CHILD ABUSE TEST PAPER 2025/2026 QUESTIONS AND
ANSWERS RATED A+
✔✔factors that impact severity of injury from immersion? - ✔✔water temperature
time of exposure
age of child
location of injury (type of skin)
clothing
✔✔liquid burn with clearly delineated borders, no flow or splash patterns, sparing of
buttocks & sole of feet is likely: - ✔✔immersion burn
✔✔true or false: there should be bruises over inflicted injuries - ✔✔false;
bruises over inflicted injuries are rare
✔✔true or false: babies bones break easily - ✔✔false;
young infants have flexible bones that bend before they break
✔✔true or false: spiral fractures are nearly always abusive - ✔✔spiral fractures can be
accidental if a twisting mechanism is implicated
✔✔fractures concerning for abuse: - ✔✔classic metaphyseal fracture, rib fracture,
complex skull fractures, sternum fracture, scapula fracture, vertebral fracture, fractures
in non-mobile infants
✔✔metaphyseal fracture - ✔✔highly specific for inflicted injury;
series of microfractures oriented across metaphysis, perpendicular to the long axis of
the bone
✔✔% of abused children with a metaphyseal fracture? - ✔✔39-50%;
commonly in distal femur, proximal tibia, distal tibia, proximal humerus
✔✔classic metaphyseal lesion - ✔✔requires shearing forces NOT produced in
accidental trauma;
consider forceful traction or twisting;
possibly during shaking when limbs flail around
✔✔infant rib fractures are typically: - ✔✔posterior, usually asymptomatic, often no
bruising or swelling
✔✔mechanism is lateral rib fractures: - ✔✔outbending of ribs with anterior posterior
compression
, ✔✔mechanism of posterior rib fractures: - ✔✔from levering over transverse process of
spinal vertebra
✔✔most common type & location of skull fractures in accidental & abusive injury? -
✔✔linear parietal bone fractures
✔✔skull fractures more suggestive of abuse: - ✔✔multiple, bilateral, complex fractures
✔✔most common fractures in children? - ✔✔long bone fractures;
occur 4x more often in children who are abused
✔✔mechanism of spiral fracture: - ✔✔rotational or twisting force
✔✔mechanism of oblique fracture: - ✔✔combines loading or compressive forces with
rotatopm
✔✔mechanism of transverse fracture: - ✔✔bending or direct force;
displaced transverse fracture due to high energy blow
✔✔mechanism of torus (buckle) fracture: - ✔✔axial loading, found on end of long bones
✔✔premature infants are at risk for what condition that could present as possible
abuse? - ✔✔osteopenia, may develop fractures in NICU from routine handling./therapy
✔✔how is diagnosis of osteopenia confirmed? - ✔✔elevated alk phos levels
✔✔presentation of nutritional rickets? - ✔✔insufficient vitamin D, flaring of distal
radius/ulnda, rachitic rosary (ribs), metaphyseal irregularity, widening physes,
psuedofractures, periosteal reactions
✔✔rare, inherited disorder of connective tissue resulting from abnormal quantity of
quality of type I collagen - ✔✔osteogenesis imperfecta
✔✔80% of OI cases, autosomal dominant inheritance, milder form, blue sclera, short
stature, variable adult hearing loss, positive family history - ✔✔Type I
✔✔rare & severe OI, autosomal dominant or new mutation, fractures at birth in 2/3 of
cases, poor growth, variably blue sclera, many Wormian bones, fragile teeth, adult
hearing loss - ✔✔Type III
✔✔tests to determine/diagnose osteogenesis imperfecta - ✔✔collagen synthetic
phenotype;
sequence of COL1A1 and COL1A2 from blood/fibroblasts
ANSWERS RATED A+
✔✔factors that impact severity of injury from immersion? - ✔✔water temperature
time of exposure
age of child
location of injury (type of skin)
clothing
✔✔liquid burn with clearly delineated borders, no flow or splash patterns, sparing of
buttocks & sole of feet is likely: - ✔✔immersion burn
✔✔true or false: there should be bruises over inflicted injuries - ✔✔false;
bruises over inflicted injuries are rare
✔✔true or false: babies bones break easily - ✔✔false;
young infants have flexible bones that bend before they break
✔✔true or false: spiral fractures are nearly always abusive - ✔✔spiral fractures can be
accidental if a twisting mechanism is implicated
✔✔fractures concerning for abuse: - ✔✔classic metaphyseal fracture, rib fracture,
complex skull fractures, sternum fracture, scapula fracture, vertebral fracture, fractures
in non-mobile infants
✔✔metaphyseal fracture - ✔✔highly specific for inflicted injury;
series of microfractures oriented across metaphysis, perpendicular to the long axis of
the bone
✔✔% of abused children with a metaphyseal fracture? - ✔✔39-50%;
commonly in distal femur, proximal tibia, distal tibia, proximal humerus
✔✔classic metaphyseal lesion - ✔✔requires shearing forces NOT produced in
accidental trauma;
consider forceful traction or twisting;
possibly during shaking when limbs flail around
✔✔infant rib fractures are typically: - ✔✔posterior, usually asymptomatic, often no
bruising or swelling
✔✔mechanism is lateral rib fractures: - ✔✔outbending of ribs with anterior posterior
compression
, ✔✔mechanism of posterior rib fractures: - ✔✔from levering over transverse process of
spinal vertebra
✔✔most common type & location of skull fractures in accidental & abusive injury? -
✔✔linear parietal bone fractures
✔✔skull fractures more suggestive of abuse: - ✔✔multiple, bilateral, complex fractures
✔✔most common fractures in children? - ✔✔long bone fractures;
occur 4x more often in children who are abused
✔✔mechanism of spiral fracture: - ✔✔rotational or twisting force
✔✔mechanism of oblique fracture: - ✔✔combines loading or compressive forces with
rotatopm
✔✔mechanism of transverse fracture: - ✔✔bending or direct force;
displaced transverse fracture due to high energy blow
✔✔mechanism of torus (buckle) fracture: - ✔✔axial loading, found on end of long bones
✔✔premature infants are at risk for what condition that could present as possible
abuse? - ✔✔osteopenia, may develop fractures in NICU from routine handling./therapy
✔✔how is diagnosis of osteopenia confirmed? - ✔✔elevated alk phos levels
✔✔presentation of nutritional rickets? - ✔✔insufficient vitamin D, flaring of distal
radius/ulnda, rachitic rosary (ribs), metaphyseal irregularity, widening physes,
psuedofractures, periosteal reactions
✔✔rare, inherited disorder of connective tissue resulting from abnormal quantity of
quality of type I collagen - ✔✔osteogenesis imperfecta
✔✔80% of OI cases, autosomal dominant inheritance, milder form, blue sclera, short
stature, variable adult hearing loss, positive family history - ✔✔Type I
✔✔rare & severe OI, autosomal dominant or new mutation, fractures at birth in 2/3 of
cases, poor growth, variably blue sclera, many Wormian bones, fragile teeth, adult
hearing loss - ✔✔Type III
✔✔tests to determine/diagnose osteogenesis imperfecta - ✔✔collagen synthetic
phenotype;
sequence of COL1A1 and COL1A2 from blood/fibroblasts
