Exam 3: Child abuse

Question 1

most common forms of abuse? General estimates (Even though they are unreliable estimates)

Answer 1

physical (5-7/1000 per yr)
sexual (3-5/1000 per yr)
emotional

(physical/emotional/educational/medical neglect) (10-15/1000 per year neglected)

Question 2

Most common forms of abuse? General estimates (Even though they are unreliable estimates)

Answer 2

physical (5-7/1000 per yr)
sexual (3-5/1000 per yr)
emotional

*physical/emotional/educational/medical NEGLECT is most common –> 10-15/1000 per yr

Question 3

what is the role of the physician in uncovering abuse?

Answer 3

• recognition and reporting
• tx
• prevention
• advocacy

NOT to figure out WHO is the offender.

Question 4

two biggest clues of abuse case?

Answer 4

1) history that does not fit with presentation

2) delay in seeking care

Question 5

2 most common features of child abuse cases? (and others)

Answer 5

• *1) history that does not fit with presentation
• *2) delay in seeking care
• stressed caretaker
• behavior of child –> crying, toileting
• prior hx of abuse in abuser

Question 6

gaze aversion

Answer 6

avoiding dealing with real problem because of discomfort with topic (not acknowledging abuse when baby comes in with discrepant history)

Question 7

Tin Ear Syndrome

Answer 7

bruising of pinna –> sign of ipsilateral subdural and retinal hemorrhages present

Question 8

Immersion burns

Answer 8

pattern of skin scalding on butt

-avoid by setting hot water heater to LOW –> preventable at 120 degrees, instate at 145-150 (HIGH)

Question 9

skull fractures

Answer 9

single linear usu= accidental fall

DEPRESSIONS are often abusive –> rely on history

Question 10

What is seen on CXR of babies squeezed while crying?

Answer 10

posterior, bilateral calloused rib fractures

Question 11

injury pattern caused when pulling a child by arm/ leg?

Answer 11

spiral fracture

Question 12

metaphyseal fractures

Answer 12

• diagnostic of abuse and rough handling
• indicative of prior injury
• “bucket handle” on xray

Question 13

subdural hemorrhage

Answer 13

=abuse in absence of severe trauma

used to be high incidence in car accidents, before seat restraint laws

Question 14

should you do fundascopic exams on every infant, child, adolescent you see?

Answer 14

yes. retinal hemorrhages

Question 15

conditions associated with child abuse?

Answer 15

• alcohol abuse
• drug abuse –> meth
• interpersonal violence –> spouse/partner abuse

Question 16

prevention of physical abuse

Answer 16

• parent education
• randomized public health nurse home visitation –> last two trimesters + first 2 years of life decrease phys abuse by 87%

Question 17

prevention of sexual abuse

Answer 17

• INTERNAL inhibitors- laws, moral standards
• EXTERNAL inhibitors –> presence of others
• resistance by child (can be overcome by erosion of resistance by developing a relationship with child over time)

**drugs and alcohol are disinhibitors

Question 18

mouse experiments with fosB

Answer 18

FosB KOs were not nurturing to pups –> did not make nest, pups died

could REVERSE this outcome if NE given prior to birth

Question 19

MAO activity?

Answer 19

higher activity predicts “Survival” in boys subjected to early abuse. Low levels –> repetition of cycle

Question 20

what is different about the brain of pedophiles?

Answer 20

reduced amygdala size –> area of brain critical for sexual development

Question 21

when reporting….

Answer 21

be direct. “I saw this/ thought this, since I cannot investigate I am obligated to report”