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FRCPC > SCAN > Flashcards

SCAN Flashcards

1
Q

Bruising red flags

A

Non-ambulatory/babies not yet cruising
Bruises on the ears, neck, feet, buttocks, torso
Bruises not on the from to the body and/or overlying bone
Patterned (loop marks, handprints, bite marks, belt)
Bruises that do not fit with causal mechanism described
Bruises that are unusually large or numerous

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2
Q

What is the differential diagnosis of bruising?

A 
ITP (most common acquired coagulopathy)
HSP
Vitamin K deficiency (CF, malabsorption, hemorrhagic disease of the newborn)
Vitamin C deficiency
Malignancy (Leukemia, neuroblastoma)
vWD (most common inherited coagulopathy)
Hemophilia
Infection (e.g. Meningococcemia)
DIC
Connective tissue disorder (Ehler's danlos)
Gardner-Diamond Syndrome
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3
Q

What are some mimics of bruising?

A 
Slate grey nevi/Mongolian spots
Post-inflammatory skin changes
Phytophotodermatitis 
Resolving hemangiomas
Skin staining from dyes
Cupping/coining
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4
Q

General indicators of child maltreatment

A 
Injury not compatible with history provided (mechanism, developmental age, amount of force)
Delay in seeking medical care
Inconsistent history
Multiple injuries
Injuries of different ages
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5
Q

Risk factors for child abuse

A 
Parents characteristics:
History of abuse
Mental illness
Substance abuse
Cognitive deficits
Anger control problems
History of criminal behaviour
Young, single, unemployed
Family characteristics:
Marital conflict
Social isolation / lack of Supports
Early mother-child separation
Crowded household
Child characteristics:
Behaviour problems
Difficulties with feeding and Sleeping
Difficult temperament i.e. colic
Pregnancy or birth complications
Physical disabilities
Parent-child relationship:
Unrealistic expectations of child
High arousal to child distress/anger
Child perceived as difficult
Lack of emotional connection
Environmental characteristics:
Poverty
Higher perceived stress
Frequent changes in residence
Low maternal education
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6
Q

Bruising work up

A 
CBC
Peripheral smear
INR/PTT
Factor 8, 9
Fibrinogen
vWF antigen/ristocetin cofactor
Blood type
LFTs and RFTs (for secondary platelet dysfunction)
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7
Q

What work up is needed for all non-ambulatory children/<2 years of age with suspected abuse?

A

Skeletal survey
MRI head if <1 year
Eye exam if findings on neuroimaging

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8
Q

Screen for abdominal trauma

A

AST, ALT, amylase

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9
Q

How are most NAI fractures detected?

A

Incidental finding on XR obtained for something else

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10
Q

Red flags for fractures

A

Non-ambulatory
Location (Metaphyseal, ribs, scapula, vertebrae, sternum)
Pattern (complex skull fracture, multiple fractures)
Age (delay in seeking medical attention, fractures at different ages)

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11
Q

What locations of fractures are most concerning for NAI?

A

Metaphyseal, ribs (especially posterior), scapula, vertebrae, sternum

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12
Q

How many x-rays are taken for a skeletal survey?

A

Typically 21 views

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13
Q

Differential diagnosis for fractures

A 
Accidental fractures
Birth injury (rib, humerus, clavicle)
Osteomyelitis
Congenital syphilis
Rickets
OI/other bone dysplasias
Neuromuscular disorders
Copper deficiency (preterm, Menke’s)
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14
Q

Causes of retinal hemorrhages other than NAI

A 
Accidental trauma
Birth-related (until 6 weeks of age)
Coagulation disorders
Leukemia
Metabolic disorders
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15
Q

What is the only situation where you are mandated to report DIRECTLY to police?

A

Gun shot wounds

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16
Q

What does Canada’s criminal code say about physical disclipine?

A

Allows use of “reasonable” force for the purposes of “teaching” child
Age 2-13
No hits to head/abdomen, objects, marks

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17
Q

Workup for abusive head trauma

A 
Dilated eye exam
Skeletal survey
Coag work up +fibrinogen+F8 and 9+FXIII
Metabolic-Glutaric aciduria (GA1)
MRI brain+spine
Photography
 CAS
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18
Q

What characteristics of retinal hemorrhages are most concerning?

A

Massive hemorrhage
Multiple layers
Extending to edge of retina

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19
Q

What is the most common physical exam finding in sexual abuse?

A

Normal exam

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20
Q

Differential diagnosis of vaginal redness

A 
Vulvovaginitis
Infection
-GAS
-Pinworms
Contact dermatitis
Psoriasis
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21
Q

Findings consistent with sexual abuse

A

Bruising, petechiae, abrasions on hymen
Acute laceration of hymen
Vaginal laceration, perianal laceration to below dermis
Healed complete transection of hymen

22
Q

Diseases suspicious for sexual contact

A 
Neisseria gonorrhea  
Syphilis (outside of newborn period)
Trichomonas vaginalis
Chlamydia from ano-genital region 
HIV (if not perinatal, blood products, needle contamination)
23
Q

Differential diagnosis for prepubertal vaginal discharge

A

Foreign body

Nonspecific infection (Strep, Bacterial vaginosis)

STD (Gonorrhea, Chlamydia, Trichomonas)

24
Q

When should HIV testing be repeated ?

A

3 and 6 months

25
Q

Which 3 STD do you definitely report to CAS and Public Health?

A

Trichomonas
Gonorrhea
Chlamydia

26
Q

How can HPV be transmitted?

A

Perinatal
Non-abrasive skin contact (warts on hands)
Sexual contact
Fomite transmission

27
Q

After how long could one consider perinatal transmission of HPV?

A

Up to 5 years (maybe 8)

28
Q

What investigations do you do for an acute sexual assault?

A 
Exam (general, SMR stage, external genital/anal)
Speculum exam in adolescents
Pregnancy test
Tox screen (based on history)
Sexual assault evidence kit
Don't do STD swabs acutely!
29
Q

In what time frame can you collect a sexual assault evidence kit ?

A

Vaginal/penile swab-12 days
Anal swab-3 days
For prepubscent, after 24 hours, yield is VERY LOW

30
Q

Management of sexual assault

A

STI prophylaxis (Azithromycin 1g, Cefixime 800 mg)
Emergency contraception
Consider HepB, HIV prophylaxis

31
Q

How long is emergency contraception effective?

A

Up to 120 hours after

32
Q

In prepubertal girls, most STDs are symptomatic

A

True. While chlamydia causes cervicitis in adolescents and is often asymptomatic, in prepubertal girls it often causes vaginitis

33
Q

Do you need to obtain separate consent for sexual assault evidence kit?

A

Yes

34
Q

Age of consent for sexual activity

A

16 years

Exceptions are 12-14 and 1-4-19

35
Q

What are the 2 indications for reporting to CAS for sexual assault

A

1) Child under 16 years of age, Perpetrator in position of authority
2) Perpetrator is a stranger and caregiver is unbelieving or unsupportive

36
Q

Abnormal sexual behaviours

A 
Repeated penetration of anus/vagina with object/digit
Coercing another child into a sexual act
Explicit imitation of sexual intercourse
Asking an adult to perform a sexual act
Oral-genital contact
37
Q

X-ray findings most consistent with abuse?

A 
Metaphyseal fractures
Posterior rib fractures
Spinous processes fractures
Scapular fractures
Sternal fractures
38
Q

Key questions to ask on history for possible bleeding disorder in child with bruising?

A

Postcircumcision bleeding
Birth cephalohematoma
Umbilical stump bleeding or delayed stump separation
Post venipuncture bleeding
Hematuria
Petechiae at clothing line pressure sites
Bruising at sites of object pressure (e.g. car seat fasteners)

Family members:
Spontaneous, easy or excessive bruising
Mucocutaneous bleeding
Epistaxis (>10 mins)
Bleeding from wounds (>15 mins)
Joint swelling with minor injury 
Menorrhagia
History of blood transfusion
Unexplained anemia
Bruises with palpable lumps under them
Prolonged bleeding with surgical procedures
39
Q

Are children with a disability or a chronic health condition more likely to be physically or sexually abused?

A

YES

40
Q

Risk factors for sexual abuse amongst young people with a disability or chronic health condition?

A

Lack of sexual health education
Low levels of privacy and high degree of physical intrusion in health care
Social isolation caused by institutionalization, hospitalization, special education
Perceived disempowerment/lack of control
Cognitive, sensory, mobility impairments, or difficulty communicating

41
Q

Indicators of sexual abuse in patients with disability or chronic health condition?

A 
STDs
Vaginal/anal trauma
Unexplained UTIs
Fear of examination
Self-harming
Sleep disturbance
Sexualized behaviour
Somatic complains with no organic cause
42
Q

How to prevent sexual abuse in patients with disability or chronic health conditions?

A

Advocate for thorough screening and monitoring of employees/volunteers
Chaperoning of physical exams and procedures
Supervised outings
Promoting patient privacy
Educating adolescents on safe sex and sexual abuse

43
Q

What diseases are children in foster care at increased risk for?

A 
LD
Developmental delay
Substance-base related birth defects
ADHD
CHornic disorder (asthma, CP, congenital anomaly)
Dental caries
44
Q

What is effective discipline?

A

Consistent
Close to behaviour needing change
Developmentally and temperamentally appropriate
Perceived as fair by child

45
Q

What is effective discipline for an infant?

A

Schedule around feeding, sleeping, play and interaction with otherance
void overstimulation
Develop tolerance to frustration

46
Q

What is effective discipline for early toddlers (1-2 years)?

A

Firm “no”

Redirecting child to alternate activity

47
Q

What is effective discipline for late toddlers (2-3 years)?

A

Superivse
Se limits and routines
Relistic expectations
Simple verbal explanations and redirection

48
Q

What is effective discipline for a preschooler/kindergarten (3-5 years)?

A

Time outs
Redirections
Small consequences
Approval/praise for good behaviour

49
Q

What is effective discipline for school age children?

A

Allow child to be more autonomous
Withdrawal or delay of privileges
Consequences
Time out

50
Q

What is effective discipline for adolescent?

A

Set rules in a non critical way
Avoiding lectures
Contracting with adolescent
Remaining available

51
Q

List 3 features of burns that are suspicious for child abuse

A

“Glove or stocking” burns of the hands and feet

Single-area deep burns on the trunk, buttocks, or back

Small, full-thickness burns (cigarette burns)

52
Q

Patient who was sexually assaulted arrives in ED. 5 steps in management

A
  1. Contact Child Protection Services
  2. Offer social/emotional support, social worker
  3. Complete Forensic Exam (less than 72-96 hours)
  4. Provide STI prophylaxes – decision to culture is controversial
  5. Offer Emergency Contraception (up to 120 hours)

FRCPC (27 decks)

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