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Peds II > Exam 2 - Child Abuse > Flashcards

Exam 2 - Child Abuse Flashcards

1
Q

What is the most common cause of lethal child abuse?

A

Abusive head trauma

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2
Q

In what age group does child abuse most often occur?

A

< 3 years of age

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3
Q

In what age group does the majority of deaths from child abuse occur in?

A

< 12 months of age

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4
Q

What are the four categories of child abuse?

Which category is most common?

A
  • Physical
  • Neglect
  • Sexual
  • Emotional

Neglect is most common

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5
Q

What are characteristics of unintentional bruising versus inflicted/intentional bruising?

A

Unintentional:
- Located on bone prominences such as forehead, knees, front of body (places you expect people to hit when falling)

Inflicted:

  • Central bruising (buttocks, back, trunk, inner thighs, neck, ears)
  • Multiple bruises in clusters
  • Human bite marks
  • Bruising in babies that are not independently mobile, or < 6 months
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6
Q

Bruising in what part of the body should cause a high level of suspicion?

A

Facial bruising

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7
Q

How can you differentiate a bite from a child versus an adult?

A

Due to distance between maxillary inter-canines which is 2.5-3 cm in an adult

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8
Q

When should you suspect possible abuse in a child with a burn?

A

Scalds in children < 5 years without unintentional spill pattern

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9
Q

What is the second most common injury in physical abuse?

A

Fractures

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10
Q

What are some fractures of high suspicion?

A
  • Rib fractures in babies, especially < 1 year
  • Long bone fractures in non-walking children
  • Multiple fractures in various stages of healing
  • Depressed skull fractures
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11
Q

Which type of intracranial bleed occurs more often in unintentional head trauma?

A

Epidural hemorrhage

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12
Q

Which type of intracranial bleed is present in nearly all fatal inflicted head traumas?

A

Subarachnoid hemorrhage

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13
Q

What is frequently seen on eye examination in a child with abusive head trauma?

A

Retinal hemorrhage

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14
Q

Which type of skull fracture should abuse be suspected in?

A

More complex, depressed skull fractures

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15
Q

What are other possible differentials other than abuse in a child that presents with bruising?

A
  • Salicylate ingestion
  • Mongolian spots
  • Coagulopathy
  • Vasculitis
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16
Q

What is an exam finding that can help you differentiate bruising due to abuse from Mongolian spots?

A

Mongolian spots will have absence of swelling or tenderness and typically are limited to the back and buttocks

17
Q

What is one exam finding that can help you differentiate bruising due to abuse from vasculitis?

A

Vasculitis will have a purpuric rash and lesions

18
Q

What are other possible differentials other than abuse in a child that presents with fractures?

A
  • Osteogenesis imperfecta
  • Nutritional deficiencies
  • Pathologic/Neoplasm
19
Q

What are other possible differentials other than abuse in a child that presents with burns?

A
  • Unintentional
  • Impetigo
  • Phytophotodermatitis
20
Q

What is one exam finding that can help you differentiate burns due to cigarettes burns from impetigo?

A

Cigarette burns are typically more defined, third degree, and heal with scarring while impetigo is only the superficial layer

21
Q

What is the primary study that you should order if concerned for skull fracture?

A

Non-contrast CT

22
Q

What is the primary study that you should order if concerned for spinal fracture?

A

CT with contrast/MRI for nerve root or spinal cord injury

23
Q

What is the primary study that you should order if concerned for thoracic injury?

A

CT with contrast

24
Q

What is the primary study that you should order if concerned for abdominal injury?

A

CT with contrast

25
Q

When should a skeleton survey be performed in a child < 24 months with bruising?

A

> 4 bruises not on bony prominences:

  • Ears, neck
  • Torso
  • Genitals/buttocks
  • Feet or hands
26
Q

When should a skeleton survey be performed in a child < 12 months with bruising?

A

> 1 bruise not on bony prominences:

  • Cheeks, eyes, ears, neck
  • Torso
  • Upper arms/legs
  • Genitals/buttocks
  • Feet or hands
27
Q

When should a skeleton survey be performed in a child < 9 months with bruising?

A

> 1 bruise, ANY location

28
Q

When should a skeleton survey be performed in a child < 6 months with bruising?

A

Any bruising with exception of reported fall and a single bruise

29
Q

Who should be contacted in cases of suspected child abuse?

A

CPS and law enforcement

Peds II (11 decks)

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