Sexual Assault and Domestic Abuse

Question 1

What drugs of abuse are associated with aggression?

Answer 1

• Cocaine
• Amphetamines
• Phencyclidine
• High doses of depressants like alcohol

Question 2

What part of the brain and what kind of people have higher rates of aggression?

Answer 2

• Amygdala

- History of Head Trauma

Question 3

What are signs to suspect child abuse in a child?

Answer 3

• often seem sad
• behavioral changes
• grades decrease
• STD/UTI in children
• genital trauma on exam

Question 4

What are adults who were abused as children at greater risk for?

Answer 4

• Dissociative Disorders / Borderline Personality
• PTSD
• Depression and Substance abuse
• Abuse their own children

Question 5

Who are people who are most likely to abuse a child or elderly?

Answer 5

• Close Family Member or Friend of Family

Question 6

What are common characteristics of the person doing the abusing to either children or elderly?

Answer 6

• Substance Abuse

- Poverty / Social Isolation

Question 7

Where are common areas for bruises/fractures to occur on victims, compared to normal activity bruising?

Answer 7

• Bruises NOT on bony prominences
• Inner flexor surfaces
• spiral fractures - multiple fractures at different phases of healing

Question 8

What is a physician suppose to do if they suspect abuse of one of their patients?

Answer 8

• Required by law to report to the appropriate authorities

- NOT required to tell the patient / family they suspect abuse or need consent

Question 9

What should a physician do immediately after a rape has occurred?

Answer 9

• Swab/Culture the orifaces for semen of the attacker
• Prescribe prophylactic antibiotics and emergency contraceptives preventatively
• Encourage the patient to notify the police

Question 10

What is the greatest risk factor in a parent that they will abuse a child after the first time?

Answer 10

History of Abuse in the parents childhood

Question 11

What location of injuries in a female adult correlate more commonly with domestic abuse?

Answer 11

• Facial and Head injuries

Question 12

After a patient admits to have been beaten by their significant other, what should be one of the first questions asked by the physician?

Answer 12

• Do you think it is safe to return home to your husband?

Question 13

A 18 year old retarded women with IQ of 50 agrees to have sexual intercourse with the 18 year old president of the high school senior class. Intercourse between these two is considered?

Answer 13

Statutory Rape

• Even though they are both 18, the mentally impaired are not capable of consenting and under state law is considered statutory rape by the 18 year old male.
• the mentally impaired female may not fully understand what her consent actually means and cannot be held to the same standard.

Question 14

33 year old comes to the ED who reports she was raped 2 days ago after being on a date with a man. PEx is unremarkable without any physical evidence of rape, but she appears anxious and disheveled. What most likely happened to this women?

Answer 14

• A man who used a condom, thus no evidence
  Women who have previously had babies may not have any signs of trauma.
• Most common defense mechanism is dissociation

Question 15

7 year old and her mother are both found to have chlamydia, where is the child’s infection most likely from?

Answer 15

Sexual Abuse – by a common person to both individuals

Question 16

On at least 3 different occasions a 10 year old steals lunch money from other children at school in his class. The boy is very thin with dirty clothing and lives with his mother and 3 other sibling in a motel room, what is the most common cause?

Answer 16

Child Neglect

Question 17

A 93 year old female who has dementia and is incontinent lives with her daughter, but during the day stays at an adult daycare and in the afternoons is watched by her neighbor who have unemployed and alcoholic sons. The elderly women is brought to the ED by the adult daycare, who most likely abused the patient?

Answer 17

• The Daughter

- Immediate family members are much more likely than unrelated caregivers, even if alcoholic

Question 18

What are the long term effects of battered women?

Answer 18

• increased hospitalization rates
• more abortions
• increased rate of psychiatric care / suicide attempts
• PTSD, Depression, Anxiety

Question 19

Children who are exposed to adverse childhood events have higher rates of what later in life?

Answer 19

Dose Dependent Response

• Smoking / Alcoholism
• IV Drug Use
• Increased sexual partners
• Depression/Anxiety/Suicide

Question 20

When should you be suspicious of intimate partner violence?

Answer 20

• Multiple stress related physical complaints

Question 21

What are the most common barriers to identifying and treating partner violence?

Answer 21

• Lack of Trust that the physician won’t turn them in
• Safety is jeopardized
• financial support compromised
• shame

Question 22

How should you ask a patient about abuse in their relationship?

Answer 22

Start broad and get more specific

• has anyone punched, hit, harmed you in anyway over the past year?
• ask about current and previous relationships
• “what happens when you argue or fight?”
• *Ask at any annual exams, well child exams, first time visits, or if you suspect it

Question 23

What are keys to asking about sensitive subject matter?

Answer 23

• private without family members around
• professional interpreters
• inform the patient of confidentiality
• nonjudgemental tones
• ask “What” not “Why”

Question 24

How can you help a patient with intimate partner violence?

Answer 24

• Support
• Safety – make sure they are safe going home
• Options – make emergency plan
• Strengths to build upon
• Document Thoroughly – quotes, don’t use alledged

Question 25

What kind of sexual assault is more likely to be reported?

Answer 25

Stranger Sexual Violence

- Attacker wants to remain unknown to the victim

Question 26

How should you approach the patient when dealing with sexual assault?

Answer 26

– Give them power back and allow them to have choice and power in their road ahead. Their experience has taken the power away from them.