Injuries and wounds: posterior rib fractures in infants: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Forensic Medicine · Injuries and wounds: posterior rib fractures in infants

Sample item

A 3-month-old infant is brought for 'excessive crying'. A skeletal survey reveals multiple healing fractures of the posterior ribs near the costovertebral junction. There is no history of a fall. How do these fractures typically arise?

AA short fall from a sofa onto a carpeted floorBWeakening of the ribs by dietary ricketsCSqueezing the chest between the hands while gripping or shakingDVigorous coughing during a chest infection

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Squeezing the chest between the hands while gripping or shaking

Posterior rib fractures in an infant are highly specific for abuse. They result from anteroposterior compression of the chest when the infant is gripped and shaken, levering the rib neck against the transverse process of the vertebra. Short falls and coughing rarely fracture the infant ribs.

Option by option

A. A short fall from a sofa onto a carpeted floor
Short falls onto soft floors seldom produce fractures of this type.
B. Weakening of the ribs by dietary rickets
Rickets can cause beading and weak bone, but it would not explain multiple posterior fractures in the absence of other signs.
C. Squeezing the chest between the hands while gripping or shaking (correct)
Correct. Chest compression during gripping and shaking levers the ribs at their posterior ends.
D. Vigorous coughing during a chest infection
Coughing does not generate enough force to break the healthy ribs of an infant.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Squeezing the chest between the hands while gripping or shaking. Posterior rib fractures in an infant are highly specific for abuse.

Why is "A short fall from a sofa onto a carpeted floor" not the answer?

Short falls onto soft floors seldom produce fractures of this type.

Why is "Weakening of the ribs by dietary rickets" not the answer?

Rickets can cause beading and weak bone, but it would not explain multiple posterior fractures in the absence of other signs.

Why is "Vigorous coughing during a chest infection" not the answer?

Coughing does not generate enough force to break the healthy ribs of an infant.

What concept does this question test?

It tests Injuries and wounds: posterior rib fractures in infants in Forensic Medicine. They result from anteroposterior compression of the chest when the infant is gripped and shaken, levering the rib neck against the transverse process of the vertebra. Short falls and coughing rarely fracture the infant ribs.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Injuries and wounds: posterior rib fractures in infants?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.