Child Abuse and Neglect — MCQs

Q: Which of the following is not a differential diagnosis of non-accidental injury?

Osteopetrosis. ***Correct: Osteopetrosis*** - Osteopetrosis is a rare genetic disorder characterized by **increased bone density** due to defective osteoclast function - While it causes bones to be brittle and prone to fracture, it has **distinctive radiological features** including diffuse sclerosis and "bone-within-bone" appearance - The **increased bone density on X-ray** is pathognomonic and readily distinguishes it from NAI, making it **less likely to be confused** with non-accidental injury in clinical practice - Fractures occur but the radiological pattern is diagnostic of the underlying metabolic bone disease *Incorrect: Osteogenesis imperfecta* - This is a **classic differential** for NAI causing **multiple brittle bone fractures** that can be mistaken for abuse - Features include **blue sclera**, **dentinogenesis imperfecta**, **wormian bones**, and **family history** - Often presents with multiple fractures at different stages of healing, mimicking the pattern seen in NAI *Incorrect: Scurvy* - Caused by **vitamin C deficiency**, leads to defective collagen synthesis - Results in **subperiosteal hemorrhages**, **metaphyseal fractures**, and **periosteal elevation** that closely mimic NAI - Additional features include **gingival bleeding**, **petechiae**, **follicular hyperkeratosis**, and **poor wound healing** *Incorrect: Caffey's disease* - Also known as **infantile cortical hyperostosis**, presents in infants under 6 months - Causes **periosteal reactions**, **bone thickening**, and **soft tissue swelling** in long bones, ribs, and mandible - The periosteal new bone formation can be mistaken for healing fractures from NAI, making it an important differential

Q: Which of the following is NOT part of the classic triad of shaken baby syndrome?

CSF Rhinorrhea. ***CSF Rhinorrhea*** - **CSF rhinorrhea** (leakage of cerebrospinal fluid from the nose) is not a typical finding in the classic triad of **shaken baby syndrome**. - It usually occurs due to a **fracture of the skull base**, which is possible in severe trauma but not a defining feature of the triad from shaking alone. *Retinal hemorrhaging* - **Retinal hemorrhages** are a hallmark sign of **shaken baby syndrome**, resulting from the violent back-and-forth motion that tears delicate retinal vessels. - Their presence, especially if bilateral and across multiple layers of the retina, is highly indicative of **abusive head trauma**. *Brain swelling* - **Cerebral edema** (brain swelling) is a common and severe consequence of **shaken baby syndrome**, often leading to increased intracranial pressure. - This swelling results from brain injury due to direct trauma, lack of oxygen, and vascular damage. *Subdural hematoma* - A **subdural hematoma** (bleeding between the dura mater and arachnoid mater) is a key component of the classic triad. - It occurs due to the tearing of **bridging veins** as the brain moves rapidly within the skull during violent shaking.

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Physical Abuse Recognition

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Emotional Abuse and Neglect

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Failure to Thrive Due to Neglect

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Shaken Baby Syndrome

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Burns and Inflicted Trauma

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Documentation and Reporting

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Interviewing Techniques

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Child Protection System

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