Child Abuse

Question 1

Suggest abuse in children

Answer 1

Spiral fractures of the humerus and femur

Question 2

shaken baby syndrome (SBS) test

Answer 2

Ophthalmologic exam to rule out retinal hemorrhages

Noncontrast CT for subdural hematomas

Question 3

Fractures to watch out for in Child abuse

Answer 3

Epiphyseal-metaphyseal “bucket fractures”: Suggest shaking or jerking of the child’s limbs; highly diagnostic of physical abuse in an infant.
Posterior rib fractures: Usually caused by squeezing of the chest.
Fractures in various stages of healing

Question 4

Definitive evidence of sexual abuse once isolated from vaginal culture

Answer 4

Neisseria gonorrhoeae isolated on a vaginal culture is definitive evidence of sexual abuse. Chlamydia trachomatis is not because it can be acquired from the mother during delivery and can persist for up to 3 years.