From: CHAMP Program

Sent: Thursday, October 15, 2015 6:10 PM

To: scottl1@sunyit.edu
Subject: CHAMP Registration Confirmation

Dear Lynn,
Below is your confirmation

for your course registration.

Date: 10/15/2015 6:09:37 PM

Course: 0001 Child Abuse Reporting: The Basics
Cost: $0.00
Please save this email for your records.
Sincerely,
CHAMP

From: CHAMP Program

Sent: Saturday, October 24, 20156:16 PM
To: scottl1@sunyit.edu
Subject: CHAMP Registration Confirmation

Dear Lynn,
Below is your confirmation for your course registration.
Date: 10/24/2015 6:14:22 PM
Course: 0002 Adolescent Sexual Assault: Consent Issues
Cost: $0.00
Please save this ernail for your records.
Sincerely,
CHAMP

From: CHAMP Program

Sent: Saturday, October 24,20157:02 PM
To: scottll@sunyit.edu
Subject: CHAMP Registration Confirmation

Dear Lynn,
Below is your confirmation

for your course registration.

Date: 10/24/2015 7:00:42 PM

Course: 0003 Fractures and Child Abuse
Cost: $0.00
Please save this ernail for your records.
Sincerely,
CHAMP

Exam:: CHAMP Program::

CHAMPprogram.com::

https:llwww.champprogram.com/exam.asp?course=5

Quiz
1. Mandated reporters are required to make an oral report of
suspected child abuse or maltreatmenUneglect immediately
and submit a written report (LDSS-2221A) within:

o a. 24 hours

Child Abuse Reporting:

The Basics

~) b. 48 hours

o c.
o d.

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72 hours
A written report is not necessary

2. Before reporting any allegations of abuse or

maltreatmenUneglect, a mandate reporter should have:

a. Clear and sufficient evidence

b. Consensus of three physicians

Take the Quiz

c.

Course Survey

d. The agreement of a social worker

Reasonable cause to suspect abuse

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3. The age group most often maltreated is between the ages of:

My

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a. 0-3 years

b. 4-5 years

0 c. 6-9 years
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o d. 10-14 years
4. If you have notified the person designated to report in your
agency and you learn a call was not made to the SCR, your
obligation as a mandated reporter:

C) a. Has been fulfilled

(~

b. Is to be sure that a report is made to the hotline

o c. Is only to notify hospital personnel as per hospital

protocol
0

d. Is to contact the police

5. Which of the following legal scenarios is false?

1 of 2

a. Mandated reporters are not required to inform the

parents that a suspected child abuse or maltreatment
report is being made.

b. If a mandated reporter has a reasonable cause to

suspect that a child is being maltreated/neglected
and fails to report, this would be a class A
misdemeanor.

10/25/2015 9:06 PM

Exam :: CHAMP Program :: CHAMPprogram.com

::

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o c.

When a mandated reporter makes a report to the

New York State Central Registry, every effort is made
to maintain the confidentiality of the reporter.

d. A mandated reporter would be liable only if the

original report was later determined to be unfounded.

Submit Answers

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All Rights Reserved. SUNY Upstate Medical University
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Syracuse, New York

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Exam:: CHAMP Program:: CHAMPprograrn.com::

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Quiz
1. A 15-year-old female presents with a complaint of a vaginal
discharge and requests a prescription for contraception. She
is unaccompanied and requests confidential treatment.
Because of her age, a NYS medical provider:

Adolescent Sexual Assault:

Consent Issues
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for this Course

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1.fi

a. Can only provide confidential treatment for the

vaginal discharge

()

b. Can only provide confidential family planning

services

c. Can provide confidential evaluation and treatment for

the vaginal discharge and prescribe contraception

d. Cannot evaluate and treat her without parental

permission

24

2. If a 16 year old gives a history of being voluntarily sexually

active, the best choice for a medical provider is to:

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o a. Ask about the age of his or her partner

b. Ask about the age of his or her partner but indicate

there are legal reporting requirements

o
o

c. Avoid asking about his or her partner's age

d. Call the teen's parents to make sure they know that
he or she is sexually active

3. When determining whether the minor is able to consent for

health care, the medical provider should consider:

a. The teen's risk-taking behavior, such as using drugs

or alcohol

b. The teen's ability to understand the need for

treatment and follow up

0 c. The state's legal requirements

@

d. All of the above

4. Which is NOT a reason to consider a teen a mature minor:

a. Has a driver's license

0 b. Lives on his own

0

c. Serves in the military

d. Is pregnant

5. Which of the following requires the medical provider to obtain

consent?

10f2

a. Communication

with police and DA's office

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Exam :: CHAMP Program :: CHAMPprogram.com

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o b. Collection and release of forensic evidence or DFSA

(drug facilitated sexual assault) evidence

c.

d. All of the above

Submit Answers

Photographic documentation

of the examination

Copyright 2006-2015, CHAMP Program, NY

All Rights Reserved. SUNY Upstate Medical University
www.CHAMPorogram.comcontact@CHAMPprogram.com
Syracuse, New York

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Exam :: CHAMP Program :: CHAMPprogram.com

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::

Quiz
1. A 6-month-old infant is found to have multiple healing rib
fractures on his follow-up skeletal survey. The initial survey,
performed after a suspicion of abuse due to facial bruises, was
read as normal. Which of the following is a true statement
regarding these fractures?

Fractures and Child Abuse

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for this Course

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b. The acute rib fractures were most likely occult, and

therefore missed, on the first survey due to
non-displacement and lack of periosteal changes.

Audio Tips

o c. The finding of healing rib fractures is most likely due

to misdiagnosis of a congenital finding.

c) d. Rib fractures on the initial skeletal survey were most

likely missed due to metabolic bone disease that
obscured the metaphysis.

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The rib fractures are most likely due to trauma that

occurred after the first skeletal survey and before the
follow-up survey.

2. In the case of this 6 month old, which of the following

techniques would improve identification of the fractures earlier
in the course of the evaluation and prior to the follow-up
skeletal survey?

Take the Quiz

Course Survey

Registered
Materials

&

a. Oblique rib films

o b. Chest palpation for signs of crepitus

0 c.
@

A nuclear bone scan

d. All of the above

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10f5

3. The parents gave a history of the baby rolling off of the couch
one month prior to the initial presentation of the baby. The
re-read of the initial skeletal survey again demonstrates no
clear evidence of rib fractures, as there is no subperiosteal new
bone formation. However, translucencies of several ribs
correlating with areas subsequently identified as fractures are
noted. Child Protective Services wants to know if a fall would
cause these fractures. Which of the following is the best
response?

a. Rib fractures are commonly caused by falls, and this

is a likely mechanism of trauma.

b. Rib fractures are commonly caused by trauma, but

the fact that the fractures are acute without signs of
healing indicates that the fall was not the mechanism
of trauma.

c.

Rib fractures are generally caused by a squeezing or

orushing mechanism, and a fall from a couch is
inconsistent with these findings.

10/25/20159:03

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Exam :: CHAMP Program :: CHAMPprogram.com

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::

d. Rib fractures that occurred at birth likely weakened

the bones so that a minor fall caused a refracture of
the bones.

4. The father of a 5 month old confesses to shaking the baby in

an attempt to stop him from crying. The radiographic image
below demonstrates a finding seen on the skeletal survey.
Which of the following is a true statement regarding this
finding?

Which of the following is a true statement regarding this

finding?

20f5

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Exam ;; CHAMP Program ;; CHAMPprogram.com

;;

https;//www.champprogram.com/exam.asp?course=14

()

a. This is a normal finding in growing infants and

demonstrates the epiphyseal growth center.

b. A classic metaphyseal lesion is shown here and

would be better demonstrated on a nuclear bone
scan.

c. Metaphyseal fractures are common findings due to

multiple etiologies and the finding is non-specific.

r!)

d. Shearing forces, presumably due to limb flailing and

generally not produced with accidental trauma, most
likely caused this classic metaphyseal lesion.

5. The skeletal survey also revealed a healed fracture of the right

radius and acute rib fractures. Due to the finding of an old
injury at the time that acute fractures are identified, the
physician might appropriately conclude one of the following:

a. The findings of fractures of varying ages are

suspicious for abuse.

b. The wrist fracture supports the diagnosis of rib

fracture due to abusive injury.

c.

d. The wrist fracture likely occurred during IV placement.

Multiple fractures of varying ages are diagnostic of 01.

6. A 26 month-old male presented to his pediatrician with a new

onset of limping. There is no history of a fall or other injury. The
physical examination is normal except for minimal tenderness
over the right lower leg. An X-ray of the right lower leg
demonstrates a non-displaced oblique fracture of the tibia. The
fibula looks normal and there are no other suspicious findings.
What is the most appropriate next step?

a. A skeletal survey to rule out non-accidental

trauma.

o b. An ophthalmologic examination and a skeletal survey.

o c. A CT scan of the brain, an ophthalmologic
examination and a skeletal survey.
@

d. None of the above since this is most likely a toddler's

fracture.

7. A 7-month-old infant presents with a history of a fall from the

mother's arms when she tripped over the family dog. The
mother dropped the baby on a carpeted surface and saw him
land on his head. The baby has bruises on his face and right
arm. An X-ray of the arm reveals a fracture of the middle third
of the ulna with loss of the fracture line definition and evidence
of subperiosteal new bone formation. Which of the following is
a true statement?

30f5

a. The injury is consistent with an acute fracture due to a

fall.

10/25/20159:03

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https://www.champprogram.comJexam.asp?course=14

Exam:: CHAMP Program:: CHAMPprogram.com::

o b. The injury is not consistent with an acute fracture but

is a commonly observed fracture after an infant is
dropped.
@

c. The injury demonstrates signs of healing and is

consistent with a nightstick fracture.

d. The injury is consistent with an acute nightstick

fracture of the ulna.

8. After discussion with the mother in the case of the 7 month old,
the mother remembers that the baby often uses that arm to
wave his rattle and may have accidentally hit his forearm
against the metal stand on his swing. Child Protective Services
asks you if this is plausible. Your response is:

o a. The baby is developmentally able to wave the rattle

and therefore could have fractured his arm in this way.
,~, b. The baby is developmentally able to wave the rattle,
but most likely could not have produced enough force
to fracture his forearm in this way.

c. The baby is developmentally able to wave the rattle

and the presence of a bruise over the site suggests
that this was an accidental injury.

d. Both A and C are correct.

9. A skeletal survey of the 7 month old described in Question 8

also reveals a linear skull fracture. There are no signs of new
bone formation. How does this affect the interpretation of the
injuries?

a. The lack of new bone formation indicates that this is a

new fracture and likely occurred at a different time
than the ulna fracture but is not consistent with a short
fall.

b. The lack of new bone formation suggests that this is a

new fracture and is consistent with a short fall.

c.

New bone formation and signs of healing typically

seen in long bones are not expected with skull
fractures, and the finding of a skull fracture suggests
that both injuries occurred at the same time.

~) d. New bone formation and signs of healing typically

seen in long bones are not expected with skull
fractures, and therefore, the timing of this injury and
the relationship to the timing of the ulna fracture
cannot be determined.
10. In the case of the 7 month Old, the family history reveals that
the mother has short stature and poor dentition. She has
suffered from several long bone fractures throughout her life.
She has a sibling, the baby's maternal aunt, who had similar
problems. Re-examination of the bones on the radiographic
images shows no definitive abnormalities.
appropriate next step?

40f5

What is the most

lO/25/2015 9:03 PM

Exam :: CHAMP Program :: CHAMPprogram.com

::

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(~ a. Make a referral to a genetic specialist.

b. No referral is necessary because the bones appear

normal and children with osteogenesis imperfecta
always have abnormal X-rays.

o c. Cancel the follow-up skeletal survey and schedule a

bone scan to look for occult injuries.

d. Schedule an appointment with the children of the

maternal aunt to determine jf they have multiple
fractures.

Submit Answers

Copyright 2006-2015, CHAMP Program, NY

All Rights Reserved. SUNY Upstate Medical University
www.CHAMPorogram.comcontact@CHAMPorogram.com
Syracuse, New York

Home
Whats New
About
CHAM,
Webcasts
Contact Us
Coursework

CHAMP
Mentors/Faculty
CHAMP Centers of
Excellence
Roster of
Mentors/Faculty
Criteria for
Mentors
Mentor/Faculty
Application
Member Area

Syracuse

50f5

CHAMP Network
Members
Official List Network
Members
How to Become Network
Member
Co ntinuinq Educatio na I
Requirements for Active
Network Members
Practice
Recommendations
Resources for
Professionals

DOH Initiatives
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Who is Child Abuse
Expert
Test Your
Knowledge

Website Designl Development

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10/25/20159:03

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