Child Abuse

Question 1

What are normal variants of anogenital findings?

Answer 1

1. Hymenal notches or transection in anterior half
2. Genitoanal erythema
3. Perianal skin tags
4. Midline anal fissures
5. Anal dilatation

Question 2

What genital/anal findings are consistent with trauma suggestive of sexual abuse?

Answer 2

1. Acute: perineum laceration or bruising
2. Nonacute: Complete transection of hymen in posterior (3 to 9o’clock position)
3. Anal dilation >20mm without stool
4. Non-midline anal lesions

Question 3

What is the most common physical exam finding of sexual abuse?

Answer 3

Normal physical exam (95%)

Question 4

The most common head injury from abusive trauma is:

Answer 4

Subdural hemorrhage

Question 5

True/false: daytime institution increases risk of sexual abuse in chronic/disabled children.

Answer 5

True

Question 6

What 6 fractures are suggestive of abuse?

Answer 6

Scapula
Vertebral (spinous processes)
Sternum
Complex skull
Posterior ribs
Classic metaphyseal lesions (bucket/corner)

(less indicative: epiphyseal separation, digital fractures, multiple fractures, fractures of different ages)

Question 7

List the risk factors for child abuse.

Answer 7

Child: congenital anomaly, delay/disabilities, failure to thrive, ADHD with hyperactivity, unwanted child, prematurity
Environment: low SES, social isolation, family stressor, domestic violence, unrelated adult in the household
Caregiver: young parents, low education in parents, parental substance abuse, parental psychiatric illness

Question 8

What is the timeframe of efficacy with postcoital contraceptive?

Answer 8

Most effective within 72h, can work up to 120h (5d)

Question 9

What can help prevent child abuse?

Answer 9

1. Nurse home visit

2. Parenting class

Question 10

What are the three most diagnostic STD for sexual abuse in children?

Answer 10

Syphillis, HIV, gonorrhea

Question 11

What can cause retinal hemorrhage?

Answer 11

Trauma (accidental/NAI), birthing (SVD, AVD, C/S), other illnesses (sepsis, inflammatory). Usually NOT CPR.

Question 12

What are the worrisome features for burns?

Answer 12

Symmetrical burns, lower extremities/perineum, >10% BSA, sharp demarcation, stun gun/cigarette burns, full thickness burns

Question 13

The age of consent for sexual activity is:

Answer 13

16 years, but when “exploitive” then 18 years

Question 14

What is the age gap for consent to sexual activity for 14 and 15 y.o.?

Answer 14

5 years (unless they are married to each other) and non exploitive

Question 15

What is the age gap for consent to sexual activity for 12 and 13 y.o.?

Answer 15

2 years and non exploitive

Question 16

greatest risk factor for child maltreatment (caregiver characteristic)

Answer 16

caregiver is a victim of domestic violence

Question 17

“red flags” for bruising

Answer 17

patterned, bilateral/symmetrical, unusually large/numerous, do not fit mechanism of injury, location (axial, ears, genitals, any soft padded places), non-mobile child

Question 18

fracture locations that are more specific for abuse

Answer 18

ribs, long-bone metaphases, scapula, sternum, vertebral spinous processes

Question 19

what is a sentinel injury?

Answer 19

a minor injury that is externally visible to health care providers (most common = bruising)

Question 20

how do you assess humoral immunity?

Answer 20

assess number and function (quantitative Ig levels - GAME, B-cells by flow cytometry), vaccine titers, isohemagglutinin antibody (anti-A or anti-B)