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Pediatric Dentistry I 2020 > Test 2: Child Abuse > Flashcards

Test 2: Child Abuse Flashcards

1
Q

___ are the single most common presentation of physical child abuse

A

cutaneous injuries

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2
Q

___ are the most common type of injury in abused children, but also the most common type of injury in non-abused children

A

bruises

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3
Q

what developmental stage is bruising most common (precruisers, cruisers, or walkers)?

A
  • walkers, followed by cruisers and then precruisers
  • in general, “if they don’t cruise, they don’t bruise”, so you want to consider abuse and potentially some other underlying condition when you see bruises in non-cruising children
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4
Q

what are the common locations of non-intentional bruises?

A
  • forehead
  • vertex of chin
  • elbows
  • knees/shins
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5
Q

what are the common locations of intentional bruises?

A
  • ears
  • neck
  • upper arms/legs
  • abdominal wall
  • buttocks and anus
  • genitalia
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6
Q

what are considered the non-discriminating bruising locations?

A

face, cheek, scalp, head, and legs

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7
Q

what bruising locations are considered highly predictive of abuse?

A

ear, neck, buttocks, GU area

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8
Q

___ tend to be bruised accidentally in ambulatory kids, whereas ___ areas tend to be bruised from abusive mechanisms

A
  • bony prominences

- soft tissue areas

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9
Q

T or F:
bruising resolution is independent of the attachment and thickness of tissue injured, depth of injury, and age of patient

A

false

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10
Q

does the type of injuring force affect bruising resolution?

A

yes

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11
Q

T or F:

bruising resolution is dependent on the underlying color of the injured person’s skin

A

true

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12
Q

does vascularity of injured/surrounding tissues affect bruising resolution?

A

yes

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13
Q

can underlying medical conditions delay healing of bruises?

A

yes

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14
Q

T or F:

bruises are easy to date

A

false

-studies have determined that “assessment of the age of a bruise in children is inaccurate and has no scientific basis”

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15
Q

are red/blue/purple colors are associated with newer or older bruises?

A

newer

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16
Q

are yellow/brown and green colors associated with newer or older bruises?

A

older

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17
Q 
T or F:
any colors (red, blue, purple, yellow, brown, and green) can be observed in a bruise at any time before it fully resolves
A

true

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18
Q

what is the appearance of patterned bruising inflicted by a hand?

A

impact of the hand forces blood into nearby capillaries causing them to rupture, resulting in an outline of the fingers/hand

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19
Q

what might produce short, linear bruises, where the bruising reflects the impact in one plane and doesn’t follow the curvature of the affected region?

A

inflexible objects

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20
Q

bruising that results from ___ may lead to ecchymosis that has no definable pattern

A

inflexible objects

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21
Q

what is the bruising pattern caused by flexible objects, and what are some common objects used?

A
  • follows the curvature of the body

- extension cords, belts, ropes, etc.

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22
Q

describe patterned injury to the buttocks

A
  • given the convexity of the surface of the buttocks, a site of injury is created between impacted and nonimpacted tissue
  • often a distinct line of vertical bruising/petechiae seen
  • may be associated with more diffuse gluteal contusions
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23
Q

___ is an example of a cultural practice that causes circular bruising

A

cupping

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24
Q

___ is an example of a cultural practice that causes extravasation of blood from the capillaries (petechiae) and may result in ecchymosis, and involves repeated strokes over the skin with a smooth edge

A

coining (gua sha)

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25
Q

___ is an example of a cultural practice that involves burning skin using a special stick, with the belief that it will relieve an infection

A

fire-burning

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26
Q

___ is a systemic disease of unknown cause, characterized by IgA-related leukocytoclastic vasculitis, palpable purpura (commonly on lower extremities and buttocks), with normal platelets

A

henoch-schonlein purpura (HSP)

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27
Q

what are the symptoms/signs of henoch-schonlein purpura?

A

edema, arthralgias, abdominal pain, and hematuria

28
Q

dermal melanosis is also known as ___ or ___

A

mongolian spots or sleight gray macule/patch

29
Q

what is the frequency of dermal melanosis in african americans, asians, hispanics, and caucasians?

A
  • 95% african americans
  • 80% asian
  • 70% hispanic
  • 10% caucasian
30
Q

___ can overly dermal melanosis

A

bruising

31
Q

___ is characterized erythematous raised plaques with “dusky” centers that result from necrosis of keratinocytes; lesions may be confused with bruising or hives

A

erythema multiforme

32
Q

___ is commonly associated with drugs (sulfonamides) and viral infections (HSV, mycoplasma, EBV)

A

erythema multiforme

33
Q

what are 7 conditions that mimic bruising?

A
  • prupural fulminans
  • phytophotodermatitis
  • allergic dermatitis
  • insect bites
  • self-inflicted bruises or cutting
  • abdominal striae
  • diaper dermatitis
34
Q

cutaneous findings that result from biting depend on what 3 things?

A
  • force
  • duration
  • degree of movement between teeth and the soft tissue
35
Q

with respect to bites, what 2 things is central ecchymosis related to?

A
  • negative pressure of suction or tongue thrust

- disruption of blood vessels enclosed within the area of the bite

36
Q

is the following characteristic of adult or child inflicted bites?

  • bites often only distinct in one arch
  • average maxillary intercuspid distance of 33mm
  • teeth tend to be rectangular
A

adult

37
Q

is the following characteristic of adult or child inflicted bites?

  • bites are often distinct in both arches
  • intercuspid distance of less than 30mm
  • teeth tend to be more rounded
A

child

38
Q

what type of bites generally tear skin, and have much narrower arch with elongated anterior-posterior aspects?

A

animal-inflicted bites

39
Q

T or F:

human bites occur most frequently on upper extremities

A

true

40
Q

what is a possible reason an adult might bite a child?

A

to stop biting behavior

41
Q

what is developmental biting behavior?

A

in preschool age children, often seen with frustration or anger

42
Q

what 3 things are included in the forensic evaluation of bites?

A
  • photography - accuracy
  • double swab technique for saliva
  • consult forensic odontogolist if possible
43
Q

abusive injuries to the ___ and ___ region are among the most common seen in abused children

A

head and neck

44
Q

what are 5 mechanisms of injury from trauma of the mouth?

A
  • blunt impact
  • insertion of object into mouth
  • sexual abuse
  • burns with hot liquids or caustic agents
  • tongue lacerations may be caused by bites
45
Q

trauma of the mouth that results from sexual injury can be ___ or ___

A
  • traumatic - petechiae, ulcerations

- infection - oropharyngeal gonorrhea, condyloma

46
Q

what is helpful in distinguishing tongue lacerations caused by self-inflicted vs abusive bites?

A

direction of the curvature of the bite mark

47
Q

what is the differential diagnosis for a frenulum tear?

A
  • congenital
  • infections (herpes or coxsackie virus)
  • accidental trauma
  • non-accidental trauma
48
Q

what does non-ambulatory mean?

A

able to walk

49
Q

any non-ambulatory child with a frenulum tear should be evaluated for ___

A

abuse

50
Q

what can erosion/scarring/bruising at the corners of the mouth be caused by?

A

gags to the mouth

51
Q

what can result from perforation of the oropharynx?

A
  • retropharyngeal free air
  • mediastinal air
  • carotid artery damage/dissection/perforation
  • tonsillar avulsion
52
Q

___ are likely a commonly missed injury of physical abuse

A

dental injuries

53
Q

you should consider physical abuse in what dental injury cases?

A
  • teeth that are missing and shouldn’t be
  • fractured teeth
  • significantly damaged teeth
54
Q

what are the major complications of dental injuries in children?

A
  • injury to primary teeth can cause injury to the developing secondary teeth
  • enamel hypoplasia
  • devitalization of periodontal ligament or dental pulp
55
Q

infant ___ are protected from injury during falls or accidents, making fractures of these structures rare

A

mandibles

56
Q

describe how infant mandibles are protected from injury

A
  • cranio-to-facial proportion of 8:1 (as opposed to 2:1 in adults)
  • infant calvarium impacts as opposed to the facial skeleton
  • elasticity of the developing mandible
  • relatively thick soft tissue of the face
57
Q

mandible fractures in infants are likely due to ___

A

direct impact to the mandible

58
Q

T or F:

infants with mandibular fractures in the symphysis and/or premolar area suffer severe pain

A

false

“not severely painful”

59
Q

what are symptoms of a subcondylar fracture in an infant?

A

trismus and pain/tenderness overlying the TMJ

60
Q

what 4 things may indicate a mandibular fracture?

A
  • contusion of the floor of the mouth
  • irregularity of the mandibular arch
  • alteration of dental occlusion
  • bruising and swelling of the face/jaw line
61
Q

if an infant has one mandibular fracture, should you suspect a second fracture?

A
  • yes, unless it is a single midline symphysis fracture

- the mandible is a “ring structure”

62
Q

what 3 things can the quality of mandibular radiographic images be limited by?

A
  • overlapping bony/soft tissues
  • patient cooperation
  • institutional availability
63
Q

when obtaining radiographic images (vs panoramic image) of the mandible using a series of xrays, how many do you need to view the entire lower jaw?

A

4 images

64
Q

what are the limitations of panoramic mandibular radiographs?

A

-same as standard radiographic images (overlapping bony/soft tissues, patient cooperation, institutional availability)

65
Q

what is the benefit of panoramic mandibular radiographs when compared to a radiographic series?

A

shows the entire mandible in one view

66
Q

what is the benefit of CT imaging over radiographs?

A
  • offers greater accuracy in diagnosis, sensitivity, and specificity
  • allows for evaluation of potential co-existing intracranial injury

Pediatric Dentistry I 2020 (12 decks)

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