{"id":770,"date":"2023-01-11T12:39:00","date_gmt":"2023-01-11T12:39:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=770"},"modified":"2025-10-01T11:40:36","modified_gmt":"2025-10-01T19:40:36","slug":"usmle-step-1-question-of-the-day-child-abuse","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Child abuse"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#E_Child_abuse\" >E. Child abuse<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#A_Osteogenesis_imperfecta\" >A. Osteogenesis imperfecta<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#B_Vitamin_C_deficiency\" >B. Vitamin C deficiency<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#C_Rickets\" >C. Rickets<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#D_Accidental_trauma\" >D. Accidental trauma<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/strong><strong>Today&#8217;s case focuses on a 6-month-old boy who was taken to a hospital following an accident. Physical examination reveals several bruises over the trunk and extremities at different stages of healing, which the parent attributes to falls that occurred while he was learning to walk. Can you figure out w<\/strong><strong>hich of the following is the most likely cause of this patient\u2019s symptoms?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 6-month-old boy is brought into the emergency department by his parent following a motor vehicle accident. The parent states they were stopped at an intersection when another car hit hers in the rear. The patient was restrained in a car seat during the accident. At arrival, the patient\u2019s temperature is 37.6\u00b0C (99.7\u00b0F), blood pressure is 95\/47 mmHg, and pulse is 109\/min. Weight is at the 10th percentile and height is at the 60th percentile. The patient is inconsolable by his parent. Physical examination reveals several bruises over the trunk and extremities at different stages of healing, which the parent attributes to falls that occurred while he was learning to walk. There is significant tenderness over the right leg and any manipulation of the extremity causes pain. Imaging reveals a spiral fracture of the femur. Which of the following is the most likely cause of this patient\u2019s symptoms?<strong>A. Osteogenesis imperfecta<br><br>B. Vitamin C deficiency<br><br>C. Rickets<br><br>D. Accidental trauma<br><br>E. Child abuse<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Child_abuse\"><\/span>E. Child abuse<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Osteogenesis_imperfecta\"><\/span>A. Osteogenesis imperfecta<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: Children with osteogenesis imperfecta have a congenital defect in the synthesis of type I collagen. These patients are predisposed to various bone fractures, even in the setting of minimal trauma. Other physical examination findings include short stature and blue sclerae, neither of which are present in this patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Vitamin_C_deficiency\"><\/span>B. Vitamin C deficiency<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: Vitamin C is necessary for proper collagen synthesis and formation. Vitamin C deficiency can result in fragile vasculature and easy bruising. Although this patient has several bruises over the body, the spiral femoral fracture and inconsistent history provided by the parent suggest a different diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Rickets\"><\/span>C. Rickets<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: Rickets is usually caused by vitamin D deficiency. In children, the condition can present with bone pain, deformation, and fractures. Although this patient has a femoral fracture, the presence of bruises in various stages of healing and the parent\u2019s inconsistent story (children do typically begin standing or walking until 9-12 months of age) are concerning for child abuse.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Accidental_trauma\"><\/span><strong>D. Accidental trauma<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: Trauma, such as a car accident, can lead to bruising and fractures. However, the bruising would typically be in a specific pattern, such as along the path of a seatbelt. In contrast, this child\u2019s bruising is widespread and in various stages of healing. Moreover, the parent\u2019s inconsistent history should raise suspicion for child abuse. In general, children do not typically begin standing or walking until 9-12 months of age.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This 6-month-old child, who is not yet capable of standing or walking, presents with several bruises in different stages of healing as well as a spiral femoral fracture. These findings are suggestive of child abuse, which demands immediate attention and action.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Children in unstable family situations (e.g., single-parent homes, domestic violence, parental substance use disorders) are at increased risk of enduring child abuse. As soon as child abuse is suspected, a skeletal survey should be performed to evaluate for additional occult fractures. Findings suspicious for child abuse include bruises or fractures at various stages of healing, femoral fractures in non-ambulatory infants, and posterior rib fractures. Additional diagnostic evaluation should include an ophthalmic examination to evaluate for retinal hemorrhages and a head CT to assess for intracranial bleeding.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If a healthcare provider suspects child abuse or neglect, local child protective services should be notified immediately. Management of patients with child abuse entails stabilization, identification, and treatment of all injuries, including a low threshold for hospitalization.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"840\" height=\"570\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pediatric-nonaccidental-trauma.png\" alt=\"\" class=\"wp-image-771\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pediatric-nonaccidental-trauma.png 840w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pediatric-nonaccidental-trauma.png?resize=300,204 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pediatric-nonaccidental-trauma.png?resize=768,521 768w\" sizes=\"auto, (max-width: 840px) 100vw, 840px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Child abuse&nbsp;<\/strong>should be promptly identified in children presenting with injuries incongruent with the patient\u2019s developmental age, repeated hospitalization for unexplained injuries, or history of sexually transmitted infections. If child abuse is suspected,&nbsp;<strong>child protective services<\/strong>&nbsp;should be&nbsp;<strong>immediately notified.&nbsp;<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Kodner, C., Wetherton, A. (2013) Diagnosis and management of physical abuse in children.&nbsp;<em>American Family Physician<\/em>. 88(10), 669-675. PMID: 24364482.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Swerdlin, A., Berkowitz, C., Craft, N. (2007) Cutaneous signs of child abuse.&nbsp;<em>Journal of the American Academy of Dermatology<\/em>. 57(3), 371-392. Doi: 10.1016\/j.jaad.2007.06.001.&nbsp;<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>_________________________<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><br><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.\u00a0<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 6-month-old boy who was taken to a hospital following an accident. Physical examination reveals several bruises over the trunk and extremities at different stages of healing, which the parent attributes to falls that [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":772,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-770","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Child abuse - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-child-abuse\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Child abuse - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 6-month-old boy who was taken to a hospital following an accident. 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