Flashcards in SCAN Deck (52)
Bruising red flags
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
What is the differential diagnosis of bruising?
ITP (most common acquired coagulopathy)
Vitamin K deficiency (CF, malabsorption, hemorrhagic disease of the newborn)
Vitamin C deficiency
Malignancy (Leukemia, neuroblastoma)
vWD (most common inherited coagulopathy)
Infection (e.g. Meningococcemia)
Connective tissue disorder (Ehler's danlos)
What are some mimics of bruising?
Slate grey nevi/Mongolian spots
Post-inflammatory skin changes
Skin staining from dyes
General indicators of child maltreatment
Injury not compatible with history provided (mechanism, developmental age, amount of force)
Delay in seeking medical care
Injuries of different ages
Risk factors for child abuse
History of abuse
Anger control problems
History of criminal behaviour
Young, single, unemployed
Social isolation / lack of Supports
Early mother-child separation
Difficulties with feeding and Sleeping
Difficult temperament i.e. colic
Pregnancy or birth complications
Unrealistic expectations of child
High arousal to child distress/anger
Child perceived as difficult
Lack of emotional connection
Higher perceived stress
Frequent changes in residence
Low maternal education
Bruising work up
Factor 8, 9
vWF antigen/ristocetin cofactor
LFTs and RFTs (for secondary platelet dysfunction)
What work up is needed for all non-ambulatory children/<2 years of age with suspected abuse?
MRI head if <1 year
Eye exam if findings on neuroimaging
Screen for abdominal trauma
AST, ALT, amylase
How are most NAI fractures detected?
Incidental finding on XR obtained for something else
Red flags for fractures
Location (Metaphyseal, ribs, scapula, vertebrae, sternum)
Pattern (complex skull fracture, multiple fractures)
Age (delay in seeking medical attention, fractures at different ages)
What locations of fractures are most concerning for NAI?
Metaphyseal, ribs (especially posterior), scapula, vertebrae, sternum
How many x-rays are taken for a skeletal survey?
Typically 21 views
Differential diagnosis for fractures
Birth injury (rib, humerus, clavicle)
OI/other bone dysplasias
Copper deficiency (preterm, Menke’s)
Causes of retinal hemorrhages other than NAI
Birth-related (until 6 weeks of age)
What is the only situation where you are mandated to report DIRECTLY to police?
Gun shot wounds
What does Canada's criminal code say about physical disclipine?
Allows use of "reasonable" force for the purposes of "teaching" child
No hits to head/abdomen, objects, marks
Workup for abusive head trauma
Dilated eye exam
Coag work up +fibrinogen+F8 and 9+FXIII
Metabolic-Glutaric aciduria (GA1)
What characteristics of retinal hemorrhages are most concerning?
Extending to edge of retina
What is the most common physical exam finding in sexual abuse?
Differential diagnosis of vaginal redness
Findings consistent with sexual abuse
Bruising, petechiae, abrasions on hymen
Acute laceration of hymen
Vaginal laceration, perianal laceration to below dermis
Healed complete transection of hymen
Diseases suspicious for sexual contact
Syphilis (outside of newborn period)
Chlamydia from ano-genital region
HIV (if not perinatal, blood products, needle contamination)
Differential diagnosis for prepubertal vaginal discharge
Nonspecific infection (Strep, Bacterial vaginosis)
STD (Gonorrhea, Chlamydia, Trichomonas)
When should HIV testing be repeated ?
3 and 6 months
Which 3 STD do you definitely report to CAS and Public Health?
How can HPV be transmitted?
Non-abrasive skin contact (warts on hands)
After how long could one consider perinatal transmission of HPV?
Up to 5 years (maybe 8)
What investigations do you do for an acute sexual assault?
Exam (general, SMR stage, external genital/anal)
Speculum exam in adolescents
Tox screen (based on history)
Sexual assault evidence kit
Don't do STD swabs acutely!
In what time frame can you collect a sexual assault evidence kit ?
Vaginal/penile swab-12 days
Anal swab-3 days
For prepubscent, after 24 hours, yield is VERY LOW