CYPT Flashcards
Define abusive head trauma
Constellation of symptoms, physical signs, laboratory, imaging and pathologic findings that are a consequence of violent shaking, impact or a combination of the two
List characteristic injuries of abusive head trauma
- intracranial hemorrhage
- retinal hemorrhage
- brain injury
- skull, rib, long bone fractures
Outline the approach to a patient with suspected abusive head trauma
- complete physical examination to detect any signs that may indicate injury or an alternate diagnosis
- ophthalmologic assessment (with dilated pupils)
- CBC with platelets
- Coagulation studies
- Glucose, lytes, metabolic screen, toxicology, microbiology
- Neuroimaging: CT for acute cases, MRI may provide additional information in delineating presence/location of intracranial injuries
- Skeletal survey (repeat 10-14 days after)
For an infant at risk of abusive head trauma with a normal physical examination, please list components of your evaluation
- ophthalmology
- neuroimaging
- skeletal survey
In which patients are autopsies necessary
All children under the age of two years who die in a sudden, unexpected, or unexplained manner
List features of accidental childhood trauma
- relatively small
- oval to round in shape with non distinct borders
- located above or near bony prominences on front of body (forehead, knees, shins)
- no recognizable shape or pattern
List red flags for inflicted injury in a child with bruising
- bruises in babies who are not yet cruising
- bruises on ears, neck, feet, buttocks, torso
- bruises not on front of body/overlying bone
- bruises that are unusually large/numerous
- bruises that are clustered or patterned
- bruises that do not fit with causal mechanism described
- **colour of bruising are not reliable indicators of age of bruise
List some hematologic conditions that cause bruising in children
- ITP
- vWD
- Factor 8 and 9 deficiency
- platelet function disorders
List some medical conditions that cause bruising in children
- infections
- malignancy
- neuroblastoma
- nutritional deficiencies
- systemic illness
- connective tissue disorders
- autoimmune/inflammatory disorders
List recommended first-line lab testing for bruising and suspected maltreatment
- CBC
- blood smear
- PTT, INR
- FIbrinogen
- vWD studies
- blood group
- Factor 8 & 9 levels
- liver function tests
- renal function tests
- Children
List injuries that are characteristic of Shaken Baby Syndrome
- retinal hemorrhage
- rib fractures
- end of long bone fractures (bucket fracture, corner metaphyseal lesion)
- intracranial hemorrhage
What are potential longterm health consequences of Shaken Baby Syndrome?
- developmental delay
- seizures
- paralysis
- blindness
- death
- no apparent effects
What are risk factors for Shaken Baby Syndrome?
- male
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