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What are the characteristics of Abusive Skin Injuries?
- Different planes of body
- Different healing stages
- Central distribution
- On back
- Pattern injuries
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Where do accidental injuries most commonly occur?
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What medical conditions usually cause bruising?
Leukemias, Hemophilia, Moxibustion, Cao Gao, Ehlers-Danlos syndrome, Mongolian spots, ITP, coagulopathies (bleeding disorders)
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What are the most common types of bruises in abused children?
Facial Bruises
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What is considered when protecting a bite mark for analysis?
- Dont wash area
- Dont medicate area
- Dont cover or bandage area
- Dont use site for IV access
- Dont place monitor leads on or near site
- Swabs for DNA may be helpful
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Describe some examples of Pattern Marks?
Hand marks, switches/paddles, mini-blind rods, fly-swatter, belts, belt buckles, ropes, cords, shoes, kitchen tools (look marks, flip-flop imprints
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What are the most common burns in small children?
Scald burns (immersions)
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What are the characteristics of an abusive burn?
- Distinct lines of demarcation
- "Stocking or glove" pattern
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What are the characteristics of an Accidental Burn?
- Irregular pattern
- "Splash/Drip" mark
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What is the extent of a burn depended on?
- Water temperature (117 F)
- Duration of exposure
- Presence/absence of clothing or material
- Area of body exposed
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What type of fracture is diagnostic of abuse unless proven otherwise?
Rib Fractures (result of direct trauma to the chest)
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What are the most common types of blunt force traumas to the chest?
- Rib fracture
- Hemo/pneumothorax
- Pulmonary contusion (rare)
- Cardiac contusion (rare)
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What are the most common blunt force traumas to the abdomen?
- Duodenal hematoma
- Splenic or liver lacerations/contusions
- Bowel rupture
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At what age are abusive fractures most common?
18 months and younger
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What fractures should you be extremely concerned about in relation to abuse?
- Posterior rib fracture
- Multiple fractures of different stages
- Metaphyseal fracture
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Name fractures that are highly specific of abuse
- Classic metaphyseal "chip" fractures/lesions
- Rib fractures, especially posterior
- Scapular fractures
- Spinous process fractures
- Sternal fractures
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Name fractures that are moderately specific of abuse?
- Multiple fractures, especially bilateral
- Fractures of different ages
- Epiphyseal separations
- Vertebral body fractures and subluxations
- Digital fractures
- Complex skull fractures
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Name fractures that are common but are low in specificity for abuse?
- Subperiosteal new bone formation
- Clavicular fractures
- Long bone shaft fractures
- Linear skull fractures
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A disorder that causes fragile bones?
Osteogenesis imperfecta
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Osteogenesis Imperfecta
- Causes fragile bones
- Genetic defect in collagen production
- Dominant (classical) IO has too little type I collagen or poor quality
- Recessive OI interference in collagen production
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what type of falls are not fatal or life-threatening?
Simple short falls (off couches, chairs, or down stairs)
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When are falls fatal/life-threatening?
When a child falls more than 40 feet to have serious/life-threatening brain injuries!
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What is the leading cause of death in children under 5 years old?
head injuries (They may NOT be evident externally)
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when are most head injuries of abusive nature?
when in babies under 1 years old
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Shaken Baby Syndrome
A form of abusive head trauma that occurs when a frustrated caregiver violently "shakes" or "shakes" and "slams" a child's head against an object. Usually to stop them from crying or to get a child to respond to the expectations of the caregiver. There are often no outward signs of abuse. usually injury to eyes and brain
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What are the most common triggers for SBS?
- Crying
- Toilet training
- Feeding problems
- Interrupting
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Who is at highest risk for being a victim of SBS?
- <5 years of age
- Premature babies
- Special Needs babies
- Babies that are difficult to soothe
- because of the extra care they require and tendency to cry more often
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What are the mild S&S that can occur with SBS?
- Irritable
- Poor feeding
- Vomiting
- Lethargy
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What are Severe S&S of SBS?
- Limp/posturing
- Respiratory distress
- Seizures
- Altered consciousness/Coma
- Death
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About what time do the S&S of SBS occur?
- Moderate - Immediate onset
- Severe/Fatal- immediate onset; No "lucid interval" following AHT incident
- * the child will not be acting "normally" and doing "normal" activities
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When are the chances of inflicted head injury highest?
When a young child sustains a serious head injury without an apparent major trauma history, such as MVC, fall from heights greater than 10 feet, etc.
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What are the "big 3" diagnostic criteria of SBS/AHT?
- Brain injury/swelling
- Retinal hemorrhage
- Subdural hemorrhage
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What are the characteristics of a Subdural Hematoma?
- Small volumes of blood
- Marker for SBS
- Bridging veins tear during abuse
- Decreased oxygen (cerebral hypoxia) heightens brain injury
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Describe the profile of a SBS/AHT perpetrator.
- SBS is a crime of ISOLATION
- Typically only 1 perpetrator who knows what happened to the child
- There is NO SPECIFIC PROFILE
- PEOPLE shake children
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What is the most common type of abusive injury?
- Rib fractures
- Posterior (back) fractures highly likely to be abuse
- CPR does not cause rib fractures in small children
- Accidental is rare, especially if multiple and in different stages of healing
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What is needed to evaluate AHT?
- All medical records
- Best evaluated by primary care physician
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Identify the characteristics leading to Failure to Thrive?
- Failure to offer adequate calories
- Failure of child to take sufficient calories
- Failure of child to retain sufficient calories
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All instances in which the basic needs of children are not met, regardless of cause is?
Failure to thrive (most prevalent form of child maltreatment)
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Identify the basic needs of children?
Adequate food, supervision, protection, clothing, health care, education, a stable home, and emotional needs for love and nurturance
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______ involves abandoning the child, failing to acknowledge the child, scapegoating the child are examples of ...?
Rejection
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_____ involves keeping the child away from a variety of appropriate relationships is called?
Isolation
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_____ involves threatening or scaring the child is called?
Terrorizing
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______ involves failing to respond to a child or pretending they are not there?
Ignoring
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______ involves encouraging or supporting illegal or deviant behaviors?
Corrupting
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disorder where a child feigns disease, illness, or psychological trauma in order to draw attention to themselves
Munchausen Syndrome by Proxy "Factitious illness by proxy"
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What are the 5 stages in the process of perpetrators preparing children to be victimized?
- Engagement
- Enactment
- Secrecy
- Disclosure
- Recantation
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What are the phases of disclosure in sexual abuse?
- Denial
- Disclosure: tentative or active
- Recantation (child no longer holds in the secret)
- Reaffirmation
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Name some reasons a child may recant his or her story.
emotional trauma, family disruption, pressure by offender and or family, negative personal consequences, judicial process
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List sequence of sexual behaviors as they gradually occur.
- Accidental touching
- Fondling or exposure to genitals
- Oral contact with genitals
- Slight penetration of vagina/anus
- Intercourse
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What should be performed when there is expected child abuse?
perform a limited anal/genital exam to determine the need for immediate referral to child sexual abuse experts or child advocacy centers
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What should be a normal part of all child wellness exams?
Genital/ Anal exam
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When should forensics be used in child abuse?
When disclosure is within the last 96 hours
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