Sexual Assault Flashcards
How do you rule out sexual abuse from your DDx?
You cannot, there is no one identifiable characteristic that can exclude the possibility that a child has not been sexually abused
Sexual abuse comprises __-__% of all child maltreatment reports
10-15%
T/F: the perpetrator of sexual abuse is typically a known and trusted caregiver
true
Female ovulation can begin during what Tanner stage?
3
Can pregnancy occur before onset of menses?
Yes, due to ovulation
When obtaining a history from a child or parent about sexual abuse, what precaution should be taken? (Hint: who should be/not be in the room?)
Parents and children should be interviewed separately from one another if the child is able to provide their own Hx (old enough, verbal, etc)
T/F It is okay to tell a child that they will not have to retell their story or be examined after their initial examination following sexual abuse reports
False, never make promises you cannot keep!
T/F You should always perform a head to toe examination on children
True
Your pt is a prepubertal child w/ complaints of sexual abuse. The individual who performed the sexual abuse is known to have other sexual partners and is promiscuous. You think that the perpetrator may have an STI. Should you treat your pt prophylactically? HIV nPEP?
Why/why not?
Do not treat prepubertal children with STI prophylaxis
Prepubertal girls are unlikely to develop ascending infections due to an underdeveloped tract
Treatment may interfere with important diagnostic resulting’s supporting sexual abuse exposure
Do consider HIV nPEP if it is a high risk situation
Assessing the patient for breathing changes, voice changes, swallowing changes, behavioral changes, among other things are all part of a workup for ___ ___
nonfatal strangulation
How many females have been born without a hymen if they had normal ano-genital anatomy at birth?
0
What percentage of ano-genital exams will be “normal” (without physical findings of injury) in children who have been sexually abused?
Females 95%
Males 98%
T/F Never use a speculum on a prepubertal child unless under anesthesia
True
When would we want to visualize the vagina in a prepubertal child?
Undetermined source of bleeding/evaluate degree & depth of injury
Foreign body that cannot be “floated” or gently extracted
In what position can the hymen best be visualized?
Prone knee-chest
