Child Abuse

Question 1

What are the three levels of stress response

Answer 1

• positive - brief increases in heart rate, mild elevations in stress hormone levels
• tolerable - serious, temporary stress responses, buffered by supportive relationships
• Toxic 0 prolonged activation of stress response systems in the absence of protective relationships

Question 2

What are the 3 goals for medical evaluation of a suspected child abuse case

Answer 2

• determine the full extent of the child’s injuries
• determine if injuries are consistent with history provided
• prevent misdiagnosis of abuse

Question 3

What are some labs ordered for occult trauma/ingestion

Answer 3

• CBC
  PT/PTT
  LFT
  Amylase/lipase
  Urinalysis
  CPK
  Urine toxicology

Question 4

What are labs ordered for differential diagnosis of fractures

Answer 4

Calcium
Phosphorus
Alk Phos
ViT D 2% OH
PTH

Question 5

Labs ordered for signs of neglect/malnutrition

Answer 5

Total protein
Albumin
Pre albumin
Mineral and vit deficiencies

Question 6

What are the fractures concerning for abuse?

Answer 6

Metaphysical fractures
Rib fractures
Sternal fractures
Acromion fractures
Scapular fractures
Spinous process fractures
Anterior compression of vertebral body

Question 7

What fractures are concerning but can be accidental

Answer 7

Mid-shaft clavicular
Long bone shaft
Linear skull fractures

Question 8

What is the acute healing period of fractures

Answer 8

Up to 7 days

Question 9

What is the time frame for soft callus formation

Answer 9

7-10 days

Question 10

What is the time frame for hard callus formation

Answer 10

10-14 days

Question 11

What is the time frame for remodeling

Answer 11

Up to several months

Question 12

Which bony fractures are the hardest to date

Answer 12

Skull bones
Metaphysical

Question 13

What bones are usually involved in birth trauma

Answer 13

Humeral and clavicular fractures

Question 14

What is the most common indication of physical abuse

Answer 14

Bruises

Question 15

What does a yellow bruise usually indicate

Answer 15

Bruise is more than 18 hours

Question 16

What does a purple bruise usually represent

Answer 16

Present from 1 hour to resolution

Question 17

What does a red bruise indicate

Answer 17

Red color can be present anytime

Question 18

What are the two characteristics used to separate abusive bruised from accidental bruises

Answer 18

Location
Pattern

Question 19

What are high risk areas for abusive bruises?

Answer 19

TEN-4 FACES
Torso - chest, abdomen, back, buttocks
Ears
Neck

Frenulum
Angle of jaw
Cheek
Eyelid
Sclera

Question 20

What are some accidental bruise locations

Answer 20

Shin
Lower arms
Under chin
Forehead
Hips
Elbows
Ankles
Bony prominences

Question 21

What are some abusive bruise locations

Answer 21

Anterior thigh
Upper arms
Neck
Face
Buttocks
Trunk
Ears
Genitalia

Question 22

What are some inflicted abuse patterns

Answer 22

• patterned
• well demarcated edges
• often uniform depth of burn
• unusual location

Question 23

What does subconjuctival hemorrhages indicate?

Answer 23

Sentinel injury - my be an indicator of physical abuse

Question 24

What is the 2nd leading cause of abuse fatalities

Answer 24

Abdominal trauma

Question 25

What is the most common form of maltreatment

Answer 25

Neglect