Emotional Abuse Test

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Emotional Abuse Test - Quiz

Violence and Abuse Post Test (Chapters 62-68)


Questions and Answers
  • 1. 

    Which of the following is the leading cause of death in the US in individuals between 4 and 34 years of age?

    • A.

      Fire/Smoke Exposure

    • B.

      Malignant Neoplasm

    • C.

      Motorized Vehicle Related Injuries

    • D.

      Homicide

    Correct Answer
    C. Motorized Vehicle Related Injuries
    Explanation
    In all of these age groups, MV related injuries are the leading cause of death. Malignant neoplasms are #2 in children between 4-15 years of age, whereas in individuals between the ages of 16-34, homicide is #2 closely followed by suicide at #3, (Rosen's pg 942)

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  • 2. 

    The theory of injury prevention focuses on the modification of 3 major factors that taken as a whole dictate the likelihood and severity of a given traumatic event.  Which of the below is not considered one of these factors? 

    • A.

      Host/Patient Characteristics

    • B.

      Environmental Conducitivity

    • C.

      Agent of Energy Transmission

    • D.

      Established EMS Response Systems

    Correct Answer
    D. Established EMS Response Systems
    Explanation
    The cornerstones of the "Injury Triangle" are the Host, Agent, and Environment. All subsequent treatment, whether pre-hospital or ED based, is not included in the actual theory. (Rosen's pg 941)

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  • 3. 

    In patients who suffer a motor vehicle related injury, several key findings regarding the event have been identified that independently predict a greater probability for a future motor vehicle related injury.  Which of the following is not one of the top 3 factors?

    • A.

      Age < 30 at the time of the initial event

    • B.

      Alcohol use at the time of the initial event

    • C.

      Seat belt use at the time of the initial event

    • D.

      Speeding at the time of the initial event

    Correct Answer
    A. Age < 30 at the time of the initial event
    Explanation
    In the case of motor vehicle injury, the three behavioral risk factors most likely to result in future crash are speeding, seat belt nonuse, and driving after drinking alcohol. Age has not been shown to be a relevant factor.(Rosen's pg 947)

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  • 4. 

    With regards to forensic handgun wound analysis, which of the following associations is correct?

    • A.

      Intermediate Range Wounds : Soot Deposition

    • B.

      Contact Wounds : Sear Margins

    • C.

      Long Range Wounds : Tattooing/Stippling

    • D.

      Close Range Wounds : Stellate Lacerations

    Correct Answer
    B. Contact Wounds : Sear Margins
    Explanation
    Soot deposition is classically seen in close range wounds, tattooing/stippling is pathognomonic for intermediate range wounds, and both sear margins and stellate lacerations are associated with contact wounds. (Rosen's pg 955-956)

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  • 5. 

    Which of the following is true regarding so called "pattern lacerations"?

    • A.

      Result when a sharp edged object (eg knife) is forcefully drawn across the skin

    • B.

      Isolated "tissue bridges" are common findings

    • C.

      Associated wound margins abrasions are rare findings

    • D.

      Involved tissue margins are smooth edged and well demarcated

    Correct Answer
    B. Isolated "tissue bridges" are common findings
    Explanation
    "Pattern lacerations" are tears in the skin caused by blunt trauma. By default, they typically exhibit irregular crushed or abraded skin edges and pathognomonic "tissue bridges". Drawing a sharp edged implement across the skin produces an incision type wound. (Rosen's pg 962)

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  • 6. 

    With regards to common injury patterns in motor vehicle related injuries, which of the following is true?

    • A.

      When broken (eg during an MVC), the tempered glass found in rear and side windows tends to produce linear/ stellate lacerations upon contact with intact skin

    • B.

      The front bumper of a vehicle that is actively braking will strike a patient at a higher point that would that bumper if the car was not actively decelerating

    • C.

      Upon a collision, the occupants of a vehicle will initially move in a direction away from the area of primary contact

    • D.

      When broken (eg during an MVC), laminated automotive glass tends to shatter into a multitute of razor edged shards

    Correct Answer
    D. When broken (eg during an MVC), laminated automotive glass tends to shatter into a multitute of razor edged shards
    Explanation
    Tempered (or "safety") automotive glass, as found in rear and side windows, tends to fragment into small cubes when broken and imparts a dicing pattern of injury to the skin. Laminated automotive glass as seen on a windshield is composed of two layers of glass laminated together with a thin layer of clear plastic sandwiched between. This type of glass will shatter into shards that impart incision type wounds to the skin. The front end of a vehicle that is actively braking will dip down toward the street and contact a pedestrian at a lower point than if the brakes were not applied. Due to inertia, when a moving vehicle contacts another object, the inhabitants will initially move towards the point of contact. (Rosen's pg 965-966)

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  • 7. 

    Regarding injury patterns commonly seen in child abuse, which of the following is true?

    • A.

      Immersion burns characteristically exhibit a classic "drip-like" appearance

    • B.

      "Bucket handle" or "corner" fractures commonly occur along the diaphyseal shafts of long bones

    • C.

      Although essentially pathognomonic, retinal hemorrhages are seen in

    • D.

      Anogenital burns are unlikely to occur via hot liquids spilling down into a child's diaper and such wounds should prompt concern for possible child abuse

    Correct Answer
    D. Anogenital burns are unlikely to occur via hot liquids spilling down into a child's diaper and such wounds should prompt concern for possible child abuse
    Explanation
    Accidental "spill burns" in children are associated with a classic "drip-like" appearance where the severity of injury is inversely proportional to the distance from the contact site. Bucket handle and corner fractures are chip fractures of the metaphysis of long bones that arise when a torsional or shearing force is applied to a limb and are pathognomonic for abuse. Retinal hemorrhages accompany approximately 75% of all cases of shaken baby syndrome. Children's disposable diapers are very absorbent of both liquid and heat, and therefore any scald burns in the anogenital area that are attributed to hot beverages falling into a child's diaper should be scrutinized carefully. (Rosen's 970-971)

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  • 8. 

    A "toddler's" of CAST fracture is commonly seen in what location?

    • A.

      Distal tibia

    • B.

      Midshaft humerus

    • C.

      Distal femur

    • D.

      Proximal fibula

    Correct Answer
    A. Distal tibia
    Explanation
    A CAST (Childhood Accidental Spiral Tibial) or "Toddlers" fracture is a non-displaced oblique fracture of the distal third of the tibia that results when a minor rotational force is applied to a weak porous section the of bone. These injuries commonly result from minor falls and present as a limping child without any clear mechanism of injury. (Rosen's pg 975)

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  • 9. 

    Regarding abdominal injury in child abuse, which of the following is false?

    • A.

      Elevated liver enzymes are a sensitive marker of clinically signifcant liver injuries

    • B.

      Duodenal hematomas can be seen despite only minor abdominal trauma (eg fall

    • C.

      Trauma is the second leading cause of acute pancreatitis in pediatric patients

    • D.

      Abdominal trauma represents the second most common type of fatal injury in child abuse related deaths

    Correct Answer
    B. Duodenal hematomas can be seen despite only minor abdominal trauma (eg fall
    Explanation
    Histories of "falls" are commonly related in children presenting with severe inflicted abdominal trauma. Although falls may lead to abdominal wall contusions and rarely splenic injuries, they are unlikely to cause duodenal hematomas, intestinal perforation, of liver lacerations. (Rosen's pg 972)

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  • 10. 

    Regarding the physical examination of a sexual assault victim (SAV), which of the following is true?

    • A.

      Anogenital lacerations are the most commonly identified traumatic injuries

    • B.

      Copious lubricant (eg Surgilube) should be utilized during the vaginal speculum exam to limit any further injury to already jeopardized tissues

    • C.

      The anterior forchette is the most common site of injury

    • D.

      Powder-free examination gloves should be used to limit the potential for evidence contamination

    Correct Answer
    D. Powder-free examination gloves should be used to limit the potential for evidence contamination
    Explanation
    Anogenital abrasions are the most commonly identified traumatic injuries post sexual assault, and the most commonly affected site is the posterior forchette. Water and water alone should be the only lubricant utilized in the vaginal speculum exam due to the potential for synthetic lubricants to interfere with proper evidence collection. (Rosen's pg 985-987)

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  • 11. 

    With regards to post-exposure prophylaxis in the sexual assault victim (SAV), which of the following is true?

    • A.

      Post assault, there is a 5 day window in which HIV prophylaxis can be successfully initiated

    • B.

      Standard STD prophylaxis should only be offered after all associated cultures have been processed

    • C.

      The immediate use of an emergency contraceptive can drop the likelihood of becomming pregnant to < 15%

    • D.

      Hepatitis B vaccine should be offered to all patients who have not been previously vaccinated

    Correct Answer
    D. Hepatitis B vaccine should be offered to all patients who have not been previously vaccinated
    Explanation
    To maximize the likelihood of success with post-SAV HIV prophylaxis, treatment should be initiated as soon as possible and definitely within 72h of the event. With regards to STD cultures, they are often expensive and offer no forensic value. As well, not all juristictions will automatically pay for this form of testing in the SAV. Given this, a more prudent course of action would entail empiric coverage for GC, Chlamydia, and Trichomonas (eg Ceftriaxone 125mg IM, Azithromycin 1g PO, and Metronidazole 2g PO). The immediate use of an emergency contraceptive can reduce the risk of pregnancy to 1-2%. Hepatitis B vaccination is recommended for SAV's who have not been previously immunized. Concurrent hepatitis B immunoglobulin administration is not necessary. (Rosen's 989-991)

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  • 12. 

    Regarding elder abuse, which of the following is true?

    • A.

      Under no circumstances should a victim of elder abuse be allowed to leave the hospital and return to a potentially abusive setting

    • B.

      The majority of states have enacted laws dictating the mandatory reporting of suspected elder abuse

    • C.

      By default, elderly patients should be assumed to lack adequate decision making capacity and therefore cannot legally refuse medical care

    • D.

      Unlike victims of other forms of abuse, elder abuse patients rarely develop associated psychological disorders (eg PTSD)

    Correct Answer
    B. The majority of states have enacted laws dictating the mandatory reporting of suspected elder abuse
    Explanation
    Unlike cases of child abuse, victims of elder abuse are competent individuals with the right to dictate their own medical care. Their wishes, even if to return to a potentially abusive situation, need to be respected. Psychological disorders including PTSD are very common in victims of all forms of abuse. (Rosen's 1014-1015)

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  • 13. 

    Which of the following is true regarding intimate partner violence (IPV)?

    • A.

      The majority of IPV cases occur outside of the home

    • B.

      Nearly 95% of all IPV victims that seek care in US emergency departments subsequently self-report the abuse to law enforcement individuals

    • C.

      Girls who either witness or directly experience intra-familial violence as children have an increased risk of becoming IPV victims when they reach adulthood

    • D.

      All 50 states have laws that mandate the emergency physician to report all cases of suspected IPV to the appropriate law enforcement individuals

    Correct Answer
    C. Girls who either witness or directly experience intra-familial violence as children have an increased risk of becoming IPV victims when they reach adulthood
    Explanation
    The majority of cases of IPV occur within the household between the times of 6P-6A. The universal reporting of cases of IPV has not been mandated across all states. The number of IPV victims that self report their abuse to law enforcement individuals is far less than 95%. (Rosen's 995, 1005)

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  • 14. 

    Regarding youth and violent crimes, which of the following is true?

    • A.

      By the age of 18, most US children will have seen over 200,000 acts of violence portrayed on television

    • B.

      Firearm related homicide rates are actually the highest in rural regions of the US

    • C.

      Assault rifles are currently the most commonly utilized firearms in gang-related homicides

    • D.

      Over the past 20 years, there has actually been a drop in the incidence of firearm related deaths in the 15-19 year-old age group

    Correct Answer
    A. By the age of 18, most US children will have seen over 200,000 acts of violence portrayed on television
    Explanation
    Firearm related homicide rates are far and away highest in inner city populations in the US. Handguns are used in > 80% of all gang-related homicides followed by shotguns (8%) and assault rifles (5%). In the last 20 years, there has been a 75% increase in the incidence of firearm related deaths in the child and adolescent age groups. (Rosen's 1019-1021)

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  • 15. 

    Regarding firearm ammunition in the US, which of the following is true?

    • A.

      Fully-jacketed rounds are the preferred munition of standard US law enforcement officers

    • B.

      The kinetic energy of a projectile is determined more by its given velocity rather than by its overall mass

    • C.

      The term "magnum", when applied to a firearm round, implies a larger caliber or diameter as compared to a standard "non-magnum" round

    • D.

      Handgun barrels are designed to impart a spin on the projectile as it exits the muzzle

    Correct Answer
    B. The kinetic energy of a projectile is determined more by its given velocity rather than by its overall mass
    Explanation
    Kinetic energy is proportional to the mass of an object multiplied by its velocity squared (KE = 1/2 mv^2), and therefore velocity is the key component to determining the KE of a given projectile. Standard law enforcement officers use hollow-point rounds to limit any collateral damage to non-combatants. The term magnum refers to rounds that have larger casings and thereby contain more gunpowder which in turn imparts a greater velocity to the projectile. Rifle barrels and not handguns are designed to impart a spin on the bullet as it exits to muzzle to improve its stability in flight and overall accuracy. (Rosen's 954-959)

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  • 16. 

    Trauma is a recurrent disease, and victims of significant trauma are 10 times more likely than the general population to experience an additional episode.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    (Rosen's 947)

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  • 17. 

    In cases of shaken baby syndrome, the majority of patients will have evidence of an impact injury to the cranium.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    (Rosen's 970)

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  • 18. 

    Projectiles from non-powder firearms (eg BB guns) do not possess enough kinetic energy to inflict life-threatening wounds.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    (Rosen's 1019)

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  • 19. 

    A firearm in the house is 43 times more likely to kill a family member or friend than an intruder.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    (Rosen's 1018)

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  • 20. 

    As a rule, firearm rounds that possess a larger quanta of kinetic energy will always effect a greater amount of tissue damage than a lower energy projectile.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Tissue injury occurs when kinetic energy is transferred from an object to said tissue. Therefore, the overall degree of tissue damage is proportional to the amount of energy transferred between a projectile and its target tissue and is not dictated solely by the total energy that the given projectile possess. (Rosen's 959)

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  • Current Version
  • Sep 07, 2015
    Quiz Edited by
    ProProfs Editorial Team
  • Aug 30, 2015
    Quiz Created by
    FlordofArena

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