LATEST CHILD ABUSE PEDIATRICS
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 3-month-old infant presents with bruising on the
face, trunk, and extremities. The parents report that
the infant "rolls over and hits the crib rails." Which
bruising pattern is most inconsistent with accidental
injury at this age?
A) Bruising on the shins and knees
B) Bruising on the forehead
C) Bruising on the abdomen, back, and buttocks
D) Bruising on the chin
Correct answer: C
Rationale: Infants under 6 months rarely have any
accidental bruising (not yet mobile). Bruising on the
torso (abdomen, back, buttocks) is highly suspicious
for child physical abuse. Accidental bruising occurs
over bony prominences (shins, forehead, elbows).
2. A 4-year-old child presents with a spiral fracture of
the femur. The caregiver reports that the child fell
,while running. Which feature of this fracture is most
concerning for non-accidental trauma (NAT)?
A) Spiral morphology in a non-ambulatory child
B) Presence of a subperiosteal new bone formation
C) A transverse fracture line
D) A greenstick fracture
Correct answer: A
Rationale: Spiral (torsional) fractures in a non-
ambulatory child (under 1 year) or in a child whose
history is inconsistent with the injury is concerning
for abuse. In a 4-year-old, a spiral fracture can occur
from a fall while running, but the history must be
consistent. Femur fractures in children under 1 year
have high specificity for abuse.
3. A 2-month-old infant presents with altered mental
status. Skeletal survey reveals healing rib fractures
(posterior) and a classic metaphyseal lesion (CML) of
the distal femur. What is the most likely mechanism of
injury?
A) Accidental fall from a changing table
B) Violent shaking (shaken baby syndrome, abusive
head trauma)
C) Birth trauma (clavicle fracture)
,D) Osteogenesis imperfecta (OI)
Correct answer: B
Rationale: The combination of posterior rib fractures
(caused by compression of the chest during shaking)
and classic metaphyseal lesions (CML, "bucket
handle" fractures from pulling/pulling on extremities)
is highly specific for abusive head trauma (shaken
baby syndrome). Birth trauma (C) does not cause
posterior rib fractures.
4. A 6-year-old child presents with a burn on the
dorsal aspect of the hand in a glove distribution
(sparing the palmar creases). The burn has sharp
demarcation and is symmetric. What is the most likely
mechanism?
A) Accidental immersion burn (child put hand in hot
water)
B) Forced immersion burn (abusive, hand held under
hot water)
C) Flame burn from a house fire
D) Scald burn from hot liquid spilled from a stove
Correct answer: B
Rationale: Forced immersion burns (abusive) often
have sharp demarcation, symmetry (stocking or
glove distribution), sparing of flexor creases
, (because the child clenches fists), and may have a
"doughnut" sparing of the buttocks if perineal
immersion. Accidental scalds (D) are usually splash
pattern (asymmetric, irregular).
5. A 3-week-old infant is brought to the emergency
department with fussiness and poor feeding. Physical
examination reveals multiple posterior rib fractures
in various stages of healing (acute and chronic
callus). No other injuries are noted. What is the most
likely underlying condition to exclude?
A) Osteogenesis imperfecta (OI)
B) Rickets (vitamin D deficiency)
C) Copper deficiency
D) Leukemia (bone lesions)
Correct answer: A
Rationale: Osteogenesis imperfecta (OI) (brittle bone
disease) can cause multiple fractures with minimal
trauma (including rib fractures). Blue sclerae,
dentinogenesis imperfecta, and family history may be
present. However, the pattern of multiple posterior
rib fractures in an infant is also highly specific for
abuse. OI must be ruled out (skin biopsy for collagen
analysis or genetic testing for COL1A1/COL1A2).
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 3-month-old infant presents with bruising on the
face, trunk, and extremities. The parents report that
the infant "rolls over and hits the crib rails." Which
bruising pattern is most inconsistent with accidental
injury at this age?
A) Bruising on the shins and knees
B) Bruising on the forehead
C) Bruising on the abdomen, back, and buttocks
D) Bruising on the chin
Correct answer: C
Rationale: Infants under 6 months rarely have any
accidental bruising (not yet mobile). Bruising on the
torso (abdomen, back, buttocks) is highly suspicious
for child physical abuse. Accidental bruising occurs
over bony prominences (shins, forehead, elbows).
2. A 4-year-old child presents with a spiral fracture of
the femur. The caregiver reports that the child fell
,while running. Which feature of this fracture is most
concerning for non-accidental trauma (NAT)?
A) Spiral morphology in a non-ambulatory child
B) Presence of a subperiosteal new bone formation
C) A transverse fracture line
D) A greenstick fracture
Correct answer: A
Rationale: Spiral (torsional) fractures in a non-
ambulatory child (under 1 year) or in a child whose
history is inconsistent with the injury is concerning
for abuse. In a 4-year-old, a spiral fracture can occur
from a fall while running, but the history must be
consistent. Femur fractures in children under 1 year
have high specificity for abuse.
3. A 2-month-old infant presents with altered mental
status. Skeletal survey reveals healing rib fractures
(posterior) and a classic metaphyseal lesion (CML) of
the distal femur. What is the most likely mechanism of
injury?
A) Accidental fall from a changing table
B) Violent shaking (shaken baby syndrome, abusive
head trauma)
C) Birth trauma (clavicle fracture)
,D) Osteogenesis imperfecta (OI)
Correct answer: B
Rationale: The combination of posterior rib fractures
(caused by compression of the chest during shaking)
and classic metaphyseal lesions (CML, "bucket
handle" fractures from pulling/pulling on extremities)
is highly specific for abusive head trauma (shaken
baby syndrome). Birth trauma (C) does not cause
posterior rib fractures.
4. A 6-year-old child presents with a burn on the
dorsal aspect of the hand in a glove distribution
(sparing the palmar creases). The burn has sharp
demarcation and is symmetric. What is the most likely
mechanism?
A) Accidental immersion burn (child put hand in hot
water)
B) Forced immersion burn (abusive, hand held under
hot water)
C) Flame burn from a house fire
D) Scald burn from hot liquid spilled from a stove
Correct answer: B
Rationale: Forced immersion burns (abusive) often
have sharp demarcation, symmetry (stocking or
glove distribution), sparing of flexor creases
, (because the child clenches fists), and may have a
"doughnut" sparing of the buttocks if perineal
immersion. Accidental scalds (D) are usually splash
pattern (asymmetric, irregular).
5. A 3-week-old infant is brought to the emergency
department with fussiness and poor feeding. Physical
examination reveals multiple posterior rib fractures
in various stages of healing (acute and chronic
callus). No other injuries are noted. What is the most
likely underlying condition to exclude?
A) Osteogenesis imperfecta (OI)
B) Rickets (vitamin D deficiency)
C) Copper deficiency
D) Leukemia (bone lesions)
Correct answer: A
Rationale: Osteogenesis imperfecta (OI) (brittle bone
disease) can cause multiple fractures with minimal
trauma (including rib fractures). Blue sclerae,
dentinogenesis imperfecta, and family history may be
present. However, the pattern of multiple posterior
rib fractures in an infant is also highly specific for
abuse. OI must be ruled out (skin biopsy for collagen
analysis or genetic testing for COL1A1/COL1A2).
