Abuse

Question 1

What key history would you obtain from a patient whom you suspect is being abused?

Answer 1

Establish confidentiality
Directly question about physical, sexual or emotional abuse
Question about fear, safety and backup plan
History of frequent accidents/injuries
Mental illness
Drug use
Firearms in the home

Question 2

What key physical exams would you perform on a patient whom you suspect is being abused?

Answer 2

Vital signs

Complete physical exam + pelvic

Question 3

28 yo F complains of multiple facial and bodily injuries. She claims that she fell on the stairs. She was hospitalize for some physical injuries seven months ago. She presents with her husband. Differentials?

Answer 3

Domestic violence
Osteogenesis imperfecta
Substance abuse
Consensual violent sexual behavior

Question 4

28 yo F complains of multiple facial and bodily injuries. She claims that she fell on the stairs. She was hospitalize for some physical injuries seven months ago. She presents with her husband. Differentials: domestic violence, osetogenesis imperfecta, substance abuse, consensual violent sexual behavior. Workup?

Answer 4

XR - skeletal survey
CT - maxillofacial
Urine toxicology
CBC

Question 5

30 yo F presents with multiple facial and physical injuries. She was attached and raped by two men. Differential?

Answer 5

Rape

Question 6

30 yo F presents with multiple facial and physical injuries. She was attached and raped by two men. Differential: rape. Workup?

Answer 6

Pelvic exam
Urine hCG
Wet mount
KOH prep
Cervical cultures
XR - skeletal survey
CBC
HIV antibody
Viral hepatitis serologies