CYPT

Question 1

Define abusive head trauma

Answer 1

Constellation of symptoms, physical signs, laboratory, imaging and pathologic findings that are a consequence of violent shaking, impact or a combination of the two

Question 2

List characteristic injuries of abusive head trauma

Answer 2

• intracranial hemorrhage
• retinal hemorrhage
• brain injury
• skull, rib, long bone fractures

Question 3

Outline the approach to a patient with suspected abusive head trauma

Answer 3

• complete physical examination to detect any signs that may indicate injury or an alternate diagnosis
• ophthalmologic assessment (with dilated pupils)
• CBC with platelets
• Coagulation studies
• Glucose, lytes, metabolic screen, toxicology, microbiology
• Neuroimaging: CT for acute cases, MRI may provide additional information in delineating presence/location of intracranial injuries
• Skeletal survey (repeat 10-14 days after)

Question 4

For an infant at risk of abusive head trauma with a normal physical examination, please list components of your evaluation

Answer 4

• ophthalmology
• neuroimaging
• skeletal survey

Question 5

In which patients are autopsies necessary

Answer 5

All children under the age of two years who die in a sudden, unexpected, or unexplained manner

Question 6

List features of accidental childhood trauma

Answer 6

• relatively small
• oval to round in shape with non distinct borders
• located above or near bony prominences on front of body (forehead, knees, shins)
• no recognizable shape or pattern

Question 7

List red flags for inflicted injury in a child with bruising

Answer 7

• bruises in babies who are not yet cruising
• bruises on ears, neck, feet, buttocks, torso
• bruises not on front of body/overlying bone
• bruises that are unusually large/numerous
• bruises that are clustered or patterned
• bruises that do not fit with causal mechanism described
• **colour of bruising are not reliable indicators of age of bruise

Question 8

List some hematologic conditions that cause bruising in children

Answer 8

• ITP
• vWD
• Factor 8 and 9 deficiency
• platelet function disorders

Question 9

List some medical conditions that cause bruising in children

Answer 9

• infections
• malignancy
• neuroblastoma
• nutritional deficiencies
• systemic illness
• connective tissue disorders
• autoimmune/inflammatory disorders

Question 10

List recommended first-line lab testing for bruising and suspected maltreatment

Answer 10

• CBC
• blood smear
• PTT, INR
• FIbrinogen
• vWD studies
• blood group
• Factor 8 & 9 levels
• liver function tests
• renal function tests
• Children

Question 11

List injuries that are characteristic of Shaken Baby Syndrome

Answer 11

• retinal hemorrhage
• rib fractures
• end of long bone fractures (bucket fracture, corner metaphyseal lesion)
• intracranial hemorrhage

Question 12

What are potential longterm health consequences of Shaken Baby Syndrome?

Answer 12

• developmental delay
• seizures
• paralysis
• blindness
• death
• no apparent effects

Question 13

What are risk factors for Shaken Baby Syndrome?

Answer 13

• male

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