Child Maltreatment SAQ Flashcards
1
Q
- Which of the following is a risk factor for child abuse?
a. Prematurity
b. Large number of siblings
c. Older parents
d. Attends daycare
A
Prematurity
RFs for maltreatment
Parent issue or kid issue
- Parental mental health, domestic violence, substance use, Hx of abuse, poor knowledge of development
- Unwanted pregnancy
- Multiple children
- Single parent
- Unrelated adult in home
- Poverty
- Younger child
- Special needs
- Behavioural issues
2
Q
- An 8 month old comes in with bruising. List 4 things on history or physical exam that would make you concerned for physical abuse.
A
- Bruises on BENT = buttocks, ears, neck, torso, feet
- Patterned bruises
- Unusually large or numerous bruises
- Doesn’t fit with described mechanism of injury
- Not meeting with developmental abilitieis - bruises before cruises
3
Q
- You see a 7y girl who discloses that she was sexually assaulted by her father. On physical exam you see the following. (This is not the real picture, it’s from Hamilton)
A. Please identify the following structures. (On the exam, asked to label urethra, introitus, hymen)
B. Based on your examination, what can you tell the police?
A
A.
- Clitoris
- Urethra
- Labia minora
- Periurethral band
- Vagina/introitus
- Hymen
- Fourchette navicularis
- Posterior fourchette
- Perineum
B. Normal physical exam does not rule out sexual abuse.
Also, don’t tell the police unless warrant or pt consents.
4
Q
- 4 mo baby brought in for irritability. On PEx you note 1x1cm purple bruise to forearm. Name 3 laboratory or diagnostic imaging tests you would do (3)
A
- CBC, peripheral smear, INR, PTT, fibrinogen
- VWF, blood group, factor 8 + 9, LFTs + renal function tests
- Skeletal survey b/c <2yo
- Consider head imaging
- Consider ophtho assessment
- Consider liver enzyme, amylase, lipase + CT abdo if abn
5
Q
- 16 month old boy brought to emergency department by his mother because of inconsolable crying. You take off the sleeper and find this: (picture shown of baby’s legs with confluent 2nd degree burns on feet up to mid calf, sharply demarcated). You suspect non-accidental injury.
a. What are 2 things about this child’s presentation that make you suspicious of non-accidental injury?
b. What are 3 important steps in management with regards to this child’s non-accidental injury?
A
A.
- Pattern of sharply demarcated burns, uniform depth of burn
- Lack of history provided. Reason for seeking attention is the inconsolable crying, not the burns
- Young age and developmental ability of child
B.
- Call CAS
- Admit this child for burn management
- Assess for other injuries + work up for suspected inflicted injury
6
Q
- 4 month old child being assessed for bilateral metaphyseal fractures. There was no history of trauma reported for the fractures. What are THREE aspects are consistent with a non-accidental cause for this injury?
A
- Metaphyseal fractures are a red flag for inflicted injury
- Multiple fractures
- No history of trauma in a non-ambulatory child
- Young age
7
Q
- 8 year old developmentally normal girl is touching boys under their pants and the teachers are wondering about sexual abuse. What are FIVE other sexualized behaviours that would make you worried about sexual abuse?
What are normal common behaivours?
A
- Any sexual behaviours that involve children >=4Y apart
- Sexualized behaviours that are associated with emotional distress of physical pain
- Sexual behaviours associated with other physically aggressive behaviour
- Sexual behaviours that involve coercion
- A variety of sexual behaviours displayed on a daily basis
- Bheaviours are persistent and child becomes angry if distracted
Normal common behaviours
- Touching/masturbating genitals in public/private
- Viewing/touching peer or new sibling genitals
- Showing genitals to peers
- Standing/sitting to close
- Trying to view peer/adult nudity
- Behaviours are transient, few + distractable
8
Q
- Baby came in with bruising on the chest, vomiting, lethargy, vitals stable; CBC and coags were normal. Name 5 management steps
A
- Admit after Hx + full PEx (esp detailed neuro exam). Document findings and use line diagram.
- Call CAS
- CBC, peripheral blood smear, INR, PTT, fibrinogen, liver + renal function, liver enzymes, amylase + lipase, vWD, blood type, factor 8+9. May need glucose, metabolic screen, toxicology, + micro.
- Skeletal survey
- CT head (vomiting + lethargy)
- Ophthalmology b/c suspected head injury
9
Q
- An 8 month old boy presents to the ED with a URTI. On exam, you find one bruise on the posterior chest, and another somewhere else on the body. The remainder of the exam is normal. The mother does not know where these bruises came from. What three questions would you ask on further questioning?
A
- PMHx: previous bleeding or bruising, medications, development
- FHx of bruising, bleeding
- Who lives at home or is a caregiver
- Any medications
10
Q
- 5 month old girl brought into foster care because her twin sister has been diagnosed with shaken baby syndrome. Her foster parents state that she is feeding well, interacting appropriately, with no concerns. What investigations would you perform in this baby?
List 3.
A
- Skeletal survey b/c <2yo
- Ophthalmology
- CT head
- Abdo trauma screening
11
Q
- A one month old infant brought into the ER by his parents, irritable and fussy. Picture given of a baby (poor picture) with erythema and blistering of feet and lower legs in a stocking distribution (? Burns). What 4 things would you do as part of management?
A
- Call CAS
- Admit to hospital
- Appropriate burn + pain management
- Screen for other injuries
12
Q
- What are 4 fractures that are very specific for child abuse?
A
- Posterior rib fracture
- Metaphyseal fracture
- Humeral fracture in <18mo
- Femoral fracture in non-ambulatory
- Scapular, spinous process, sternal
13
Q
- What are four characteristics of a child that puts them at increased risk of abuse?
A
- Premature
- Unwanted pregancy
- Special needs
- Behavioural issues
- Developmental delay
- Multiples (twins)
14
Q
- Father brings 3 y.o. child for suspected abuse. Multiple bruises acquired while staying with mom over weekend.
A) Three things required for immediate management in the E.R
B) Identify four radiological signs consistent with abuse.
A
A.
- Call CAS
- Full physical exam to assess for other injuries
- Skeletal survey
- Blood work for bruises
B.
- Metaphyseal fractures
- Posterior rib fractures
- Humeral fractures <18mo
- Femoral fractures before ambulatory
- Scapular, spinous, sternal fractures
15
Q
14yo was sexually assaulted by a stranger several hours ago and presents to the loacal ER. SHe is complaining of vaginal pain + bleeding. List 5 things you would consider in your management
A
- Ensure hemodynamically stable. Hx + PEx to assess for other injuries. Address any injuries that require immediate attention
- Call CAS + CYPT
- Consider forensic collection if <72H since assault
- STI testing + PEP: G+C, HIV, Hep B/C, syphilis
- Pregnancy test and emergency contraception
19
Q
A
20
Q
A
