Burns and Inflicted Trauma — MCQs
Which of the following is not a differential diagnosis of non-accidental injury?
Which of the following statements is true regarding femoral shaft fractures in infants?
A baby was vigorously shaken by parents. What do you expect in the baby?
A child is brought to the casualty department with reports of violent shaking by parents. What is the most likely injury?
An 11-year-old female in the school was brought to the principal by a teacher because she is always crying, unattentive, and not taking an interest in any activity. On further investigation, the girl revealed that she was inappropriately touched by her uncle on her private parts at her home. To whom should the principal report this incident?
What percentage of total body surface area is affected in an adult with burns involving both lower limbs and genitalia?
A 16-year-old girl comes to a doctor with fractured forearm. She said she tripped and fell but cigarette burns were observed on her forearm. What will be your next step?
Which of the following is NOT part of the classic triad of shaken baby syndrome?
A man regularly derives sexual gratification by inflicting pain upon his partner. He would often produce cuts and cigarette burns on his partner's arms. This is best described as?
According to the Lund and Browder chart, what percentage of total body surface area (TBSA) does the head and face represent in a 1-year-old child?
Burns and Inflicted Trauma Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is not a differential diagnosis of non-accidental injury?
- A. Osteogenesis imperfecta
- B. Scurvy
- C. Caffey's disease
- D. Osteopetrosis (Correct Answer)
Explanation: ***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
Question 2: Which of the following statements is true regarding femoral shaft fractures in infants?
- A. Femoral shaft fractures in infants heal rapidly.
- B. Traction is usually sufficient for treatment.
- C. Child abuse is a common cause of femoral shaft fractures in infants. (Correct Answer)
- D. Non-accidental trauma should be considered in the differential diagnosis of femoral shaft fractures in infants.
Explanation: ***Child abuse is a common cause of femoral shaft fractures in infants.*** - **Non-accidental trauma** is a significant cause of femoral shaft fractures in infants, necessitating a high index of suspicion. - The forces required to fracture a healthy infant's femur are substantial, making **accidental trauma** less common than in older children. *Femoral shaft fractures in infants heal rapidly.* - While pediatric fractures generally heal faster than adult fractures, the statement is too broad and doesn't capture the critical context of infant femur fractures. - The primary concern in infant femoral fractures is the etiology (i.e., ruling out child abuse), not solely the healing time. *Traction is usually sufficient for treatment.* - **Pavlik harness** or **spica casting** are common treatment modalities for femoral shaft fractures in infants. - While traction can be part of the initial management, definitive treatment typically involves casting to maintain reduction and allow healing. *Non-accidental trauma should be considered in the differential diagnosis of femoral shaft fractures in infants.* - While true, this statement is less precise than stating that child abuse is a "common cause." - **Child abuse** encompasses non-accidental trauma and highlights the likelihood that such fractures are inflicted.
Question 3: A baby was vigorously shaken by parents. What do you expect in the baby?
- A. Ruptured spleen
- B. Rib fractures
- C. Sub-dural hematoma (Correct Answer)
- D. Pelvic fracture
Explanation: ***Sub-dural hematoma*** - **Shaken baby syndrome** results from violent shaking, leading to rapid acceleration and deceleration that causes tearing of the **bridging veins** in the brain. - This tearing results in a **subdural hematoma**, which is a collection of blood between the dura mater and arachnoid mater. *Ruptured spleen* - While possible in severe trauma, a ruptured spleen is less common with shaking alone and more often associated with **direct abdominal impact**. - The mechanisms of injury for splenic rupture typically involve significant blunt force to the abdomen, which is not the primary injury in shaken baby syndrome. *Rib fractures* - Rib fractures are indicators of significant chest compression or **direct impact**, which can occur in child abuse but are not the primary, immediate effect of shaking a baby. - While rib fractures can be a component of child abuse, they typically result from a different type of forceful interaction than shaking. *Pelvic fracture* - Pelvic fractures in infants typically require **high-energy trauma**, such as a fall from a significant height or a motor vehicle accident. - They are highly unlikely to result from shaking alone, as the pelvis is not directly impacted during a typical shaking event.
Question 4: A child is brought to the casualty department with reports of violent shaking by parents. What is the most likely injury?
- A. Skull bone fracture
- B. Long bone fracture
- C. Subdural haematoma (Correct Answer)
- D. Ruptured spleen
Explanation: ***Subdural haematoma*** - **Violent shaking** in infants (known as **shaken baby syndrome**) causes characteristic neurological injuries due to acceleration-deceleration forces, leading to tearing of **bridging veins** and often presenting as **subdural haematoma**. - The infant's immature brain and weak neck muscles make them particularly vulnerable to these forces, resulting in significant intracranial bleeding without direct impact. *Skull bone fracture* - While possible in cases of severe trauma, **skull fractures** are less specific to violent shaking alone, often requiring a direct impact. - Shaking causes shearing forces on the brain's delicate structures rather than directly fracturing the skull unless there is an impact. *Long bone fracture* - **Long bone fractures**, such as spiral fractures, can occur in child abuse but are typically associated with **twisting or direct impact** rather than the primary mechanism of violent shaking. - While possible, they are not the most immediate or common injury directly resulting from the shearing forces of shaking. *Ruptured spleen* - A **ruptured spleen** indicates significant **abdominal trauma**, usually a direct blow or crush injury, which is not the primary mechanism of injury in violent shaking. - While internal organ damage can occur in child abuse, it's less characteristic of trauma solely from violent shaking compared to intracranial injuries.
Question 5: An 11-year-old female in the school was brought to the principal by a teacher because she is always crying, unattentive, and not taking an interest in any activity. On further investigation, the girl revealed that she was inappropriately touched by her uncle on her private parts at her home. To whom should the principal report this incident?
- A. Child welfare
- B. Parents
- C. Police (Correct Answer)
- D. Magistrate
Explanation: ***Police*** - Under the **POCSO Act (Protection of Children from Sexual Offences Act), 2012, Section 19(1)**, the principal and teacher are **mandated reporters** who have a legal obligation to report any knowledge or suspicion of child sexual abuse to the **local police or Special Juvenile Police Unit**. - Failure to report such cases is a punishable offense under POCSO Act, with imprisonment up to 6 months and/or fine. - The police are responsible for **immediate investigation** of the criminal offense and ensuring the child's safety. - The police will then coordinate with the Child Welfare Committee (CWC) as required under the Juvenile Justice Act. *Child welfare* - While the **Child Welfare Committee (CWC)** plays an important role in child protection under the Juvenile Justice Act, 2015, the **primary and immediate legal obligation** under POCSO is to report to the **police**. - The CWC becomes involved either through police referral or parallel reporting, but they are **not the first point of contact** for reporting criminal sexual offenses. - Child welfare agencies work on rehabilitation and protection, whereas police handle the criminal investigation. *Parents* - Since the perpetrator is the **uncle (family member)**, reporting to parents first could compromise the investigation or further endanger the child. - Parents may be in denial, protective of the family member, or unaware of the severity. - POCSO Act mandates reporting to **authorities (police)**, not to family members. *Magistrate* - A magistrate is a **judicial officer** involved in legal proceedings after police investigation and filing of chargesheet. - They issue orders, record statements under Section 164 CrPC, and conduct trials. - They are **not the appropriate authority** for the initial mandatory report of child sexual abuse.
Question 6: What percentage of total body surface area is affected in an adult with burns involving both lower limbs and genitalia?
- A. 18%
- B. 19%
- C. 36%
- D. 37% (Correct Answer)
Explanation: ***37%*** - The **Rule of Nines** is used to estimate the percentage of **Total Body Surface Area (TBSA)** affected by burns in adults. - According to this rule, each lower limb accounts for **18%** of TBSA, and the genitalia/perineum accounts for **1%**. Therefore, both lower limbs (18% + 18%) + genitalia (1%) = **37%**. *18%* - This percentage represents only **one entire lower limb** or the entire anterior trunk in an adult according to the Rule of Nines. - It does not account for both lower limbs and the genitalia. *19%* - This would represent one lower limb (18%) plus the genitalia (1%), or an entire lower limb plus a small additional area. - It does not cover the **entirety of both lower limbs** and genitalia. *36%* - This percentage would typically refer to the **entire back** (18%) and the **entire chest/abdomen** (18%), or both lower limbs without the genitalia. - It specifically **excludes the 1% for the genitalia**, making it an underestimation for the scenario described.
Question 7: A 16-year-old girl comes to a doctor with fractured forearm. She said she tripped and fell but cigarette burns were observed on her forearm. What will be your next step?
- A. To tell or discuss with colleagues that she is a case of abuse
- B. To inform higher authorities
- C. To do a complete physical examination (Correct Answer)
- D. To call local social worker for help
Explanation: ***To do a complete physical examination*** - A comprehensive **physical examination** is essential to assess the full extent of injuries and to identify any other signs of abuse that might not be immediately apparent. - This step ensures that all medical needs are addressed and that any potential harm is documented appropriately within the medical record. *To tell or discuss with colleagues that she is a case of abuse* - While suspicion of abuse is high, immediately labeling the patient as a "case of abuse" to colleagues without further assessment can be premature and may compromise patient confidentiality. - Discussing with colleagues should follow a thorough examination and be part of a structured approach to **interprofessional collaboration** once concerns are medically substantiated. *To inform higher authorities* - Reporting to higher authorities is a critical step in cases of suspected abuse, but it typically follows a **thorough medical evaluation** and documentation of findings. - Informing authorities prematurely without a complete medical assessment could lead to incomplete information and potentially delay necessary medical care for the patient. *To call local social worker for help* - Involving a social worker is an important component of managing suspected child abuse, as they can provide support and guidance for the patient and family. - However, the immediate priority is to address the patient's medical needs and gather medical evidence through a **complete physical examination** before initiating social services.
Question 8: Which of the following is NOT part of the classic triad of shaken baby syndrome?
- A. Retinal hemorrhaging
- B. Brain swelling
- C. Subdural hematoma
- D. CSF Rhinorrhea (Correct Answer)
Explanation: ***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.
Question 9: A man regularly derives sexual gratification by inflicting pain upon his partner. He would often produce cuts and cigarette burns on his partner's arms. This is best described as?
- A. Masochism
- B. Voyeurism
- C. Sadism (Correct Answer)
- D. Fetishism
Explanation: ***Sadism*** - **Sexual sadism** is defined by recurrent, intense sexually arousing fantasies, urges, or behaviors involving inflicting **physical or psychological suffering** on another person. - In this case, the man derives sexual gratification from causing pain (cuts and cigarette burns) to his partner, which is a direct manifestation of sadistic behavior. *Masochism* - **Sexual masochism** involves deriving sexual gratification from being **humiliated, beaten, bound, or otherwise made to suffer**. - The scenario describes the individual inflicting pain, not experiencing it, thus ruling out masochism. *Voyeurism* - **Voyeurism** is characterized by deriving sexual gratification from **observing unsuspecting people** who are naked, disrobing, or engaging in sexual activity. - The behavior described involves active participation and infliction of pain, not covert observation. *Fetishism* - **Fetishism** involves recurrent, intense sexually arousing fantasies, urges, or behaviors involving the use of **non-living objects (fetishes)** or a highly specific focus on non-genital body parts. - While some fetishes might involve pain, the primary driver here is the act of inflicting suffering, not the attachment to an inanimate object or specific body part.
Question 10: According to the Lund and Browder chart, what percentage of total body surface area (TBSA) does the head and face represent in a 1-year-old child?
- A. 16%
- B. 10%
- C. 19% (Correct Answer)
- D. 13%
Explanation: ***19%*** - The **Lund and Browder chart** accounts for age-related variations in body proportions, assigning a larger percentage of **total body surface area (TBSA)** to the head in infants and young children. - For a **1-year-old child**, the head and face are estimated to represent approximately **19% TBSA**, which decreases with age as the body proportions change. *16%* - While 16% is a value sometimes associated with the head, it is not the accurate percentage for a **1-year-old child** according to the **Lund and Browder chart**. - This percentage is typically closer to that of an **older child** or adult's head, as body proportions change over time. *10%* - **10% TBSA** is far too low for the head and face of a **1-year-old child** as per the Lund and Browder chart. - This value is usually associated with areas like the **arms** in children or the head of an **adult** in some simpler TBSA estimation methods. *13%* - **13% TBSA** is an underestimation for the head and face of a **1-year-old child** when using the **Lund and Browder chart**. - The large relative size of an infant's head means it contributes a significantly higher percentage to their **total body surface area**.
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