forensic medicine

Question 1

Scenario: 32-year-old female, alleged assault, multiple ED visits, suspected intimate partner violence

a) List four (4) physical injury characteristics that would support your suspicion of intimate partner violence. (4 marks)

Answer 1

• multiple injuries at different healing stages (old/new bruises)
• patterned injuries (belt marks, bite marks, handprints)
• evidence of strangulation (linear bruising/abrasions to neck)
• stated mechanism not consistent with observed injuries.

Question 2

list 3 features of strangulation injuries

Answer 2

• linear bruising/abrasions to neck
• hoarse voice
• subconjunctival/retinal haemorrhages

Question 3

List five (5) risk factors on history which indicate an increased risk of lethality in intimate partner violence

Answer 3

• access to or threats with weapons (guns, knives)
• threats to kill pt or children
• planning to leave or recent separation
• escalating severity or frequency of violence
• stalking, controlling behaviour (financial/isolation from family)
• physical assault while pregnant/following new birth

Question 4

State three (3) resources an ED needs to adequately manage cases of suspected intimate partner violence.

Answer 4

• ED protocols and guidelines for assessment of suspected family violence.
• safe discharge planning to shelters, police
• referral pathways to multidisciplinary teams/support services, social workers

Question 5

You suspect an elderly woman you are reviewing is a victim of elder abuse.
a) Outline the two essential elements of elder abuse.

Answer 5

A relationship of trust exists between the victim and the abuser (e.g., family member, carer).
Intentional or unintentional harm occurs, resulting in physical, emotional, or financial damage.

Question 6

Outline four (4) types of elder abuse with an example for each.

Answer 6

• Physical abuse causing pain and injury
• Verbal abuse designed to humiliate, degrade, demean, intimidate, or subjugate
• Sexual abuse including sexual assault
• Financial exploitation or economic abuse
• Psychological or emotional abuse involving manipulative behaviour intended to lower self-worth
• Social abuse such as through forced isolation from family or friends
• Neglect including deprivation of basic necessities

Question 7

List five (5) factors that can make an elderly person vulnerable to potential abuse.

Answer 7

• Cognitive impairment (e.g., dementia)
• Physical frailty or dependence on others for care
• Social isolation or lack of support networks
• Financial dependence on a carer or family member
• Chronic illness or disability

Question 8

List four (4) characteristics of carers that predispose them to commit elder abuse.

Answer 8

• Substance abuse (e.g., alcohol or drugs)
• Mental health issues (e.g., depression or stress)
• Financial dependence on the elderly person
• Lack of training or support in caregiving

Question 9

Despite discussion of your concerns for elder abuse, your patient refuses admission and social work intervention.
Outline three essential elements your patient must demonstrate to ensure that they are competent to make this decision.

Answer 9

• Ability to understand the information relevant to the decision (e.g., risks of refusing intervention).
• Ability to appreciate the consequences of their choice (e.g., potential for worsening abuse).
• Ability to communicate their decision clearly and consistently (e.g., verbal or written refusal).