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Royal College: Emergency Medicine > Abuse/Partner Violence/Forensic > Flashcards

Abuse/Partner Violence/Forensic Flashcards

This deck covers Chapters 58-59 in Rosens, compromising all of sexual assault, IPV, and forensics.

1
Q

What are 6 blunt force injury patterns in IPV?

A
  1. Slap marks
  2. Looped or flat contusions from belts
  3. Circular contusions from finger tips
  4. Parallel contusion with central clearing (eg. hit with stick)
  5. Patterned contusion (shoe /tennis racket)
  6. Bite marks/scratch
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2
Q

Name 5 characteristics of self-inflicted knife wounds

A
  1. Superficial to trunk, arms, face
  2. Parallel incisions on the non-dominant side of body
  3. Sparing sensitive areas
  4. Intact clothing over wound
  5. Prior wounds healed
  6. Linear or curved wounds towards dominant hand
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3
Q

List 5 historical features suspicious of child abuse

A
  1. Unexplained delay in seeking medical attention
  2. History is not consistent with time
  3. History is not consistent with mechanism
  4. History is not consistent with developmental abilities
  5. Child has “magical” injuries
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4
Q

List 6 fractures that would be highly suspicious of child abuse. What are the indications for a skeletal survey?

A
  1. Long bone fractures
  2. Non-linear skull fractures
  3. Posterior rib fractures
  4. Multiple fractures in various stages of healing
  5. Classic Metaphyseal Injury
  6. Spinous process fracture

Skeletal Survey Indication

  • Age <2 with suspected inflicted injuries
  • Includes x-rays of skull, long bones, ribs, vertebrae
  • Multiple fractures in various stages of healing
  • If high index of concern despite normal skeletal survey, repeat in 2 weeks or order a bone scan
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5
Q

Provide 4 DDx for pediatric skeletal fracture presumed to be from child abuse?

A
  1. Accidental trauma
  2. Birth trauma (occult skull #s)
  3. Osteomalacia of prematurity
  4. Osteogenesis imperfecta
    * Congenital disorder of collagen
    * Blue sclerae, hearing loss, short, brittle bones
  5. Ricketts (Vitamin D or Calcium Deficiency or Hyper PTH)
  6. Scurvy (Vitamin C Deficiency)
  7. Hyperparathyroidism
  8. Juvenile Osteoporosis
  9. Pathologic #’s
  10. Menke’s disease
    * X-linked recessive disorder –> copper deficiency
    * Weak bones, developmental delay, sz, hypotonia
  11. Congenital syphilis
  12. Congenital rubella
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6
Q

Provide 5 DDX for vaginal discharge in a child

A
  1. Foreign body
  2. STI, sexual abuse
  3. Pinworms
  4. Shigella infection
  5. GAS infection
  6. Candida
  7. Irritant/allergic vaginitis (bubble bath)
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7
Q

List 5 strategies to make the interview more comfortable for the sexual assault victim.

A
  1. Explain who you are
  2. Leave tough questions to the end
  3. Quiet safe confidential place
  4. Advocate
  5. Offer to have chaperone present
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8
Q

What special stain is used to help identify injuries during genital exam (gross visualization or with colposcopy)?

A

Toluidine Blue

  • Nuclear stain that has been shown to enhance gross visualization of external genital (vulvar) injuries
  • Has some spermicidal activity but shown in one study not to influence DNA analysis
  • Stain results depend on the presence or absence of nucleated cells

Positive results:

  • Trauma
  • Cancer
  • Inflammation
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9
Q

What prophylactic antibiotic regimen would you provide for prophylaxis after a sexual assault?

A

Gonorrhea

  • Cefixime 800 mg PO in a single dose OR
  • Ciprofloxacin 500 mg PO in a single dose
  • if low resistance in community; test for cure needed
  • If pregnant: Cefixime 800 mg PO in a single dose

Chlamydia

  • Azithromycin 1 g PO in a single dose
  • Doxycycline 100 mg PO bid for 7 days
  • Pregnant adults: Azithromycin 1 g PO

Trichomoniasis

  • Metronidazole 2g PO single dose
  • only if proven Trich, not empiric!
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10
Q

What’s the deal with Hep B prophylaxis following a sexual assault?

A

Step 1

  • Check immunization status
  • If immune, stop
  • If not, go to Step 2

Step 2

  • Hep B vaccine for all (0, 1, 6 months)
  • HBIg 0.06 mL/kg IM x1 within 48h for sexual assault
  • May be given up to 14d, but less efficacious
  • Indicated for vaginal, rectal, and anal-oral contact
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11
Q

List 2 types of emergency contraception that could be offered to women after unprotected sex.

A

Within 72h:

  1. Plan B - Levonorgestrel 1.5 mg
  2. Copper IUD
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12
Q

What are 4 indications for toxicological testing of urine and serum in suspected drug-facilitated sexual assault?

A
  1. <72 hours
  2. LoC
  3. Altered
  4. Suspicion
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13
Q

What strangulation patient needs imaging?

  • No LoC, No voice change
  • No LoC, but voice change
  • LoC
A
  • No LoC or voice change: No imaging
  • LoC : CT/CTA
  • Voice changes: CTA + Fibreoptic laryngoscopy
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14
Q

Outline the components of history taking in sexual assault

A

Components of History:

  • Patient history (past medical history, last intercourse)
  • Assault history (where, when, who)
  • Methods used (choking, weapons)
  • Post-assault activity (shower, eat, drink)
  • Assault acts (oral, anal, ejaculation)
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15
Q

What are the 7 things you need to consider PEP for?

A
  1. Gonorrhea
  2. Chlamydia
  3. Trichomonas
  4. HIV
  5. Hep B
  6. Tetanus
  7. Pregnancy
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16
Q

List 3 populations who should get HIV PEP

A

Given within 72h

  1. Known assaulted by multiple assailants
  2. Known HIV-positive assailant
  3. Known high-risk assailant
    * IVDU
    * Known MSM
    * Rectal penetration
    * No barrier used
  4. High-risk patient
    * Sex worker
    * Human trafficking
17
Q

List 6 types of elder abuse

A
  1. Neglect
  2. Physical
  3. Emotional
  4. Financial
  5. Sexual
  6. Abandonment
18
Q

List 5 caregiver and 5 elder risk factors for elder abuse

A

Caregiver Risk Factors

  1. Drug/Alcohol
  2. Mental illness
  3. Financial stress
  4. Caregiver burnout
  5. Financial dependence

Elder Risk Factors

  1. Physical or functional impairment
  2. Cognitive impairment
  3. Female
  4. Advanced age
  5. Falls
  6. Incontinence
  7. Financial dependent on caregiver
19
Q

Outline 5 questions you would ask to help with a danger assessment in the context of IPV

A
  1. Violence increased in frequency/severity in the last 6 mo?
  2. Have you ever been threatened with a weapon?
  3. Do you think he/she is capable of killing you?
  4. Have you ever been beaten while pregnant?
  5. Is he jealous?
20
Q

What is this?

A

Classic Metaphyseal Lesion

  • Planar fractures that extend through the primary spongiosa on the metaphyseal side of the growth plate
  • Appear as chips or bucket handle lesions
  • Around the growth plate
  • Most common at distal femur, proximal humerus
21
Q

List a 6 DDx for this

A

CRVO

Infection

  • IE, CMV/HSV/Toxo, Retinitis, Cerebral malaria
  • Meningitis

Iatrogenic

  • Post-op, traumatic delivery, CPR, Pressure changes

Tumor

  • Retinoblastoma, ALL

Toxic

  • CO

Trauma

  • Shaken baby, traumatic delivery

Metabolic

  • Diabetic retinopathy, galactosemia

Cardiovascular

  • HTN, AVM, Aneurysm (ICH)

Neurologic

  • ICH, ICP

Hematologic

  • DIC, Coagulopathy
22
Q

What are the recommendations to do further testing when you suspect abuse?

A

Skeletal survey

  • <24 months

Neuroimaging

  • Signs/symptoms of HI
  • History of shaking
  • <6 mo, facial bruising, rib fractures, multiple fractures

Retinal exam

  • Any TBI

AST/ALT

  • All patients <60 months

Abdominal CT

  • Signs/symptoms of abdominal injury
  • History of abdominal assault
  • AST/ALT >80

Siblings

  • Skeletal survey for all <24 months
23
Q

What is the TEN-4 Rule in pediatric suspected abuse?

A

TEN-4

  • Torso
  • Ear
  • Neck
  • <4 years old

Bruising to Torso/Ears/Neck and <4 yo, 97% sens/84% spec for abuse

24
Q

You see a bite on a child, how can you tell if its an adult bite?

A

Inter-canine distance >3 cm = Adult

25
Q

What 4 factors influence the severity of a gunshot wound? What is considered a high-velocity gun?

A
  1. Bullet velocity
  2. Bullet mass
  3. Bullet type
  4. Tissue type

High-velocity gun = 1500 ft/s

Royal College: Emergency Medicine (25 decks)

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