Child abuse

Question 1

Types of child abuse?

Answer 1

Physical
Emotional
Sexual
Neglect
Munchausen syndrome by proxy

Question 2

MC child abuse?

Answer 2

Neglect (hardest to prove/document)

Question 3

Munchausen syndrome by proxy is?

Answer 3

Caregiver reports/causes factitious S/S in child

Question 4

Proof of physical abuse?

Answer 4

Bruises - varying stages of healing/unusual sites
Non-ambulatory infants
Injury patterns - suggestive
Burns - circumferential/immersion or cigarette

Question 5

Bruises on bony prominences is Abuse or NL?

Answer 5

NL

Question 6

Bone Fx sites suggestive of abuse?

Answer 6

Rib
Metaphyseal (Arm twist)
Scapular
Vertebral

Question 7

Injuries MC found in infants/toddlers?

Answer 7

Abdominal injuries

Question 8

Leading cause of mortality from physical abuse?

Answer 8

Head injuries

Question 9

Shaking or blunt impact abuse may cause?

Answer 9

Subdural or retinal hemorrhages

Question 10

DDx of physical abuse?

Answer 10

Mongolian spots
Cultural practices
Bleeding dyscrasias
Brittle bone Dz (Osteogenesis imperfecta)

Question 11

NL areas to find injury sites?

Answer 11

Forehead along brow
Nose/mouth
Occipital region - along back of head (Crown)
Upper buttocks - iliac crest
Shins/Knees/Elbows
Spinal protuberances

Question 12

Stages of bruising colors/days?

Answer 12

Red - 0-2d
Blue/Purple - 2-5d
Green - 5-7d
Yellow - 7-10d
Brown - 10-14d
Gone - 2-4w

Question 13

Fx types suggesting abuse?

Answer 13

Spiral

Bucket handle

Question 14

Unlikely bones to be Fx accidently?

Answer 14

Scapular
Posterior Rib Fx
Spinous process/vertebral
Skull (Non-linear)
Sternal Fx

Question 15

Youngest age to perform skeletal survey?

Answer 15

<3yo

Question 16

Skeletal survey Bone healing XR appearances/days?

Answer 16

1-2w = New periosteal bone/callus
2-3w= Lose Fx line - Callus matures to trabecular
3-6w= Callus more dense
>6w= Subtle, fusiform, sclerotic thickening

Question 17

Shaken baby syndrome triad?

Answer 17

Retinal Hemorrhage
Subdural Hematoma
Brain swelling

Question 18

Other interview indicators of physical abuse?

Answer 18

Wary of adult contact
Afraid to go home/caregiver
Withdrawn
Aggressive
Inappropriate clothing for weather
Moves uncomfortably
Controlling parents or physically directive

Question 19

Sexual abuse Pts may present w/?

Answer 19

Recurrent UTIs
Hypersexual (Precocious sexual behavior)
Guilt/low self esteem

Question 20

When should a sexual assault kit be used to evaluate pt?

Answer 20

Trauma w/in last 72h

Question 21

Interview clues of sexual abuse?

Answer 21

Advanced sexual knowledge/Promiscuity
Sudden school difficulties
Self imposed social isolation
Avoids physical contact
Depression
SI/attempt
Night-terrors/Nightmares
Runaway

Question 22

Emotional abuse presents as?

Answer 22

FTT/withdrawn/untrusting
Depression/poor bonding
Low self esteem/SI
Sleep issues
Somatic complaints
Excess anger/aggression

Question 23

Behavioral indicators of emotional neglect?

Answer 23

Habit d/o
Antisocial/Destructive
Developmental delay
Behavior extremes

Question 24

Neglect may present as?

Answer 24

FTT (type I growth deficit -wgt low (head/hgt NL)

Question 25

Behavioral indicators of neglect?

Answer 25

Self destructive
Beg/steal food
Constant fatigue
Adult responsibilities/concerns assumed
No caretaker at home
Parents not engaged/doesn't pay attention

Question 26

TXT/Resources for mgmt of abuse?

Answer 26

Thorough Hx
Complete PE - Trauma w/in 72h
CPS/Family advocacy