LEcture 17: Child Abuse & Neglect

Question 1

T/F: Failure to act falls under child abuse.

Answer 1

True

Question 2

T/F: Neglect due to lack of financial means still falls under child abuse

Answer 2

False

Thats what im guessing?

Question 3

T/F: Sexual contact under sexual abuse applies even if victim is married to the actor.

Answer 3

False

If i am misinterpreting pls lmk

Question 4

80% of child abuse deaths occur to children younger than () years

Answer 4

4 years old

Question 5

T/F: Referral and CPS contact means a child is extremely unlikely to die from child abuse.

Answer 5

False

Question 6

Who is required to report child abuse?

Answer 6

ANYONE who suspects it!

She wrote anyone, but then had this slide after.

Question 7

Failure to report suspected child abuse is a (misdemeanor/felony) in 40 states

Answer 7

Misdemeanor

Can upgrade to felony if child is harmed and you shouldve suspected.

Question 8

Although abuse is very tragic, we do need to keep in mind that ()

Answer 8

Not all abusers do it intentionally

Question 9

One of the biggest common historical features seen in child abuse is that there was a () in seeking care

Answer 9

delay

Question 10

The two biggest red flags of child abuse seen are () of care and () injury

Answer 10

• Delay of medical care
• Unwitnessed injury

Question 11

The MC form of child abuse is ()

Answer 11

Neglect

75%+ of reported CPS cases

Question 12

The #1 way children are neglected is via…

Answer 12

Inadequate supervision

Used to be FTT

Question 13

Child neglect should always be reported to () and any child experiencing FTT should be ()

Answer 13

• Report to CPS
• Hospitalize FTT kids

Also educate parents, maybe they are first-time and really clueless

Question 14

Children who return to their families after an event of maltreatment can have up to a 50% chance of recurrent events. The recurrent abuse type is ()

Answer 14

Neglect again :(

Question 15

The most common perpetrators of physical child abuse are…

Answer 15

Biological parents, esp fathers (abusive head trauma)

Mother’s BFs, female sitters, then mothers

Question 16

Physical abuse is slightly different than discipline because discipline is (), it is not due to (), and it is not to keep their child in line.

Answer 16

• Discipline is usually predictable
• It usually is not due to anger

Question 17

The MC physical finding seen in child abuse is…

Answer 17

Bruises (esp weird ones)

Question 18

Sentinel injuries can be memorized by the mnemonic TEN-4, which means:

She had two images

Answer 18

• Trunk
• Ear
• Neck
• In any child less than 4 months = suggestive of abuse

A child cannot roll over prior.

Question 19

The most common isolated fx in child abuse is…

Answer 19

Femur

Question 20

Fx of what bone is pretty indicative of abuse?

Answer 20

Rib fx

71%

Question 21

The most normal bruising areas in a child that are NOT suspicious would be

Answer 21

• Elbows
• Shins

As long as they are a toddler or older

Question 22

The most common fx seen on XR in physical abuse is…

Answer 22

Spiral or transverse fx of the diaphysis of long bones.

Question 23

In a patient 2 years or younger with a suspicious fx, the imaging of choice is…

Answer 23

Skeletal survey

Question 24

A child suspected of being a victim of physical abuse might need labs ordered, such as: (2)

Answer 24

• CBC/Coags
• ALT/AST/Lipase (internal injuries)

Question 25

One of the biggest red flags when it comes to interviewing a child is ()

Answer 25

A parent who won’t let the child interview alone

Question 26

T/F: Sexual abuse also includes exposing a child to sexual situations/abusive materials

Answer 26

True

Flashing, undressing, showing porn, or saying dirty jokes

Question 27

Gonorrhea/Syphilis is diagnostic of sexual abuse after the () period

Answer 27

Perinatal period

Question 28

Chlamydia, Trich, and HIV is only diagnostic of sexual abuse if the mother had ()

Answer 28

A prenatal care workup.

Question 29

The presence of these (4) STDs is not automatically diagnostic of sexual abuse.

Answer 29

• HSV
• HPV
• BV
• Molluscum

Question 30

The main factor in deciding whether you go to the ED vs sexual abuse clinic for sexual abuse management is…

Answer 30

120 hours or less = ED

And always refer to CPS!

Im guessing high suspicion but 120+ hrs is still sexual abuse clinic

Question 31

T/F: You should always perform a speculum exam in all cases of sexual abuse.

Answer 31

False. Only if active bleeding.

Question 32

The anogenital area for a child is best viewed in the () position

Answer 32

Knee-chest

Question 33

A rape kit is needed if sexual abuse occurred within the past () hours

Answer 33

120 hours

Otherwise culture G/C and evaluate for trichomonas

Question 34

Sexual assault cases require serum testing for (3) STDs at baseline, 3 months, 6 months, and 12 months

Answer 34

• RPR (syphilis)
• Hep B
• HIV

Question 35

Sexual abuse requires () prophylaxis, but () and () are only for high risk.

Answer 35

• Always do STI prophylaxis with Rocephin + Metro + Azithromycin
• Hep B with Ig for high risk
• HIV for high risk

Also pregnancy prevention if its been less than 120 hours.

Question 36

Generally, the first-line treatment for emotional child abuse is…

Answer 36

Parental education

Can also refer to psychologist and psychiatrist.

CPS only for extreme cases

Question 37

The most common perpetrator of Munchausen by Proxy is…

Answer 37

Mother

85% of the time!!!!!!!!!!!!!

Question 38

Munchausen by Proxy can be characterized by a child’s symptoms () in the hospital, but () at home

Answer 38

Improving in the hospital, but worsening/recurring at home

Question 39

Generally, the primary way to prevent child abuse is…

Answer 39

Parent education!

Question 40

If you suspect child abuse, you should call (3)

Answer 40

• Police
• CPS
• Hospital personnel

Question 41

Any sort of injury on the () is suspect

Answer 41

Ear