CYPT and Ethics Flashcards
Which is not a risk factor for child maltreatment?
a) Poverty or single parent household
b) Corporal punishment or spanking
c) Parental history of substance abuse or mental health problems
d) Parental history of low educational status
e) Parental history of domestic violence or child abuse
b) Corporal punishment or spanking
What are some child specific factors that increase risk for abuse?
speech and language disorders learning disability failure to thrive ADHD chronic or recurrent illnesses prematurity unplanned pregnancy/unwanted child
What are environmental factors that increase risk for child abuse?
unrelated adolescent or adult male in the house
intimate partner violence
animal cruelty
acute or chronic family stressors (job loss, divorce, illness)
living in poverty
no supports/isolation (no family around)
What are features of a caregiver that make them more likely to abuse their children?
young or single parents
lower education
unrealistic expectations of the child/poor knowledge of child development
caregiver was abused or neglected as a child
substance or alcohol abuse
psychiatric illness
What age group is most likely to be sexually or physically abused?
a) 0-7 years
b) 8-15 years
c) >15 years
a) 0-7 years
What are some factors that protect a child against abuse?
healthy, intelligent, engaging child
parent: higher education attainment, organized, mother’s concern for child
family: both parents involved, support from extended family
community: access to health care, safe neighbourhood
Which of the following is a risk factor for child abuse?
a. prematurity
b. daycare attendance
a. large families
b. older parents
a. prematurity
Which is true regarding infants of depressed mothers:
a) Infants of depressed mothers tend to be more fussy and withdrawn than infants of non-depressed mothers
b) If the father is involved, it minimizes the negative impact of the mother’s mood on the infant
c) A mother with postpartum depression should not breast feed
d) As soon as the mother’s depression has resolved, the infant will revert to normal
e) There is no risk of attachment disorders in infants of depressed mothers
a) Infants of depressed mothers tend to be more fussy and withdrawn than infants of non-depressed mothers (infant can be withdrawn and can experience anger and turn away from mother)
Note: CPS does say:
o Father: non depressed fathers could ‘buffer’ effect of mother’s depression on infant interaction behaviour
Which pair cannot have legal consenting sex?
a) 16 year old high school couple
b) 16 year old and 22 year old teacher
c) 12 year old and 13 year old friends
d) 14 year old and 18 year old couple
e) 13 year old and 15 year old teammates
b) 16 year old and 22 year old teacher
● A 16 or 17 year old cannot consent to sexual activity if their sexual partner is in position of trust or authority towards them, for example their teacher or coach
Close in age exceptions
● A 14 or 15 year old can consent to sexual activity as long as the partner is less than five years older and there is no relationship of trust, authority or dependency or any other
exploitation of the young person
● A 12 or 13 year old can consent to sexual activity with a partner as long as the partner is less than two years older and there is no relationship of trust, authority or dependency or any other exploitation of the young person
5 month old girl, Sarah, is in foster care - her twin was recently diagnosed with shaken baby syndrome. Foster parents report no complaints – is feeding and sleeping well.
Physical examination is completely normal. What three investigations would you do in this child?
- skeletal survey
- retinal exam with dilated pupils by ophthalmologist
- head CT
Per CPS statement on AHT (specific point on investigation of sibs, EVEN if normal physical exam)
A 20 month old boy is seen by his GP and sent to the ER because of decreased LOC and bruising. The mother reports “He jumped out of bed 3 times because he wanted attention. He was limping afterwards and was whiny.” The remainder of the history is unremarkable. After medical stabilization, which investigations would you order? 1- CBC, coags, vWscreen, renal fxn, LFTs, urine, plt fxn assays 2- Skeletal survey 3- CT Head, Ophtho Consult a) 1 and 2 b) 1 and 3 c) 2 and 3 d) 1, 2, and 3
d) 1, 2, and 3
- confirmed by CPS statement
What are risk factors for abusive head trauma?
- male
- <6 months old
- young parents, social isolation
- toileting or feeding difficulties
What are the most common acquired and inherited coagulation disorders?
Acquired: ITP
Inherited von Willebran disease (1% of population)
- hemophilia A is the most commonly diagnosed inherited coagulation disorder in pediatrics
Which of the following is not a cause of subdural hemorrhage?
a) Accidental short fall
b) Birth trauma
c) MVC
d) Minor or no trauma with factor 13 deficiency
e) Minor trauma with Marfan syndrome
f) Abusive head trauma
e) Minor trauma with Marfan syndrome
List FOUR fracture types are that highly specific for child abuse.
- CMLs (classic metaphyseal lesions of long bones)
- rib fractures, especially posteromedial
- scapular fractures
- sternal fractures
(all high specificity per AAP paper on fractures and physical abuse)
Most physical abuse occurs in the context of corporal punishment.
a) True
b) False
a) True
Most physical abuse is physical punishment in intent and form. Incidents of confirmed abuse often result from physical punishment but parents cannot control their own anger or are not aware of their own strength or the child’s vulnerabilities. In Canada, 75% of cases of substantiated physical abuse started as corporal punishment
Children who are physically abuse are more likely to have all of the following except.
a) Conduct disorder
b) Physically aggressive behaviour
c) Poor academic performance
d) Decreased cognitive functioning
e) Increased resilience
e) Increased resilience
Which is most likely an abusive fracture?
a) Spiral fracture of femur in 3 year old
b) Spiral fracture of the tibia in 15 month old
15
c) Lateral rib fracture in 8 month old
d) Radial buckle fracture in 2 year old
c) Lateral rib fracture in 8 month old
In a 2 year old girl, which of the following fractures is MOST concerning for child abuse?
a) Clavicle
b) Femur
c) Scapula
d) Linear skull fracture
c) Scapula
What is on the differential diagnosis of a fracture that is suspicious for abuse? (name at least 4)
osteopenia of prematurity OI nutritional deficiencies (Rickets, scurvy, copper deficiency) osteomyelitis neoplasia congenital syphilis renal osteodystrophy
A child is sent to the hospital for pneumonia. There is an obvious consolidation on the chest x-ray, but the radiologist calls you to inform you that he also sees several rib fractures, and he is worried about child abuse. What do you do:
a) inform parents that you think they abused the child, call Social Services to arrange foster care
b) call Social Services and send the child back to the referring doctor
c) tell the parents that you are admitting the child for pneumonia, and investigate for other injuries
d) do further investigations before informing the parents
e) discuss the fractures with the parents, explain the need to inform Social Services, and admit the child for further investigations
e) discuss the fractures with the parents, explain the need to inform Social Services, and admit the child for further investigations
5-year-old child is sexually abused. Definitive evidence is most likely to come from:
a) the child
b) the parents
c) the physical examination
d) cultures positive for STDs
d) cultures positive for STDs
STI in a prepubertal child:
- gonorrhea beyond neonatal period - diagnostic
- trichomonas beyond one year of age - highly suspicious
- chlamydia beyond three years of age - diagnostic
- syphilis and HIV only indicative of abuse if other means of transmission excluded (perinatal, transfusion for HIV) - but if no way it could have been transmitted otherwise then diagnostic for abuse
- genital warts: low specificity for abuse (but consider it on differential and discuss with family, especially in kids who first present with warts after the age of 3) - suspicious
- HSV1/2 concerning but not diagnostic, ditto HPV
5 year old child tells daycare worker her father was sexually abusing her. A full exam is performed. Showed picture of normal hymen, child examined in frog leg position. What does this show.? Based on your findings what will you report to child services and the
authorities?
this image shows a normal hymen/normal genital exam. Physical exam is usually normal in children assessed for suspected sexual abuse. A normal physical exam does not make the occurrence of sexual abuse any more or less likely
(95% of children examined for sexual abuse have a normal exam)
What are some physical exam findings that are in keeping with sexual abuse?
- lacerations/bruising of labia, penis, scrotum, perianal tissues or perineum are indicative of trauma
- hymenal bruising and lacerations, perianal lacerations extending deep to external anal sphincter indicate penetrating trauma
- complete transection of hymen between 4-8 o’clock - diagnostic for trauma (need to ask about cause of injury)
Which of the following physical findings would make you most suspicious of child abuse:
a. anal markings away from the midline
b. anal tags at the midline
c. anus opening 20 mm with stool in the rectum
d. 3 mm hymenal opening in a 3 year old
e. parchment, reddened skin in vaginal area
a. anal markings away from the midline
