Case 9 - 25 yo F following sexual assault Flashcards
1
Q
Information gathering
A
CC Onset Incident location Did you recognize the assailants? Did you report the incident? Description of assault Assault objects Sexual assault Did they use condoms? Did they ejaculate? Type of intercourse (oral, vaginal, anal) Foreign objects used LMP Contraceptives Pain Location of worst pain Radiation Severity Exacerbating and alleviating factors Bleeding or bruises LOC HA Vision changes Dizziness, weakness or numbness SOB, palpitations Blood in stool or urine Vaginal bleeding N/V/D/C Abdominal pain Joint pain PMHx PSHx FHx Social Hx (occupation, tobacco, alcohol, drug use) Current medications Drug allergies
2
Q
Physical examination
A
Head and neck exam (including JVD) Mouth exam CV exam Pulmonary exam Abdominal exam Neurologic exam (mental status, CNs, gross motor) Musculoskeletal exam
3
Q
Closure
A
Mention need for pelvic exam
Emphasize this is not her fault and she should not feel guilty
Collect evidence and test for STDs and pregnancy
Emergency contraception
Antibiotics to protect against infection
Social worker
Do you have any questions for me?
4
Q
Differential diagnosis
A
Rib fracture
STD
Pregnancy
5
Q
Diagnostic work-up
A
Pelvic exam XR - skeletal survey CXR Urine hCG Wet mount, KOH prep, cervical culture, gonorrhea and chlamydia tests HIV antibody, VDRL, HBV antigen Evidence collection using rape kit
