Clinical Approach to Child/Elder Abuse (Schmidt)

Question 1

What are some signs of child maltreatment?

Answer 1

1) Fussy, colicky infant
2) Hyperactive behavior
3) Illness
4) Non-biologic relationship with caregiver
5) Prematurity

Question 2

What is an important caregiver risk factor for child maltreatment?

Answer 2

Substance abuse

Question 3

What are the four main types of child abuse?

Answer 3

1) Neglect
2) Emotional
3) Physical
4) Sexual

Question 4

What is the most common type of child abuse?

Answer 4

Neglect

Question 5

Neglect is the most common cause of?

Answer 5

Death in abused children

Question 6

What is the physician’s role when suspecting neglect?

Answer 6

1) Full medical history
2) Psychosocial history
3) Complete physical exam

Question 7

What should you do when suspecting neglect, even when in doubt?

Answer 7

Ensure safety of child and contact Child Protective Services

Question 8

When should the physician report to child protective services due to emotional abuse?

Answer 8

If it appears recurrent or possibility of imminent harm to child

Question 9

What are suspicious signs of abuse on the physical exam?

Answer 9

1) Posterior rib, scapular, and sternal factures
2) Cigarette burns
3) Metaphyseal lesions

Question 10

What are the three types of sexual abuse?

Answer 10

1) Non-touching
2) Touching
3) Exploitation

Question 11

What are examples of non-touching sexual abuse?

Answer 11

1) Expose child to porn

2) Neglectfully allow child to see/hear active sexual activity

Question 12

What are examples of sexual exploitation?

Answer 12

1) Engaging a child for purposes of prostitution
2) Using a child to film, photograph or model pornography
3) Human trafficking

Question 13

Most victims of sexual abuse are in what age range?

Answer 13

9-12 years old

Question 14

While 25% of US females report were a victim of child sexual abuse, what percentage of victims have never told anyone?

Answer 14

50% - 70%

Question 15

In the evaluation of sexual abuse what is the general rule in diagnosis?

Answer 15

No single behavior, sign, or symptom is diagnostic

Question 16

What is usually found on PE when examining a child for sexual abuse?

Answer 16

Normal PE

Question 17

If immediate interview is necessary, what should be done?

Answer 17

Minimal Facts Interview

Question 18

What is asked in a Minimal Facts Interview?

What should be avoided?

Why is this question avoided and what should be asked instead of this question?

Answer 18

1) Who, what, where, how
2) When
3) Young children are poor at spatial timing, instead ask “Did this happen one time or more than one time?”

Question 19

What are very high risk populations for sexual abuse?

Answer 19

1) Deaf children
2) Developmentally disabled adults
3) Transgender

Question 20

What is a Class A misdemeanor in Missouri and a Class B in Kansas for physician’s when presented with a sexual abuse case?

Answer 20

Failure to report

Question 21

What are victim risk factors for elder abuse?

Answer 21

1) Dementia, psychiatric diagnosis
2) Physical dependence
3) Incontinence

Question 22

What is a perpetrator characteristic for elder abuse?

Answer 22

Substance abuse

Question 23

What are the types of elder abuse?

Which type makes up 50% of cases?

Answer 23

1) Physical
2) Sexual
3) Psychological
4) Financial
5) Neglect (50% of cases)

Question 24

What are abuse signs of elderly neglect?

Answer 24

1) Lack of nutrition
2) Poor personal care
3) Lack of medications

Question 25

What are signs of elderly abuse in terms of bruises?

Answer 25

Often bilateral and on the inner surface of the arms from being grabbed

Question 26

What are signs of elderly abuse in terms of burns?

Answer 26

Often cigarette burns

Question 27

What are signs of elderly abuse in terms of fractures?

Answer 27

1) Fractures at different stages of healing

2) Spiral fractures caused by twisting of limbs

Question 28

What are other common signs of elderly abuse?

Answer 28

1) Wrist rope burns
2) Injury to mouth caused by forced feeding
3) Depleted personal finance

Question 29

What is a class A misdemeanor in Missouri (1 year jail + $2,000 fine) and a class B misdemeanor in Kansas (6 months jail + $1,000 fine) in terms of elderly abuse?

Answer 29

Failure to report