhage is suspected or found?

Answer 12

Ophthalmology consultation

Question 13

How are rib fractures treated?

Answer 13

Analgesics for pain control and chest PT (including incentive spirometry for prevention for atelectasis)

Question 14

What is the treatment for child abuse patients?

Answer 14

Hospitalization, rib fracture management (Analgesia: NSAIDs or Narcotics), child protective service, ophthalmology and psychiatric consultation

Question 15

What should be ran for every chest pain patient?

Answer 15

Pulse oximetry and chest x-ray