CYPT

Question 1

When should an investigation for AHT be done?

Answer 1

1. evidence of acute or chronic trauma with inconsistent, evolving or no explanation
2. severe HI after alleged short fall or minor trauma
3. unexplained HI in child who was well when last seen
4. subdural hemorrhage, retinal hemorrhage, rib or skull fracture or metaphyseal fracture

Question 2

What is included in the assessment of AHI?

Answer 2

complete physical exam
retinal exam by optho
CBC, lytes, glu
renal function
coags
metabolic screen, tox screen and microbiology
skeletal survey, then 10-14d later
CT head for acute cases
MRI for additional info re presence or location of injury

Question 3

what is strongly suggestive of AHT?

Answer 3

Traumatic retioscisis

Question 4

Who is involved in investigation of AHT?

Answer 4

medical physician
Child proteiction agency
police
psychosocial professionalas (SW, psychologist)
Coroner (if death)
neurosurgery
neurology
optho
radiologist

Question 5

What are the risk factors for shaking a baby?

Answer 5

Social isolation
substance abuse
psychiatric problems
parent having been abused themselves
family violence
poor parental attachment to the child

Question 6

What is in the ddx for bruises?

Answer 6

congenital dermal melanocytosis (Mongolian spot)
erythema multiforme
incontinentia pigmenti
cupping and coining practices
discolouration from dyes
hemangioma
photophytodermatitis

Question 7

What are the characteristics of accidental bruising?

Answer 7

small
oval to round shape with nondistinct borders
no recognizable pattern to shape of bruise
front of body
on or above bony prominence (forehead, knees, shins)
makes sense in context of developmental ability of child

Question 8

what are the red flags for inflicted injury?

Answer 8

Bruises in babies not yet cruising
bruises on back of neck, ears, chest, back, abdo, buttock, genitalia, feet
bruises not on front of body or overlying a bone
patterned bruises
numerous or unusually large bruises
bruising not fitting with causal mechanism described

Question 9

Should babies not cruising be bruising?

Answer 9

No,

Question 10

Is colour a reliable indicator for aging bruises?

Answer 10

No; colour or progressive changes in colour is NOT a reliable indicator of the age of bruise

Question 11

what is the most common ACQUIRED disorder of coagulation?

Answer 11

ITP

Question 12

Most common inherited coagulation disorder

Answer 12

vWD>hemophilia A> hemophilia B

BUT hemophilia A more commonly dx in pediatric population

Question 13

Other than hematoloic disorders, what medical conditions are associated with bruising?

Answer 13

Infections (meningococcemia)
Severe systemic illness (DIC)
Malignancies (leukemia, neuroblastoma)
connective tissue disorders (ED, OI)
autoimmune/inflammatory (ITP, HUS)
Nutritional deficiency (vit K, vit C def)

Question 14

What hematologic disorders are associated with bruising?

Answer 14

ITP, vWD, Hemophilia A, Hemophilia B

Question 15

What is important on hx in pt with bruising in infancy?

Answer 15

post circumcision bleeding
cephalohematoma
IV site bleeding
bruising at pressure sites (car seat fastener)
bruising at clothing pressure sites
macroscopic hematuria
bleeding with separation of umbilical stump

Question 16

What is important on hx in family and index child?

Answer 16

spontaneous, easy or excessive bruising
gingival bleeding
epistaxis lasting more than 10min or needing medical attention
GI or GU bleeding
excessive bleeding after surgery
menorhhagia
hx of blood transfusion
joint swelling after minor trauma
hx of unexplained anemia
bleeding from minor wounds
FHx: bleeding d/o, d/or predisposing to bleeding (ED), consanguinity, moms periods, postpartum bleeding, need for transfussions, recurrent severe epsistaxis
SHx: family disciplinary methods and childs behaviour

Question 17

What is important on physical exam?

Answer 17

injury to frenulum
dental health
full skin exam
dysmorphisma
HSM, LN
joint hypermobility and skin laxity

Question 18

What lab tests to order if bleeding and suspected child abuse?

Answer 18

CBC
peripheral blood smeat
PTT/INR
aPTT
liver function (for secondary plt dysfunction)
kidney function (for secondary plt dysfunction)
factor 8
factor 9
fibrinogen
vWD studies
blood group (for interpretation of vWD studies)

Question 19

What tests need to be done in all children under 2 with bleeding and suspected abuse?

Answer 19

skeletal survey
consider head imaging
optho eval

Question 20

when are parents more likely to use physical punishment?

Answer 20

if they experienced it themselves
if they approve of it
hx of depression or other stress
if they feel anger in response to child’s behaviour