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Pedo 1 > Child Abuse > Flashcards

Child Abuse Flashcards

1
Q

True or false… an injured upper labial frenulum is very concerning

A

False. Its likely due to trauma

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2
Q

What are the most common type of injuries in abused children?

A

Bruises

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3
Q

What are the most common injuries in non-abused children?

A

Bruises

They are the most common in abused and non-abused children

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4
Q

The greatest % of children with bruising are of the recruiser, cruiser, or walker age?

A

Walkers

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5
Q

What age are children most likely to be bruised?

A

Preschool-school age

Infants are not very likely

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6
Q

Bruising is rare in ___.

Bruising is more common when?

What is it meant by”don’t cruise, don’t bruise”

A

Infants/precruisers

As children age (are more mobile)

Children who do not move about do not get bruises. If they do, consider abuse AND potentially some other underlying condition

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7
Q

What are some locations of bruises that would be suspected of being non-intentional

A

Forehead

Vertex of chin

Elbows

Knees/shins

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8
Q

What are some locations of bruises that are more likely to be intentional?

A

Ears

Neck

Upper arms/legs

Abdominal wall

Buttocks and anus

Genitalia

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9
Q

___ tend to be bruised accidentally in ambulatory kids

___ areas tend to be bruised from abusive mechanisms

A

Bony prominences

Soft tissue

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10
Q

Bruising resolution is dependent on many factors such as…

A

Attachment of tissue injured

Thickness of tissue injured

Type of injuring force

Depth of the injury

Vascularity of the injured/surrounding tissues

Underlying color of the injured persons skin

Age of pt

Underlying medical conditions can delay healing

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11
Q

Can be bruises be dated?

A

Not really. Assessment of the age of a bruise in children is inaccurate and has no scientific basis

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12
Q

Why does a bruise form a red outline?

A

The blood is shifted away from the object, leading to patterned bruising

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13
Q

Bruising reflect impact in one plane and should not follow the ___ of the affected region

A

Curvature

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14
Q

What does a patterned injury to the buttocks typically look like?

A

Often a distinct line of vertical bruising/petechiae seen

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15
Q

True or false… patten bruising can happen with accidents

A

True. Such as a seatbelt

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16
Q

What are some cultural practice that can produce bruising/bruise-like lesions?

A

Cupping

Coining (gua sha)

Fire-burning

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17
Q

What are some systemic diseases that can produce bruise-like lesions?

A

Henoch schonlein purpura

Dermal melanosis (bruising can overly melanosis)

Erythema multiforme

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18
Q

What are some other things that can mimic bruises?

A

Purpura fulminans (DIC and fatal)

Phytophotodermatitis (citrus and sun)

Allergic dermatitis

Insect bites

Self-inflicted bruises or cutting

Abdominal striae

Diaper dermatitis

19
Q

What are some coagulation disorders that can cause bruising?

A

Hemolytic uremic syndrome

Thrombocytopenia

Vitamin K deficiency

Hemophilia

Von willebrand

Leukemia

Factors 13 deficiency

20
Q

Central ecchymosis can be caused by…

A

Negative pressure o suction or tongue thrust (hickey)

Disruption of blood vessels enclosed within the area of the bite

21
Q

How can you tell the difference between an adult-inflicted bite and a child-inflicted bite?

A

Adult inflicted:

Bites often only distinct in one arch

Average maxillary intercuspid distance of 33mm

Teeth tend to be rectangular

Child inflected:
Bites are often distinct in both arches

Intercuspid distance of less than 30mm

Teeth tend to be more rounded

22
Q

What do animal-inflicted bites look like?

A

Generally tear in skin

Much narrower arch with elongated anterior-posterior aspect than human bites

23
Q

Where do bite injuries most frequently occur?

When do they most likely occur?

A

Occur most frequently on upper extremities

May occur during play, fight, sports, or sex (lolz)

24
Q

Developmental biting behavior in ___ age is often seen with ___

A

Preschool age

Frustration/anger

25
Q

When do adults typically bite their children?

A

“To stop biting behavior” …smh..

26
Q

Abusive injuries to the ____ region are among the most common seen in abused children

A

Head and neck (specifically orofacial injuries)

27
Q

What are the mechanisms of injury for trauma of the mouth?

A

Blunt impact

Insertion of object into mouth (forceful feeding)

Sexual abuse

Burns with hot liquids or caustic agents

Tongue lacerations may be caused by bites (curvature of the bite mark is helpful in determining if self inflicted)

28
Q

What is the differential diagnosis for a lingual frenulum tear?

A

Congenital anomalies (midline sinus)

Infections, such as herpes or coxsackie virus

Accidental trauma (simple falls in ambulatory child, striking face against an object, iatrogenic (endotracheal intubation, nasogastric tube insertion))

Non-accidental trauma (blow to mouth, forced feeding, forced oral sex)

29
Q

What do you do when you see a non-ambulatory child with a lingual frenulum tear?

A

They should be evaluated for abuse

30
Q

True or false.. no studies define the incidence of torn labial frenula in abused children. Current literature does not support the diagnosis of abuse based on a torn labial frenulum in isolation in an ambulatory child.

A

True

31
Q

What are some types of lip and oropharyngeal (tonsilar) injuries?

A

Bruises

Lacerations

Burns from hot food

Scars from persistent trauma

Erosion/scarring/bruising at the corners of the mouth can be caused by gags to the mouth

Perforation of oropharynx-retropharyngeal free air, mediational air, carotid artery damage/dissection/perforation, tonsilar avulsion

32
Q

True or false… dental injuries are likely a commonly missed injury of physical abuse

A

True

Consider physical abuse in cases with teeth that are missing (and shouldnt be), fractured, or significantly damaged

33
Q

What are 3 complications of dental injuries?

A

Major complication of injury to primary teeth is injury to the developing secondary teeth

Enamel hypoplasia

Devitalization of PDL or pulp

34
Q

Name 6 classifications of tooth injuries

A

Concussion (neither loose nor displaced. PDL inflamed)

Subluxation (loose, but not displaced. Inflamed PDL)

Intrusion (driven into the socket causing fracture of socket, PDL compressed)

Extrusion (centrally dislocated from socket. PDL lacerated)

Lateral luxation (displaced anteriorly, posteriorly, or laterally, alveolar socket is fractured. PDL lacerated)

Avulsion (completely displaced from alveolar ridge. PDL severed)

35
Q

True or false… infant mandibles are highly likely to fracture

A

False.. infant mandibles are protected from injury during falls or accidents

36
Q

The cranio-to-facial proportion of infants is ___ compared to __ seen in adults

A

8: 1
2: 1

37
Q

In an infant, which is more likely to be impacted, calvarium or facial Skelton?

A

Calvarium

38
Q

In addition to the smaller mandible, what else protects the mandible from injury in an infant?

A

Elasticity of the developing mandible

Relatively thick soft tissue of the face

39
Q

What is the clinical presentation of a mandibular fracture in the symphsis or premolars area?

A

Not severely painful

40
Q

What is the clinical presentation of a mandibular fracture in the subcondylar area in an infant?

A

Trismus/pain/tenderness overlying the TMJ

41
Q

What are some other clinical presentations of mandibular fractures in infants?

A

Contusion of the FOM

Irregularity of the mandibular arch

Alteration of dental occlusion

Bruising and swelling of face/jaw line may indicate mandibular fractures

42
Q

Since the mandible is a “ring structure” if one fracture is found, there is a high suspicion for…

A

A second fracture. Unless single midline symphisis fracture

43
Q

The mandibular series of x-rays includes ___ views of the lower jaw

A

4

44
Q

Which is better in accuracy, panorex or CT imaging?

A

CT offers greater accuracy in diagnosis, sensitivity and specificity as compared to panorex views

Allows for evaluation of potential co-existing intracranial injury

Pedo 1 (14 decks)

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