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Dip GUM > Sexual Assault > Flashcards

Sexual Assault Flashcards

1
Q

what are the key factors to document in a history of sexual assault

A

Any injuries requiring urgent medical care
History required to assess the risk of pregnancy, STIs, HIV and Hep B / C
History to guide forensic examination and sampling
- Date and Time of assault
- nature of assault
- number of assailants
- details of assailants if known to assist risk assessment
- nature of assault - oral, anal, vaginal
- condom use
- ejaculation

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2
Q

Define abrasion

A

Superficial wound caused by friction damage
Damage to epidermis
Causes bleeding and execution of serum

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3
Q

Define ecchymosis

A

Bruise
Extravasation of blood into the skin and subcutaneous tissues
area >1cm

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4
Q

Define haematoma

A

localised collection of blood outside of the blood vessels
Palpable as a fluctuant mass
Caused by trauma or by blood coagulation disorders

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5
Q

define petechiae

A

small red dots seen on the skin
<3mm diameter
occur due to capillary damage

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6
Q

Cause of peri-oribtal petechiae

A

crying
vomiting
coughing
strangulation / asphyxiation

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7
Q

define laceration

A

a full thickness skin split
caused by blunt trauma
edges of the wound tend to be ragged

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8
Q

define incised wound

A

full thickness linear skin injury caused by a sharp instrument

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9
Q

Under what circumstances may a doctor release confidential information to the courts

A

With patient consent

If the requested to do so by law or ordered to do so by court

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10
Q

what proportion of children in the UK have been sexually abused

A

1 in 20 children in the UK have been sexually abused

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11
Q

What should be included in a professional witness report

A

Name and qualifications and experience
Basic information of the events - names, dates, locations
Reason the report has been requested
History and examination findings
results of any investigations
details of any additional documents or diagrams
conclusion of the report writer based on the facts

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12
Q

Definition of rape

A

Intentional, non-consensual penetration of the vagina, anus or mouth with a penis

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13
Q

What form of consent is recommended before performing a forensic medical examination

A

Written consent

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14
Q

Components of a sexual assault history

A 
The incident - approximate time
any events after the incident
current symptoms or injuries 
Pmhx / surgical hx
medication / Allergies
sexual hx / O+G hx
Drug and alcohol hx
social hx
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15
Q

Components of an examination in a SARC

A

Height, weight
BP, pulse, temp, resp rate
Head to toe examination - document findings on body diagrams
forensic samples - wet swab first then dry swab
+/- speculum / proctoscope

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16
Q

Possible psychological impact of sexual assault

A 
Anxiety
irritability 
poor concentration
sexual dysfunction
depression
drug or alcohol issues
suicidal ideation
PTSD
17
Q

What is the commonest substance used in a drug facilitated sexual assault

A

Alcohol

18
Q

Vulnerability factors for CSE

A 
More females than males 
Average age 13-15 years old 
Life experiences associated with increased risk of CSE:
• Family dysfunction
• Prior (sexual) abuse / neglect
• Going missing / running away
• Substance misuse
• Disengagement from education
• Social isolation
• Low self esteem
• Socio-economic disadvantage
• Learning difficulties / disabilities
• Peers who are sexually exploited
• Gang-association
• Attachment issues
• Homelessness
• Being in care
19
Q

Possible warning signs of CSE

A
  • Missing from home or care
  • Physical injuries
  • Drug or alcohol misuse
  • Involvement in offending
  • Repeated STIs, pregnancies and termination
  • Absent from school
  • Change in physical appearance
  • Evidence of sexual bullying/vulnerability through the internet and/or social networking sites
  • Estranged from their family
  • Gifts from unknown sources
  • Recruiting others into exploitative situations
  • Poor mental health
  • Self-harm or thoughts of or attempts at suicide
20
Q

Immediate needs of a patient presenting within 7 days of a sexual assault

A

Immediate safety
Treatment of injuries
Offer referral for FME in SARC

baseline screening STIs +/- STI prophylaxis
Baseline HIV test or save serum sample
HIV PEPSE (within 72 hours)
Hepatitis B vaccination (and Hepatitis B immunoglobulin if assailant likely or known surface antigen carrier)
Emergency contraception
Self-harm risk identification

Be aware of child and vulnerable adult protection issues

21
Q

Medium term needs of a patient presenting >7 days after a sexual assault

A

STI screening - at baseline and/or 2 weeks after assault

Hepatitis B vaccination as appropriate
Pregnancy testing as appropriate

Assessment of coping abilities

Identify symptoms PTSD
Practical and psychosocial support

22
Q

Long term needs of a patient presenting 1 year + after a sexual assault

A

STI screening
Psychological problems dealt with with support of the GP +/- appropriate referrals for counselling / psychological therapies

Assess for PTSD - consider referral for CBT or EMDR
GP may also consider anti-depressant medication

23
Q

Forensic timescale for gathering DNA from kissing / licking / biting

A

48 hours

24
Q

Forensic timescale for gathering DNA from Oral penetration

A

48 hours

25
Q

Forensic timescale for gathering DNA from Vaginal penetration

A

7 days

26
Q

Forensic timescale for gathering DNA from Digital penetration

A

12 hours

27
Q

Forensic timescale for gathering DNA from Anal penetration

A

72 hours

28
Q

What is in an Early Evidence Kit (EEK)

A

urine sample pot
mouth swab
mouth rinse

allowing early collection of DNA evidence and toxicology

29
Q

For a patient presenting after sexual assault what antibiotics may be considered for prophylaxis against STIs

A

Ceftriaxone 1g IM STAT
doxycycline 100mg BD 7/7
+/- metronidazole 2g STAT or 400mg BD 7/7

30
Q

What is the % pregnancy risk associated with rape

A

Rape carries a 5% risk of pregnancy

31
Q

Psychological consequences of sexual assault

A

Anxiety
Depression
- V common - Appear early

PTSD 
poor concentration and memory problems
irritability
being easily startled / hyper vigilance to threat
sleep disturbances 
appetite disturbance
relationship difficulties 
sexual dysfunction
suicidal ideation 
self-harm

Dip GUM (27 decks)

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