Diagnostic Patterns and Interpersonal Indicators

TEN-4-FACESp

Which clinical decision rule is used to evaluate bruise locations and characteristics for suspected physical child abuse?

Torso, Ear, and Neck

In the TEN-4 bruising rule, what do the letters T, E, and N stand for?

Frenulum, Auricle, Cheek, Eyelid, Sclera, and Patterned

In the FACESp part of the bruising rule, what do the specific letters represent?

4 years or 4 months

The TEN-4 rule specifies that any bruise in these areas is suspicious if the child is under what two age thresholds?

Those who don't cruise rarely bruise

What is the rhyming clinical principle used to identify suspicious bruising in non-mobile infants?

Less than 1 percent

What is the recorded prevalence of bruising in infants under 6 months of age who are not yet mobile?

Frenular tears

Which oral injury is highly suspicious for abuse, often caused by the forceful insertion of a bottle or spoon?

Stocking and glove

Which pathognomonic burn pattern is characterized by sharply demarcated bilateral burns on the hands or feet without splash marks?

Forced immersion

Stocking and glove burns are the result of what specific type of abusive action?

Mirror-image

Because they involve forced positioning in liquid, stocking and glove burns often have what type of appearance on the limbs?

Intercanine distance of 3 cm or more

What specific measurement of a bite mark is pathognomonic for an injury inflicted by an adult?

Patterned marks

What is the general term for injuries that reflect the shape of the object used, such as a belt buckle, cord, or hand?

Tramline bruises

What specific type of parallel bruising is characteristic of being hit with a rod, stick, or slap?

Subdural hematoma, retinal hemorrhages, and brain swelling

What three findings comprise the classic diagnostic triad of Shaken Baby Syndrome/Abusive Head Trauma?

Inconsolable crying

What is the most common trigger that leads a caregiver to violently shake an infant?

Bridging veins

In Shaken Baby Syndrome, the rupture of which specific vessels leads to a subdural hemorrhage?

Retinal hemorrhages

What eye finding is present in approximately 80 percent of Abusive Head Trauma cases?

Bucket-handle fracture

What is the common name for a classic metaphyseal fracture, which is pathognomonic for child abuse?

Pulling, twisting, or shaking

Bucket-handle fractures are caused by which three types of mechanical forces applied to a limb?

Sentinel injuries

What term refers to minor, unexplained injuries in infants that are often early warning signs of more severe future abuse?

Head and neck

What are the two most common sites for abusive injuries encountered in the Philippines?

Thoracic and Abdominal injuries

Which type of internal injuries are often not visible externally and are associated with Mechanically Insufficient explanations like "falling from a bed"?

Targeting the Child

What is the first stage of the Grooming process, where an offender identifies a childs vulnerability?

Gaining the Childs and Caregivers Trust

What is the second stage of Grooming, where the offender appears helpful and supportive?

Filling a Need

In which stage of Grooming does the offender use gifts, money, or emotional support to become important to the child?

Isolating the Child

Which Grooming stage involves creating situations where the child is alone with the offender and feels understood only by them?

Sexualizing the Relationship

In which stage of Grooming does the adult exploit a childs curiosity through talk, pictures, or stimulation?

Maintaining Control

What is the final stage of Grooming, where the perpetrator uses secrecy, guilt, or threats to prevent disclosure?

Secrecy

What is the first stage of the Child Sexual Abuse Accommodation Syndrome?

Helplessness

Which stage of the Accommodation Syndrome involves the child developing coping mechanisms like dissociation or pretending to be asleep?

Accommodation

In which stage of the Accommodation Syndrome does the child experience self-blame and take on the role of protecting the family?

Delayed, Conflicted, Unconvincing Disclosure

What stage of the syndrome occurs when a child finally reports abuse, often appearing angry or rebellious?

Retraction

What is the final stage of the Accommodation Syndrome, where a child reverses their testimony under pressure?

Incest victims

The Child Sexual Abuse Accommodation Syndrome is most commonly observed in which specific group of victims?

Notch

What is the term for a hymenal finding that is not a full-thickness tear?

Transection

What is the term for a full-thickness tear through the entire width of the hymenal membrane to the vaginal wall?

Missing segment

An anogenital injury with a width greater than 3 mm is classified as what?

Huffman Stages

What is the name of the staging system used to demonstrate how estrogen affects the appearance of the hymen over time?

Redundant hymen

Which Huffman Stage 4 finding involves thick projections and is normal in premenarcheal girls?

Estrogenization

What process during puberty can mask previously sustained prepubertal hymenal injuries?

97.8 percent

What percentage of sexually abused children have a normal physical examination when examined non-acutely?

78.6 percent

Even in acute cases (within 3 days), what percentage of sexually abused children still show normal anogenital findings?

24 hours

Forensic evidence such as sperm or blood is unlikely to be identified on a childs body after how many hours?

Verbatim with quotation marks

How must a childs disclosure of abuse be documented in a medical record to maintain legal integrity?

Full-face picture

What is the first mandatory photograph that must be taken to identify a suspected abuse victim before documenting injuries?

ABFO scale

Which L-shaped plastic scale is used in forensic photography to correct distortion and verify size?

Personal devices

Physicians are strictly prohibited from using what to take photos of abuse victims due to subpoena risks?

Pudendal cleft

Penile introduction into which specific anatomical area is legally sufficient to consummate the crime of rape?

Bully

In the Bullying Circle, who is the individual who starts the bullying and takes an active part?

Follower or Henchman

Who takes an active part in bullying but does not start the action?

Supporter or Passive Bully

Which role in the circle supports the bullying, such as by liking a mean post, but does not take an active part?

Passive Supporter

Who likes the bullying but does not display open support?

Disengaged Onlooker

Who watches the bullying but does not take a stand, claiming "it is none of my business"?

Possible Defender

Who dislikes the bullying and feels they ought to help but does not act?

Defender of the Victim

Who is the "upstander" who actively dislikes the bullying and tries to help the victim?

10 seconds

More than half of bullying incidents stop when a peer intervenes within what timeframe?

Physical appearance

What is identified as the most frequent reason children and adolescents are targeted for bullying?

Somatization

Children who are bullied often present to clinics with physical complaints like abdominal pain or headaches, a process known as what?

Thicker cortex in the fusiform gyrus

What specific neurobiological change has been observed in the brains of 10-year-olds who are frequently bullied?

Telomere erosion

Exposure to multiple types of violence is associated with what cellular marker of accelerated biological aging?

RIP

What is the acronym for the three defining features of Bullying: Repeated, Intentional, and Power imbalance?

Digital footprint

What refers to the impression of an identity that lingers online even when the user is offline, complicating cyberbullying?

Stop, Walk, Talk

What is the three-step approach taught to victims to respond firmly to bullying?

Do you feel safe at school?

What is identified as the most critical screening question regarding bullying in the primary care setting?

Lethargic or unconscious

What is the general danger sign in IMCI that involves a child who is abnormally sleepy or difficult to wake?

Not able to drink or breastfeed

What is the first IMCI general danger sign assessed in a sick child?

Vomits everything

Which danger sign is positive if a child cannot keep any liquids or solids down?

Convulsions

Which danger sign involves the child having fits or involuntary muscle contractions?

50 breaths per minute or more

What is the fast breathing threshold for an infant aged 2 months up to 12 months in IMCI?

40 breaths per minute or more

What is the fast breathing threshold for a child aged 12 months up to 5 years?

60 breaths per minute or more

What is the fast breathing threshold for a sick young infant under 2 months old?

One full minute

For how long must a clinician count a childs breaths to accurately assess for tachypnea?

Stridor

What harsh noise heard during inspiration in a calm child is a sign of severe pneumonia?

Severe chest indrawing

What physical finding in a young infant (under 2 months) is an abnormal sign of serious illness?

Pink

Which IMCI color code indicates a severe classification requiring urgent pre-referral treatment and referral?

Yellow

Which IMCI color code indicates a condition that should be treated at the health facility with specific medicine?

Green

Which IMCI color code represents simple advice for home management and counseling?

Edema of both feet

What physical finding is the first check when assessing a child for acute malnutrition?

Less than 115 mm

What MUAC measurement indicates severe acute malnutrition in a child aged 6 months or older?

Minus 3 Z-score

A weight-for-height measurement below what threshold indicates severe acute malnutrition?

Severe palmar pallor

What specific finding on the hand is the indicator for the pink classification of severe anemia?

Yellow palms and soles

Which physical finding in a young infant indicates severe jaundice?

Less than 24 hours old

Any jaundice in an infant of what age is automatically classified as severe jaundice?

Swollen eyes draining pus

What physical finding indicates a severe eye infection (possible gonorrhea) in a young infant?

3rd or 4th day of life

On what days of life does mild physiologic jaundice typically first appear?

14 days

At what age is jaundice in an infant considered a reason for mandatory hospital referral?

Red or draining pus

What two findings in the umbilicus suggest a local or systemic infection in an infant?

Skin pustules

What term describes red spots or blisters containing pus on an infants body?

Plan C

Which IMCI treatment plan involves rapid intravenous fluid administration for severe dehydration?

120 minutes

Daily social media use exceeding what duration is considered a concerning response on the HEADS-4 tool?

16 years old

What is the minimum age for social media use recommended by the Philippine Pediatric Society?

Vulnerability Zone

What term describes the adolescent period where reward systems mature before the prefrontal cortex?

Technoference

What term refers to technology-driven interruptions in routine social interactions between a caregiver and child?

Respiratory sinus arrhythmia

Technoference in infants results in a reduction of what index of parasympathetic control?

Video deficit effect

What term describes the phenomenon where infants learn less from a screen than from a live human demonstration?

Bottom-up attention

Which type of attention is automatic, stimulus-driven, and sharpened by fast-paced digital content?

Top-down attention

Which type of attention is deliberate and goal-directed, but weakened by excessive screen use?

Digital pacifier

What term describes the use of screens to soothe a child during a tantrum, creating a "vicious cycle"?

Alexithymia

What term refers to the difficulty in identifying and expressing emotions, linked to high frequency gaming?

Blue-light exposure

Which physical factor from screens disrupts the physiological secretion of melatonin?