Test 2: Child Abuse Flashcards
___ are the single most common presentation of physical child abuse
cutaneous injuries
___ are the most common type of injury in abused children, but also the most common type of injury in non-abused children
bruises
what developmental stage is bruising most common (precruisers, cruisers, or walkers)?
- 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
what are the common locations of non-intentional bruises?
- forehead
- vertex of chin
- elbows
- knees/shins
what are the common locations of intentional bruises?
- ears
- neck
- upper arms/legs
- abdominal wall
- buttocks and anus
- genitalia
what are considered the non-discriminating bruising locations?
face, cheek, scalp, head, and legs
what bruising locations are considered highly predictive of abuse?
ear, neck, buttocks, GU area
___ tend to be bruised accidentally in ambulatory kids, whereas ___ areas tend to be bruised from abusive mechanisms
- bony prominences
- soft tissue areas
T or F:
bruising resolution is independent of the attachment and thickness of tissue injured, depth of injury, and age of patient
false
does the type of injuring force affect bruising resolution?
yes
T or F:
bruising resolution is dependent on the underlying color of the injured person’s skin
true
does vascularity of injured/surrounding tissues affect bruising resolution?
yes
can underlying medical conditions delay healing of bruises?
yes
T or F:
bruises are easy to date
false
-studies have determined that “assessment of the age of a bruise in children is inaccurate and has no scientific basis”
are red/blue/purple colors are associated with newer or older bruises?
newer
are yellow/brown and green colors associated with newer or older bruises?
older
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
true
what is the appearance of patterned bruising inflicted by a hand?
impact of the hand forces blood into nearby capillaries causing them to rupture, resulting in an outline of the fingers/hand
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?
inflexible objects
bruising that results from ___ may lead to ecchymosis that has no definable pattern
inflexible objects
what is the bruising pattern caused by flexible objects, and what are some common objects used?
- follows the curvature of the body
- extension cords, belts, ropes, etc.
describe patterned injury to the buttocks
- 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
___ is an example of a cultural practice that causes circular bruising
cupping
___ 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
coining (gua sha)
___ is an example of a cultural practice that involves burning skin using a special stick, with the belief that it will relieve an infection
fire-burning
___ is a systemic disease of unknown cause, characterized by IgA-related leukocytoclastic vasculitis, palpable purpura (commonly on lower extremities and buttocks), with normal platelets
henoch-schonlein purpura (HSP)
what are the symptoms/signs of henoch-schonlein purpura?
edema, arthralgias, abdominal pain, and hematuria
dermal melanosis is also known as ___ or ___
mongolian spots or sleight gray macule/patch
what is the frequency of dermal melanosis in african americans, asians, hispanics, and caucasians?
- 95% african americans
- 80% asian
- 70% hispanic
- 10% caucasian
___ can overly dermal melanosis
bruising
___ is characterized erythematous raised plaques with “dusky” centers that result from necrosis of keratinocytes; lesions may be confused with bruising or hives
erythema multiforme
___ is commonly associated with drugs (sulfonamides) and viral infections (HSV, mycoplasma, EBV)
erythema multiforme
what are 7 conditions that mimic bruising?
- prupural fulminans
- phytophotodermatitis
- allergic dermatitis
- insect bites
- self-inflicted bruises or cutting
- abdominal striae
- diaper dermatitis
cutaneous findings that result from biting depend on what 3 things?
- force
- duration
- degree of movement between teeth and the soft tissue
with respect to bites, what 2 things is central ecchymosis related to?
- negative pressure of suction or tongue thrust
- disruption of blood vessels enclosed within the area of the bite
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
adult
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
child
what type of bites generally tear skin, and have much narrower arch with elongated anterior-posterior aspects?
animal-inflicted bites
T or F:
human bites occur most frequently on upper extremities
true
what is a possible reason an adult might bite a child?
to stop biting behavior
what is developmental biting behavior?
in preschool age children, often seen with frustration or anger
what 3 things are included in the forensic evaluation of bites?
- photography - accuracy
- double swab technique for saliva
- consult forensic odontogolist if possible
abusive injuries to the ___ and ___ region are among the most common seen in abused children
head and neck
what are 5 mechanisms of injury from trauma of the mouth?
- blunt impact
- insertion of object into mouth
- sexual abuse
- burns with hot liquids or caustic agents
- tongue lacerations may be caused by bites
trauma of the mouth that results from sexual injury can be ___ or ___
- traumatic - petechiae, ulcerations
- infection - oropharyngeal gonorrhea, condyloma
what is helpful in distinguishing tongue lacerations caused by self-inflicted vs abusive bites?
direction of the curvature of the bite mark
what is the differential diagnosis for a frenulum tear?
- congenital
- infections (herpes or coxsackie virus)
- accidental trauma
- non-accidental trauma
what does non-ambulatory mean?
able to walk
any non-ambulatory child with a frenulum tear should be evaluated for ___
abuse
what can erosion/scarring/bruising at the corners of the mouth be caused by?
gags to the mouth
what can result from perforation of the oropharynx?
- retropharyngeal free air
- mediastinal air
- carotid artery damage/dissection/perforation
- tonsillar avulsion
___ are likely a commonly missed injury of physical abuse
dental injuries
you should consider physical abuse in what dental injury cases?
- teeth that are missing and shouldn’t be
- fractured teeth
- significantly damaged teeth
what are the major complications of dental injuries in children?
- injury to primary teeth can cause injury to the developing secondary teeth
- enamel hypoplasia
- devitalization of periodontal ligament or dental pulp
infant ___ are protected from injury during falls or accidents, making fractures of these structures rare
mandibles
describe how infant mandibles are protected from injury
- 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
mandible fractures in infants are likely due to ___
direct impact to the mandible
T or F:
infants with mandibular fractures in the symphysis and/or premolar area suffer severe pain
false
“not severely painful”
what are symptoms of a subcondylar fracture in an infant?
trismus and pain/tenderness overlying the TMJ
what 4 things may indicate a mandibular fracture?
- contusion of the floor of the mouth
- irregularity of the mandibular arch
- alteration of dental occlusion
- bruising and swelling of the face/jaw line
if an infant has one mandibular fracture, should you suspect a second fracture?
- yes, unless it is a single midline symphysis fracture
- the mandible is a “ring structure”
what 3 things can the quality of mandibular radiographic images be limited by?
- overlapping bony/soft tissues
- patient cooperation
- institutional availability
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?
4 images
what are the limitations of panoramic mandibular radiographs?
-same as standard radiographic images (overlapping bony/soft tissues, patient cooperation, institutional availability)
what is the benefit of panoramic mandibular radiographs when compared to a radiographic series?
shows the entire mandible in one view
what is the benefit of CT imaging over radiographs?
- offers greater accuracy in diagnosis, sensitivity, and specificity
- allows for evaluation of potential co-existing intracranial injury
