Initial Approach to the Medico-Legal Examination

Question 1

Locard Exchange Priniciple:

Answer 1

“every contact leaves a trace” i.e. perpetrator brings something to the scene and leaves with something from it

Question 2

Process of events after a sexual offence: (4)

Answer 2

Question 3

Medico-legal consent:

Answer 3

Question 4

The J88 is an official form issued by the Department of Justice which documents the medico-legal examination that the medical practitioner (incl. registered nurses and clinical associates) performs on a victim and highlights findings that are potentially relevant for legal purposes.

Format of the form:

When filling out the form:

Answer 4

Question 5

What approach is recommended for history-taking during a consultation regarding sexual assault?

Answer 5

Open-ended questions, funneling, and patient-centered approaches are recommended for history-taking during a consultation regarding sexual assault.

Question 6

What details should be elicited regarding the incident during history-taking?

Answer 6

Details should include the position of the survivor during the rape/assault, description in the survivor’s words, injuries sustained, specifics of the sexual contact involved (vaginal, oral, anal, use of objects, condoms, lubricants, saliva, kissing), number of perpetrators, consumption of drugs or alcohol, and activities after the assault (e.g., changing clothes, washing/showering, urinating, defecating, tampon insertion/removal, brushing teeth, eating/drinking).

Question 7

What medical history should be considered during the consultation?

Answer 7

Relevant medical conditions, medications (especially anticoagulants, those affecting mental awareness, and those causing acute episodes of hypotension), recreational substance use, gynecological history including pregnancy and childbirth, and condom use should be considered.

Question 8

How should the patient’s mental health and emotional status be assessed during the consultation?

Answer 8

The patient’s mental health and emotional status should be assessed, including any suspicion of mental retardation, by relating mental age to chronological age (for adults) or using developmental milestones (for children).

Question 9

What clinical evidence of drugs or alcohol should be looked for during the consultation?

Answer 9

Clinical evidence of drugs or alcohol should be assessed through observation for smells (e.g., liquor, marijuana), signs such as pupil size and congested conjunctiva, slurred speech (taking into account conditions that mimic intoxication), and marks such as injection sites.

Question 10

What aspects should be examined during the general examination of a patient reporting sexual assault?

Answer 10

During the general examination, the condition of the clothing should be noted, including tears, missing buttons, absent pockets, and stains. Additionally, the patient’s general body build should be assessed to determine if they are within normal limits for age, sex, height, and weight.

Question 11

How should clinical findings be documented during the examination?

Answer 11

Clinical findings should be documented in a manner that avoids medical/technical terminology. Wounds should be described individually and fully, indicating their nature, position, extent, probable date, and manner of causation. Sketches can be used to indicate the extent and position of injuries.

Question 12

What should be considered when collecting evidence during the examination?

Answer 12

When collecting evidence, thorough documentation of findings is crucial. This includes detailed descriptions of injuries, sketches indicating their position and extent, and proper handling of any physical evidence.

Question 13

• Female patients: note the extent of breast development and pubic hair (Tanner Staging)

Breast development: (5)

Answer 13

1. Prepubertal
2. Breast and papilla are elevated
   as a small mound, areolar
   diameter increases
3. Further enlargement of the
   breast bud with loss of the contour separation between breast and areola
4. Areola and Papilla form a secondary mound
5. Mature Areola is part of the normal breast contour

Question 14

• Female patients: note the extent of breast development and pubic hair (Tanner Staging)

Pubic Hair: (5)

Answer 14

1. Prepubertal
2. Sparse Lightly pigmented (mainly along
   medial boarder on the labia majora)
3. Darker and begins to curl, increasing in
   amount and spreading to the mons
4. Further increased amount, course and
   curly
5. Spread to the medial thigh

Question 15

• Male patients: note the extent of genitalia and public hair development

Genitalia: (5)

Answer 15

1. Prepubertal, testicular size less than 4cc and 2. 5cm in the longest dimension
2. Enlargement of the scrotum and testes, scrotal skin reddens and changes in texture
3. Enlargement of the penis (length first), further enlargement of the testes
4. Increased size of the penis in breadth and development of the glans, testes and scrotum larger, scrotal skin darker
5. Adult genitalia

Question 16

• Male patients: note the extent of genitalia and public hair development

Pubic hair: (5)

Answer 16

1. Prepubertal
2. Sparse Lightly pigmented (at base of
   the penis)
3. Darker and begins to curl, increasing in
   amount
4. Further increased amount, course and
   curly
5. Spread to the medial thigh

Question 17

When examining a child, different positions can be used: (3)

Answer 17

When examining a child, different positions can be used:

a) supine position with feet together,

b) knee chest position

c) lateral decubitus position

Question 18

Answer 18

Question 19

• Laceration –

Answer 19

Irregular tear like wound caused by blunt trauma or heavy edged weapons like axes or hatchet.

Question 20

• Abrasion -

Answer 20

Superficial with loss of epidermis. Caused by skin coming into moving contact with a rough surface. If more traumatic with loss of all skin layers, then it’s an avulsion

Question 21

• Contusion -

Answer 21

Blunt force causes rupture of capillaries and venules with extravasation of blood into extracellular space

Question 22

• Haematoma –

Answer 22

Collection of blood under the skin

Question 23

• Puncture

Answer 23

…

Question 24

• Incision Wound -

Answer 24

regular margins caused by sharp edged object like knife, razor or glass (length of wound > depth of wound)

Question 25

• Penetration Wound –

Answer 25

– Sharp object entering body e.g. knife (depth > length)

Question 26

• Gunshot wound

Answer 26

…