child abuse

Question 1

highest percentage of death from child abuse occurs in children under what age

Answer 1

12 months

Question 2

what is the most common cause of lethal child abuse

Answer 2

abusive head trauma

Question 3

who are the primary perpetrators of child abuse

Answer 3

parents

Question 4

risk factors for babies/children to be abused

Answer 4

• medical conditions
• non-biologic caregiver
• Age
  
  • severe physical abuse common children < 3 yo
• prior abuse

Question 5

What is the most common form of abuse

Answer 5

Neglect

Question 6

bruising over the pinna of the ear is suggestive of

Answer 6

blow to ear or side of head

Question 7

what is the normal distance between maxillary inter-canines in adults

Answer 7

2.5-3 cm

Question 8

what is the second most common injury in physical abuse

Answer 8

fx

Question 9

what are fx of high suspicion

Answer 9

• rib fx in babies < 1 yr
• long bone fx in non-walking children

Question 10

presentation

• third degree burn
• heal slowly with scarring
• typically dorsa of hands, feet or face

Answer 10

cigarette burns

Question 11

rejection

Answer 11

lack of affection or attention

Question 12

locking child in a room or basement

Answer 12

isolation

Question 13

verbal assault, threatening behavior

Answer 13

terrorizing

Question 14

psychological unavailability to the child

Answer 14

ignoring

Question 15

encouraging destructive or sexually exploitative behavior

Answer 15

corrupting

Question 16

name-calling, sarcasm, humiliation

Answer 16

verbal assault

Question 17

Neglect is failure to provide a child basic needs. this comes in what 4 categories

Answer 17

1. physical: starvation, dehydration
2. emotional: injuries caused by lack of supervision
3. educational: excessive absences
4. medical: poor dental health, untreated illness

Question 18

which type of intracranial bleeding is not typically accidental

Answer 18

• subdural hemorrhage
  
  • would require significant force such as MVA or drop from high height

Question 19

which type of intracranial bleeding occurs more frequently following unintentional head trauma

Answer 19

epidural hemorrhage

Question 20

which type of intracranial bleeding is present in nearly all fatal inflicted head trauma

Answer 20

subarachnoid hemorrhage

Question 21

what is something you are looking for in optic exam after a head injury if you expect abuse

Answer 21

• retinal hemorrhage
  
  • typically numerous in abusive trauma

Question 22

what are the two most common type of fx associated with abuse

Answer 22

• metaphyseal lesions of the long bones (injuries in infancy)
• rib fx
  
  • most often posterior ribs near costovertebral articulation

Question 23

salicylate ingestion can present with

Answer 23

• hyperventilation
• vomiting
• metabolic acidosis
• bruising

Question 24

clinical presentation

• african american, asian, or hispanic infants
• lower back and buttocks
• absense of swelling or tenderness
• fade over months to years

Answer 24

Mongolian spots

Question 25

what is osteogenesis imperfecta

Answer 25

* genetic disorder resulting in brittle bones, due to problem with collagen formation * prone to repeated fx * prone to bruising, subdural hemorrhage, and retinal hemorrhage

Question 26

what is impetigo and how can it be differentiated from cigarette burns

Answer 26

* infection of skin caused by strep or staph * superficial layers only * cigarette burns are usually 3rd degree and heal with scarring

Question 27

What is phytophotodermatitis

Answer 27

* burn-like skin lesion when sun interacts with certain fruits/vegetables (lemons, oranges, celery, figs)

Question 28

what is Caida de mollera

Answer 28

* poultices * shaving of head * suction or immersion of top of head in water * seen in mexican american cultures

Question 29

describe spooning

Answer 29

* wet skin is rubbed with a spoon * causes ecchymosis * seen in china

Question 30

what is coining

Answer 30

* oiled coin is rubbed firmly into skin * seen in SE asia

Question 31

what labs should be gotten when you expect child abuse

Answer 31

* Coag studies * CBC with diff and platelets * CMP * amylase, lipase for pancreatic injury * UA * toxicology (serum and urine)

Question 32

what is first line imaging for abdominal injury if you expect abuse

Answer 32

CT with contrast

Question 33

skeletal survey is necessary in children under 9 months old with bruising in the following locations

Answer 33

\>1 bruise in any location

Question 34

skeletal survery is necessary in children \< 24 m.o with bruising if any of the following are present

Answer 34

* h/o confessed abuse * domestic violence * additional injuries on PE * patterned bruising * \> 4 bruises NOT limited to bony prominences * ear, neck, torso, buttocks, genital, hands, feet if no h/o trauma

Question 35

skeletal survery is necessary in children \< 12 m.o with bruising in the following locations

Answer 35

* cheeks, eye, ear, neck * upper arms or legs (not bony) * hands, feet * torso, buttocks, genital * \> 1 bruise NOT limited to bony prominences

Question 36

skeletal survery is necessary in children \< 6 m.o with bruising in the following locations

Answer 36

* bony prominences except if single bruise and patient presents with h/o fall