A woman brings in her 5-year-old son to your office for well child checks. You notice on each visit that the child is very unkept, dirty, does not speak proper sentences, and seems malnourished on physical exam. You have mentioned your concerns to the mother in the past.
What is the most appropriate next step at this time?
Correct Answer C: Child protection service (CPS) or children’s aid society (CAS) is a service physicians or the general public can contact and report suspected cases of child neglect or abuse.
CPS agencies generally perform a series of functions as follows:
Which one of the following statements concerning childhood sexual abuse is true?
Correct Answer D:
The risk factors associated with childhood sexual abuse are:
Perpetrators of sexual abuse are usually male, and often trusted adult acquaintances.
A 6-month-old child is hospitalized with multiple bruises. Child abuse is suspected. As part of her evaluation, an ophthalmology consult is obtained.
Which of the following ocular findings is most consistent with child abuse?
Correct Answer A: Retinal hemorrhages may indicate shaken baby syndrome and, in some cases, may be the only verifiable sign of child abuse.
B. Conjunctivitis is the result of an infection, allergy, or contact irritation and is not typical of abuse.
C. Strabismus is not a typical early finding in an abuse case.
D. May be seen as a late finding if an abused child has suffered severe trauma or retinal detachment, but would not coexist with new bruises.
E. Dacryocystitis results from infection of the lacrimal duct and is not associated with trauma.
A 2-year-old girl with well-demarcated bilateral “stocking” distribution scald burns is brought to your office by her mother. The mother says that the child climbed into the bathtub before the mother had a chance to test the water temperature.
Which of the following items makes you highly suspicious that this injury is due to non-accidental trauma?
Correct Answer B: Burns with sharp margins should raise a suspicion of abuse. A child who steps into hot water with one foot would not place the second foot into the hot bath water. The stocking distribution is seen when a child is intentionally “dipped” into hot water, often as punishment.
A. Getting medical care soon after an injury demonstrates parental concern. Seeking care long after an injury may raise suspicion for abuse.
C. Scaled burns may be the result of intentional or unintentional mechanisms. In fact, scalds are the most common type of burns in childhood.
D. Splash burns are often the result of unintentional injury.
E. Many good caring parents do not know that hot water heater temperatures should be set below 125 degrees to minimize the chance of unintentional scald burns. Most Child Protective Service agencies would not consider this child neglect.
A 13-year-old boy comes into your office for a pre-participation sports physical. He has a harsh systolic ejection murmur at the right upper sternal border, which diminishes with the Valsalva maneuver. The murmur is preceded by an ejection click. The patient reports no symptoms at rest or with activity.
Which advice is most appropriate for this patient?
Correct Answer A: The patient described above has an exam consistent with aortic stenosis. Symptoms are often absent even if obstruction is severe. The patient should not be allowed to participate in sports, as sudden death has been reported. An echocardiogram should be performed to assess the valvular lesion, the degree of the stenosis, and the left ventricular function. All of these factors will determine the appropriate intervention to repair or replace the valve. Antibiotic prophylaxis is no longer indicated for the prevention of infective endocarditis in patients with aortic stenosis.
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