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Clin Med Peds > child abuse > Flashcards

child abuse Flashcards

1
Q

what are low specificity fx’s?

A

fracture that can happen in abuse and accident

  • femur fx’s
  • fibia/fibula fx’s
  • radius/ulna fx’s
  • skull fx’s
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2
Q

what kind of fractures are more commonly abuse in pre-ambulatory children (<1 y/o)?

A

extremity fractures

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3
Q

how many fractures are seen in >50% of abusive fx’s?

A

multiple fx’s

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4
Q

what are the 4 stages of dating fx’s?

A

induction, soft callus, hard callus remodeling

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5
Q

what is the induction phase of dating fx’s? (time characteristics)

A

3-7 days

inflammation, pain, swelling

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6
Q

what is the soft callus phase of dating fx’s? (time and characteristics)

A

infants: 7-10 days
child: 10-14 days

periosteal new bone formation

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7
Q

what is the hard callus phase of dating fx’s? (time and characteristics)

A

14-21 days

union at fracture site

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8
Q

what is the remodeling phase of dating fx’s? (time and characteristics)

A

3 months -1 year

woven to lamellar bone

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9
Q

what imaging is recommended for all children <2 y/o if suspect abuse?

A

skeletal surveys

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10
Q

most of the fx’s seen on skeletal surgery won’t be evident when?

A

clinical evident

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11
Q

skeletal surveys look for evidence of ___ fx’s

A

prior fx’s

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12
Q

when do you follow-up with skeletal survey?

A

at 2 weeks to pick up injury that wasn’t seen before

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13
Q

what fx’s are highly specific for abuse?

A

classic metaphyseal lesions (CML)

rib fx’s

acromion

spinous processes

scapular fx’s, sternal and pelvic fx’s, hand and foot in infants, occipital compression fx

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14
Q

classic metaphysical lesion fx’s are aka?

A

bucket handle dx b/c get fx at growth plate

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15
Q

what are bucket handle fx’s caused by?

A

forceful yanking or shaking

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16
Q

bucket handle fx’s are found on what imaging?

A

skeletal survery

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17
Q

where are bucket handle fx’s the most common?

A

distal femur, proximal tibia, and distal tibia (b/c near joints)

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18
Q

what 2 fractures are seen with shaken baby syndrome?

A

bucket handle fx’s and rib fractures

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19
Q

what fx’s are pathognomonic for shaken baby syndrome?

A

posterior rib fractures

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20
Q

posterior rib fx’s are due to what forces?

A

compressive

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21
Q

what 4 boney lesions are mistaken for abuse?

A

(1) osteogenesis imperfecta
(2) congenital syphilis
(3) osteomyelitis
(4) toddler’s fx

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22
Q

what does OI look like on x-ray?

A

radiolucent bones b/c not dense

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23
Q

s/s of OI? dx?

A

blue sclera, hearing loss, dental abnoramlities

dx: punch bx

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24
Q

how does congenital syphilis present?

A

diffuse osteomyelitis with symmetric metaphysical irregularities and diaphysial fx’s associated with extensive periostitis resembling traumatic lesions

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25
Q

how do you dx congenital syphilis?

A

focal erosion on medial aspect of proximal tibia (Wimberger sign)

confirmed by serologic testing

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26
Q

presentation of osteomyelitis in kids?

A

fever, swelling

hard to differentiate from abuse -> need good hx and referral to ortho for bx

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27
Q

what is a toddler’s fx?

A

spiral or oblique, non-displaced fx of the mid or distal tibia

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28
Q

does a toddler’s fx require a lot of force?

A

no, so may not be concerned for abuse if good story

29
Q

age of toddler’s fx?

A

2-4 y/o

30
Q

what is the definition of abuse?

A

child < 18 y/o, non-accidental harm (physical, emotional, sexual) adult that is in charge Ota king care of the child is “the abuser”

31
Q

what is the definition of physical injury?

A

any injury, death, FTT, addiction to drugs at birth

32
Q

what is the definition of neglect?

A

when caretaker deliberately doesn’t take care of kid with the resources they have

33
Q

what is the definition of abandonment?

A

if leave child with someone or without any building and after 4 weeks they don’t attempt to retrieve the child

34
Q

what does it mean when DCF screens “in”?

A

follow-up with investigation

35
Q

what does it mean when DCF screens “out”?

A

no investigation

36
Q

if you don’t cruise, you don’t ___

A

bruise

37
Q

what are pre-cruisers?

A

no upright ambulation

38
Q

what are cruisers?

A

walk upright holding onto another person’s hand or furniture

39
Q

what are walkers?

A

can take >/= 2 independent steps

40
Q

what are the 4 uncommon areas of accidental bruises?

A

back, chest, forearm, face

41
Q

where is bruising on ear common? due to what?

A

pinna

d/t pinching or hand slap to side of head

42
Q

brushing on neck is most common d/t what?

A

choking

43
Q

frenulum tears d/t?

A

forceful jamming of object into mouth

44
Q

human bite marks associated with what sign on skin?

A

petechiae in center of a circular lesion

45
Q

what is key for bite marks?

A

photo’s

46
Q

what are 7 injuries often mistaken for abuse?

A

(1) impetigo
(2) coining
(3) cupping
(4) monogolian spots
(5) henoch-schonlein purpura
(6) phytophotodermis
(7) sunburn

47
Q

what’s the leading cause of death and disability in kids < 2y/o?

A

abusive head trauma

48
Q

most accidental closed head injury occurs from what?

A

significant falls

49
Q

what are the most common accidental and abusive injuries in young children?

A

skull fx’s

50
Q

what is the pattern of most abusive skull fx’s?

A

linear

51
Q

when do you look for abusive head trauma in kids?

A

presence of multiple fx’s, presence of rib fx’s, presence of facial injury, < 6 months y/o

52
Q

what is commonly seen with abusive head trauma?

A

retinal hemorrhages

53
Q

what are the retinal hemorrhages d/t?

A

pulling of vitreous on retina during child being shaken

54
Q

what MUST you check with head trauma in baby?

A

the eyes -> for retinal hemorrhages

55
Q

retinal hemorrhages are evidence towards what syndrome?

A

shaken baby syndrome

56
Q

what’s the most common type of burns in kids?

A

scald burns

57
Q

what is the pattern of accidental scald burns?

A

see splash marks and are asymmetric

58
Q

what is the pattern of abusive scald burns?

A

symmetrical, bilateral, w/out splash marks

59
Q

what is the doughnut sign? worrisome for what burn?

A
  • spared flexor creases on foot

- worrisome of forced immersion burn

60
Q

what do immersion burns affect on the body? what do they spare? what does it look like?

A

affect feet, butt, both legs

spares knees

sharply delivered with no splash marks, jack-knife posture

61
Q

what are the most worrisome causes of vaginal discharge concerning for sexual abuse?

A

Intravaginal foreign body, gonorrhea, trichomonas, syphillis,

62
Q

what is the MOST concerning cause of veginal discharge concerning for sexual abuse?

A

gonorrhea

63
Q

what are the high-risk stirs for abuse?

A

gonorrhea, chalmydia >3 y/o, HIV with no known RF’s

64
Q

what’s the best position for genital inspection in girls?

A

supine, frog-leg

65
Q

what position is good for looking at the posterior rim of hymen?

A

prone, knees to chest

66
Q

what is the most common area with sexual abuse injuries?

A

posterior forcet

67
Q

when should you immediately examine a child for sexual abuse?

A

bleeding, discharge, injury

68
Q

what are follow-up resources for sexual abuse?

A

SANE
-if sexual assault occurred w/in last 72 hours or 13 y/o and in last 5 days

-trained in forensic medical exams

Clin Med Peds (10 decks)

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