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Sexual Abuse and Intimate Partner Violence

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A 20-year-old woman presents to your office with a chief complaint of abdominal pain. Upon further questioning, the woman reveals that she was sexually assaulted at a party 3 weeks ago by a male friend whom she recently started dating. She tells you that she has not revealed this to anyone else, and has not informed the police because she was drinking. Her abdominal and pelvic examinations are normal. Which of the following is the best management to offer this patient?

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a. Counsel patient to sue the male friend.

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b. Provide an antidepressant.

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c. Provide emergency contraception.

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d. Test for and treat sexually transmitted infections.

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e. Order CT of the abdomen and pelvis.

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The answer is d. The physician's responsibility in the care of a rape victim includes medical, medical-legal, and emotional support. The physician's medical responsibilities include treatment of injuries, testing, and prevention and treatment of both infections and pregnancy. This patient has a normal examination, and a CT is not indicated. She should be tested for sexually transmitted infections and given prophylactic antibiotics to treat such diseases. A pregnancy test should be performed, and if negative, she should be offered emergency contraception. Since emergency contraception should be given within 72 hours of the event, this patient is not a candidate for emergency contraception. Even though there can be long-standing psychological consequences of rape, antidepressants are not indicated at this time for this patient.

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An 18-year-old undergraduate student presents to the emergency department at 5 AM on a Saturday morning reporting that she was the victim of sexual assault while attending a fraternity party the evening before. When you first encounter this patient to take a detailed history, she remains very calm, but has trouble remembering the details of the experience. She reports that she has not used any alcohol or illicit drugs. The victim's inability to think clearly and remember things is best explained by which of the following?

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a. Alcohol use

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b. Head injury

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c. Illicit drug use

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d. Rape trauma syndrome

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e. Secondary gain

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The answer is d. Rape trauma syndrome is the medical term that refers to the response that survivors have to rape. It is considered to be the natural response of a psychologically well person to the traumatic event. As part of the rape trauma syndrome, victims of sexual assault may appear calm, tearful, or agitated, or they may ...

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