Mehl. kids abuse + Trichotillomania + skin + bidy dysmorphic

Question 1

Child abuse. fractures?

Answer 1

Spiral fractures (rotational/twisting force applied to bone).

Posterior rib fractures (squeezing).

Question 2

Child abuse. Skin?

Answer 2

Circular burns (cigarettes).

Burns sparing flexor regions (from being dipped in hot water [child flexes limbs to ̄ exposed surface area).

Question 3

Child abuse. CNS? 2

Answer 3

Retinal detachment / hemorrhages.
Subdural hematoma (shaken baby syndrome).

Question 4

Child abuse. contact?

Answer 4

Avoidance of eye contact (if they say Hx of meningitis, think instead neurosensory hearing loss).!!!!!!

Question 5

Trichotillomania. definition?

Answer 5

Pulling out one’s hair; can be anywhere (i.e., eyebrows, scalp, etc.).

Question 6

Trichotillomania.
!!!!!!!Patient may sometimes also eat his/her hair, leading to gastric bezoar (asked on NBME exam). This is an undigestible mass that can lead to bowel obstruction.

Answer 6

.

Question 7

Skin-picking disorder. definition?

Answer 7

Aka excoriation disorder.
Patient picks at his/her skin, leading to skin lesions.

Question 8

Body dysmorphic disorder.

Excessive preoccupation with one or more aspects of one’s appearance, leading to socio-occupational dysfunction.

Answer 8

.

Question 9

Trichotillomania, Skin-picking disorder, Body dysmorphic disorder. Tx?

Answer 9

CBT can be attempted for all of these conditions, otherwise anti-depressants like SSRIs can be tried.