1 Female and Male Sexual Assault

Question 1

Emergency contraception is most effective when started within

Answer 1

72 hours of assault

Question 2

remarks on extraction of pubic hair samples

Answer 2

Begin the genital exam with combing of the pubic hair and **extraction of hair samples.
Patient can pluck their own hair, but make sure that the hair root is included

Question 3

used to highlight microtrauma

Answer 3

toluidine blue dye
- a dye with affinity for DNA and RNA

Question 4

drugs that are typically though of as “date rape” drugs

Answer 4

ketamine
flunitrazepam (Rohypnol)
y-hydroxybutyric acid

Roypnol can be detected in the urine for up to 72 hours, and y-hydroxybutyric acid can be detected for 12 hours

Question 5

test for these in sexual assault victims

Answer 5

syphilis, hepatitis B and C, and HIV
Testing for gonorrhea, chlamydia, and bacterial vaginosis is not necessary, because treatment is provided at the ED encounter

Question 6

Follow baseline HIV testing with repeat testing when?

Answer 6

at 6 weeks and 3 and 6 months

obtain serum chemistry, liver function studies, and CBC for patietns who will receive HIV postexposure prophylaxis.

Question 7

CDC recommended regimens for infection prophylaxis in sexual assault

Answer 7

Ceftriaxone 250mg IM, single dose
PLUS
Azithromycin, 1 g PO, single dose
PLUS
Metronidazole, 2g PO , single dose
OR
Tinidazole 2 g PO single dose

Question 8

Emergency contraception regimens

Answer 8

1. Levenorgestrel (Plan B®)
2. Combined estrogen-progestin (Yuzpe®)
3. Mifepristone
4. Ulipristal acetate (Ella®/Fibristal®)

Question 9

Dose of Levenorgestrel

Answer 9

(Plan B®)
1.5 mg once
or
0.75 at 1 and 12 hours

Question 10

Dose of Combined estrogen-progestin

Answer 10

(Yuzpe®)
100 mcg ethinyl estradiol
plus
0.50 mg levenorgestrel
at 1 and 12 h

Question 11

Dose of Mifepristone

Answer 11

25-50 mg pO as a single dose

Question 12

Dose of Ulipristal acetate

Answer 12

(Ella® / Fibristal®)
30 mg PO as a single dose

Question 13

Emergency contraception with lowest estimated pregnancy risk

Answer 13

Mifepristone
(1-10 / 1000 estimated pregnancy risk)

menstrual dealy most common side effect

Question 14

most significant factor predicting failure of emergency contraception

Answer 14

cycle day of intercourse

Question 15

most significant factor determining HIV infectivity

Answer 15

viral load in the assailant

Question 16

antiretroviral with sulfa moiety

Answer 16

tenofovir (Truvada®)