SANE A Exam 164 Questions with Verified Answers,100% CORRECT

SANE A Exam 164 Questions with Verified Answers The four core disciplines that comprise a SART are... - CORRECT ANSWER Law enforcement, SANE, advocacy, and prosecuters Clamydia - CORRECT ANSWER -Most Common Bacterial -Doxy 100 mg PO BID x7 days -Azithromycin 1000 mg PO x1 dose -NAAT Gonorrhea - CORRECT ANSWER -Rocephin (Cefiraxone) 500 mg IM x1 -If allergic to penicillin give azithromycin -NAAT Trichomoniasis - CORRECT ANSWER -Protozoan -Frothy discharge -Metronidazole (Flagyl) 2000 mg x1 dose -Male to Male transmission Rare -NAAT Metronidazole (Flagyl) - CORRECT ANSWER -Treats Trich and BV - NO ALCOHOL within 48 hours -No vagina = No Flagyl Bacterial Vaginosis - CORRECT ANSWER -Not always sexually transmitted -Metronidazole 500 mg BID for 7 days - No alcohol Herpes - CORRECT ANSWER -Viral Infection -1st outbreak is the worse Syphillis - CORRECT ANSWER Latent - No symptoms Active - Symptoms 3 stages of Syphilis - CORRECT ANSWER -Primary, Secondary, Tertiary Primary Syphilis - CORRECT ANSWER Painless ulcer at site of contact 1 week - 3 months Secondary Syphilis - CORRECT ANSWER Rash on palms and soles Tertiary Syphilis - CORRECT ANSWER Neurological problems Testing and Treatment of Syphilis - CORRECT ANSWER -No prophylactic treatment - Testing at 6 weeks, 3 months, and 6 months - Penicillin G is treatment Hep B - CORRECT ANSWER -More infectious than HIV - 3 to 6 months - Fever, fatigue, N/V -tested w/ prenatal care. Apart of newborn vaccines if born after 91 Hep B Treatment - CORRECT ANSWER -If vaccinated no tx -If not vaccinated give vaccine - 3 shots over 6 months -If perp is of known Hep B status give vaccine and HBIG HIV NPEP - CORRECT ANSWER -within 72 hours of assault -Takes 28 days and requires baseline testing -oral assault = no npep -pregnant qualify -hep c - talk to a provider -N/V/D side effects HPV - CORRECT ANSWER -spread skin to skin -symptoms are warts -Initial exam = vaccine - unless pregnant Copper IUD - CORRECT ANSWER placed within 5 days of assault Plan B - CORRECT ANSWER -Levonorgestrel 1.5 mg x1 dose -Not abortion -Can get pregnant after Ella - CORRECT ANSWER -Victim BMI above 30 -Assault 72 - 120 hours Rape Trauma Syndrome - CORRECT ANSWER -Retired nursing diagnosis -Acute - shock, disbelief, anger, sleep disturbances, decreased appetite -Last days to weeks During a traumatic experience, patients can experience neurobiological and physiological changes that can impact short term memory. This is largely due to - CORRECT ANSWER An interruption within the hippocampus, which dan lead to problems with short term and long term memory recall PTSD - CORRECT ANSWER -Cannot be diagnosed for 4 weeks -Intrusive thoughts, avoiding reminders, negative thoughts and feelings, and arousal and reactive symptoms, such as hypervigilance Alternative Light Source - CORRECT ANSWER -guide for swab collection -screening tool - not diagnostic -Profuse area of florescence on neck and arms = topical products -areas of secretion will be smaller -Need complete darkness - no daylight Locards Principle - CORRECT ANSWER Every contact leaves a trace What is the most popular drug used in sexual assault? - CORRECT ANSWER Alcohol Moist to Dry Swab collection - CORRECT ANSWER swab with moist then dry Photos by non medical personnel - CORRECT ANSWER Head and extremities only Why aren't law enforcement the ideal people to take the photographs? - CORRECT ANSWER Police photos are not protected by HIPPA Where is the best collected vaginal specimen from? - CORRECT ANSWER The vaginal vault A wound to the posterior pharynx suggests what? - CORRECT ANSWER An oral assault Clothing collection procedure - CORRECT ANSWER 1. Place clean cloth or paper barrier sheet on floor (use exam stretcher if mobility issues) 2. Place paper debris sheet over barrier 3. Shoes should be removed prior to clothing collection; while standing on the debris sheet, clothing should be collected and placed in separate labeled paper bags 4. Clothing should be one item per bag 5. Do not pick debris off clothing. Keep any debris contained that fall on the paper debris sheet, folding carefully when collected 6. place folded debris sheet in separate paper bag 7. Label and seal bags per protocol Oral Swabs - CORRECT ANSWER -should be obtained prior to buccal swabs -use 2 dry swabs on cheek, gumline, and under tongue -If dentures, remove and reswab with same set of swabs -Have pt rinse mouth with tap water after obtaining swabs -do not use dental floss Penile swabs - CORRECT ANSWER -Swab external penile shaft, glans, and around corona and scrotum with moist swabs -Not circumcised, pull back foreskin for glans and corona -Avoid urethra What tubes are used for tox screen? - CORRECT ANSWER Gray tubes containing sodium fluoride and potassium oxalate - 12 ml if less than 24 hours since assault. Should be kept in refrigerator Blood draw procedure - CORRECT ANSWER 1. order of blood draw is tox, DNA, then medical 2. Blood samples should never be frozen 3. Should be priority because of fast metabolization of drugs What should you do when changing locations on swabbing? - CORRECT ANSWER Change your gloves How long after an assault can you do a urine tox screen? - CORRECT ANSWER 120 hours - 100ml urine sample that should be refrigerated How long after an assault can you do a blood draw? - CORRECT ANSWER 24 hours 4 categories of evidence - CORRECT ANSWER 1. Physical 2. Documentary 3. Demonstrative 4. Testimonial A child advocacy center (CAC) offers the following benefits - CORRECT ANSWER 1. increase felony prosecution of child abusers 2. improves child forensic interviewing 3. leads to increased referrals for mental health 4. increases nonoffending caregiver satisfaction A dual coordinated community response (CCR) is best for... - CORRECT ANSWER rural communities Physical evidence - CORRECT ANSWER that which can be detected with 5 senses - includes tangible and biological Documentary Evidence - CORRECT ANSWER written, recorded, or taped Demonstrated evidence - CORRECT ANSWER shown through mock ups or models Testimonial evidence - CORRECT ANSWER said, heard, seen, or known Standards of Practice - CORRECT ANSWER 1. Assessment 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation Assessment - CORRECT ANSWER Involves the collection of data to form clinical understanding Diagnosis - CORRECT ANSWER Analyze data obtained during the assessment to determine actual diagnosis or potential risks the pt may be facing Outcomes identification - CORRECT ANSWER All outcomes must be measurable with a reasonable timeline of achievement. Can be modified based on pts response. This is what you hope to achieve. Example: Creating a safety plan before discharge Planning - CORRECT ANSWER Plan to promote and restore the pts health while preventing further injury, illness, or death. Facilitate healing while alleviating suffering. Should focus on long term and short term. Example: referral to a trauma informed counseling with a scheduled appointment a week after the exam Implementation - CORRECT ANSWER Putting the plan to work along with health teaching and promotion Evaluation - CORRECT ANSWER Ongoing systematic assessment Types of elder abuse - CORRECT ANSWER 1. physical 2. sexual 3. emotional 4. Financial 5. neglect 6. self neglect 7. abandonment Principles of trauma informed care - CORRECT ANSWER 1. Safety 2. Trustworthiness and Transparency 3. Peer support 4. Collaboration and mutuality 5. Empowerment, voice and choice 6. Cultural, Historical, and Gender Issues Capcity - CORRECT ANSWER The ability to use and understand information to make a decision then communicate that decison Competency - CORRECT ANSWER A legal determination is made that a patient is unable to consent for themselves Implied Consent - CORRECT ANSWER Only for emergency life threatening measures. Can not be used for a forensic exam Blunt force injuries - CORRECT ANSWER Contact with a blunt object or surface may result in injuries such as redness, bruising, abrasions, and or lacerations. Fractures, sprains, and strains may also occur. Erythema - CORRECT ANSWER Redness due to capillary dilation. Considered non specific because it could be due to other conditions Bruise/Contusion - CORRECT ANSWER Blunt force injury the produces diffuse extravasation of blood without rupture of skin. Does not blanch with pressure and cannot time. Include palpation of body surfaces as part of assessment as tenderness could be a sign of deeper bruising Ecchymosis - CORRECT ANSWER A extravasation of blood into tissue but is not interchangeable with bruising as the mechanism differs. May be noted in areas near or below where blunt force occurs. Abrasion - CORRECT ANSWER the removal of some or all of the first layer of epidermis as a result of friction or compression Laceration - CORRECT ANSWER Tear in the skin when the stretching of fibers is exceeded due to blunt force trauma. Has ragged uneven edges Petechiae - CORRECT ANSWER Pinpoint hemorrhagic spots due to rupture of thin walled venules above a point of pressure from strangulation, prolonged vomiting, or severe coughing. Will not blanch under pressure. Differential diagnosis is important as is not always from blunt force trauma(i.e. bacterial meningitis) Avulsion - CORRECT ANSWER Occurs when skin is torn away by shearing or blunt force trauma. Typically deeper than it is wide over bony prominences. Bites - CORRECT ANSWER If breaks skin, rabies and tetnus immunization status should be discussed. Higher infection sites such as hands, feet, and genitals or involving bone, joints, and tendons, may require antibiotics Sharp force injuries - CORRECT ANSWER Contact with objects that have sharp or pointed edges. May produce injuries such as incisions, cuts, or stab wounds Incision/Cut - CORRECT ANSWER When a sharp object comes against the skin with sufficient force to divide the skin it makes a cut. Edges are smooth and longer than they are deep. Incision is a cut made in a surgical procedure Penetrating injury - CORRECT ANSWER A wound that causes disruption of the body surface that extends into underlying tissue or into a body cavity. Stab wounds and gun shot wounds are two types Stab - CORRECT ANSWER A puncture into the body made by the stabbing motion of a knife or similair object. Often deeper than they are wide. Handle of knife can cause bruisin or abrasion at site Thermal Injuries - CORRECT ANSWER Caused by heat or any cauterizing agent. Use wallace rule of nines for documentation. When calculating total body surface area, do not include superficial burns (first degree) Characteristics of non accidental thermal burns - CORRECT ANSWER 1. Dry burn injury - result of application of hot object to skin. May be patterned, resemble shape of object, and be consistent uniformity of thickness. 2. Intentional submersion injuries have a clear pattern or stocking like appearance 3. Donut burns from being held down in hot water displays central clearing 4. Wet burns from hot liquid being pulled down will be in v shaped pattern in direction of spill if it was accidental. Patterened injury - CORRECT ANSWER has a distinctive pattern that is consistent or suggestive of an object Pattern of injury - CORRECT ANSWER A group of injuries occur together. Can be old and new injuries together Manual Strangulation - CORRECT ANSWER occurs when blood and airflow is obstructed from external pressure of the neck by one or two hands, or chokehold Ligature Strangulation - CORRECT ANSWER Occurs when a nonanatomic object is used to obstruct the flow of blood and/or air. Hanging Strangulation - CORRECT ANSWER Occurs with a ligature but in addition to victims own body weight to cut off air supply Proactive AFSA/DFSA - CORRECT ANSWER The pt is covertly, or with force, administered incapacitating substance for the purpose of assault Opportunistic AFSA/DFSA - CORRECT ANSWER The sexual assault occurs when the pt is unable to consent due to incapacitation from substances through self-ingestion or their own actions. Tanner staging - CORRECT ANSWER Classification system to document and assess pts stage of secondary sex characteristics -Females assessed on pubic hair and breasts -Males assessed on genital development and pubic hair Common for females to have two different tanner stages Tanner Stage 1 - CORRECT ANSWER Girls - Prepubertal only for breast development. The papilla is elevated above the level of chest wall. Vellus hair similar to abdominal hair. Boys - Vellus hair, male anatomy similar to early childhood Tanner stage 2 - CORRECT ANSWER Girls - Breast budding, elevation of breast as small mounds, enlargement and widening of areolas. May be tender and not symemetrical. Sparse growth of long, slightly pigmented, hair on labia majora Boys - Enlargement of scrotum and testes; scrotum skin will be thin and red. Same as girls pubic hair but located at base of penis Tanner stage 3 - CORRECT ANSWER Girls- Breast enlarges, elevating beyond the areolae. Pubic hair becomes curly, coarser, extends outwards over junction of pubes. Boys- Penis lengthening, testicles continue to grow. pubic hairs same as girls Tanner stage 4 - CORRECT ANSWER Girls - Breast enlarges and areolae and papilla form secondary mounds. Hair adult in type, but covers smaller area, to spread to thighs Boys - Penis and testicles grow, scrotum darker in color. pubic hair same as girls Tanner stage 5 - CORRECT ANSWER Girls - Breast achieves adult contour. Hair adult in type and quantity and extends onto medial thigh. Boys - Adult genitalia, pubic hair same as girls Supine Lithotomy - CORRECT ANSWER Ling on back, face upward position with buttocks at the end of exam table and the hips and knees fully flexed with feet in a fixed position. -works well for adolescent and adult female pts for genital assessment Supine knee to chest - CORRECT ANSWER A supine position with feet and knees together holding knees to chest. -allows visualization of the anus Supine frog leg - CORRECT ANSWER A supine position with feet close together (plantar aspects touching) and knees loosely apart. - helpful for patients with mobility issues (hip issues, on a vent) Prone knee to chest - CORRECT ANSWER Face downward toward the exam table position with head and torso flush with table, knees separated, and buttocks raised -best for prepubescent female pts who have the cognition to understand and execute positioning directions. Very helpful for hymenal assessment Lateral decubitus - CORRECT ANSWER Side lying with knees flexed and pulled in close to chest. -works for any gender and any aged pt when other positions are not feasible Labial seperation - CORRECT ANSWER Can be done in any position where SANE grasps the labia majora bilaterally and separates them towards inguinal areas Labial Traction - CORRECT ANSWER While the pt is in supine position the SANE grasps the labia majora bilaterally and applies traction, pulling toward the SANE and slightly downward. When in knee prone SANE would grasp buttocks near posterior fourchette at approx the 10 and 2 position and lifting buttocks to visualize hymen Floating the hymen - CORRECT ANSWER Saline is used to moisten the hymen when it appears folded or adhered to help visualize structure Perianal venous pooling - CORRECT ANSWER Venous congestion due to engorgement of vessels in anal area. May appear blue or purple in color around anal verge and may be mistaken for injury. Will resolve quickly once pt is in a normal position Anoscopy - CORRECT ANSWER -Unless this is used the SANE is assessing the anus not the rectum -Not typically used on prepubescent Annular hmen - CORRECT ANSWER Hymenal tissue forms a circumferential ring like collar around vaginal opening. Common in prepubescent Crescentic Hymen - CORRECT ANSWER Has anterior attachments at approx 11 and 1 positions forming a crescent shape. No tissue at 12 position. Common in prepubescent Septate hymen - CORRECT ANSWER There is a band of tissue attached to either edge of hymen, creating 2 opening cribiform hymen - CORRECT ANSWER Hymen stretches across vaginal opening but is perforated with more the two openings imperforate hymen - CORRECT ANSWER the hymen tissue is completely occluding the vaginal opening Microperforate hymen - CORRECT ANSWER A very small hymenal opening Estrogenized - CORRECT ANSWER effect of estrogen that causes hymen characteristic of a thickened, redundant, pale appearance, with no visible vascularity. Typically able to tolerate a speculum exam Fimbriated - CORRECT ANSWER A hymen with multiple projection like appearances along the edge making it looked ruffled Redundant hymen - CORRECT ANSWER Abundant hymenal tissue that tend to fold back on itself or protrude Type 1: Clitoridectomy - CORRECT ANSWER Partial or total removal of the clitoral gland and/or the prepuce 1a - Removal of prepuce/clitoral hood 1b - Removal of the clitoral hood with the prepuce Type 2: Excision - CORRECT ANSWER Partial or total removal of the clitoral glans and the labia minor, with or without excision of the labia majora 2a - Removal of labia minora only 2b - Partial or total removal of the clitoral glans and the labia minora (possible involvement of prepuce) 2c - Partial or total removal of the clitoral glans, the labia minora, and labia majora (possible involvement of prepuce) Type 3: Infibulation - CORRECT ANSWER Narrowing of the vaginal opening with the creation of a covering seal by cutting and appositioning the labia minora or labia majora with or without excision of the clitoral prepuce and glans 3a - Apposition of the labia minora 3b - Apposition of the labia majora Type 4 - CORRECT ANSWER All other harmful procedures to the female genitalia for non medical purposes For example - pricking, piercing, excising, scraping, and cauterization Ectropion cervix - CORRECT ANSWER circumferential erythema around the cervical os due to exposed columnar epithelium from the cervical canal (normal) Vestibula papillae - CORRECT ANSWER Most commonly seen in adolescents. Small, soft, flesh colored, tubular papillae appear in grouped cluster in the area of the vestibule and are hormonally triggered changes that are asymptomatic. Do not mistake for infection Lichen Sclerosus - CORRECT ANSWER Chronic inflammatory skin disease that presents as patchy, white skin changes such as hyperkeratosis and sclerosis, often in a figure 8 pattern. Irritation and bleeding may also be present. Found mostly in postmenopausal women. Can have intense itching, dysuria, and pain with defecation. Refer to derm and treat with corticosteroid. Anal fissures - CORRECT ANSWER A superficial break in the perianal area or mucus membrane of the anus. Commonly associated with constipation. A non specific finding without disclosure of sexual abuse How would the SANE show location of a wound on the breast? - CORRECT ANSWER Using a clock Partial Thickness - CORRECT ANSWER second degree burn; blistered, skin moist, pink or red. burns epidermis and dermis Full thickness - CORRECT ANSWER third degree burn; charring, skin black, brown, red. burns all layers of skin plus the underlying tissue (4th degree burn) Strangulation - CORRECT ANSWER A form of asphyxia that is produced by constant application of pressure to the neck Unconsciousness can occur in as little as 10 seconds and fatality in 4 to 5 mins Death by Strangulation - CORRECT ANSWER 1. Cardiac arrythmia from pressure on the carotid artery nerve ganglion 2.Pressure obstruction to the carotid arteries 3. Pressure on jugular veins 4. Pressure obstruction of larynx cuts off airflow Perianal folds - CORRECT ANSWER wrinkles around anal opening Piercings and tattoos - CORRECT ANSWER generally unnecessary to document unless trafficking is suspected or they are a location for body swabs Senile Lentigines - CORRECT ANSWER age spots Pectinate Line - CORRECT ANSWER located within the anal canal and is the line between the simple columnar epithelium of the rectum and the stratified epithelium of the anal canal (beefy red in appearance, normal) Nabothian Cyst - CORRECT ANSWER mucus filled cyst on the surface of the cervix Cystocele - CORRECT ANSWER Anterior vaginal wall prolapse allowing the bladder to protrude into the wall of the vagina. Still ok to insert speculum. If posterior wall prolapse it is called a rectocele Prolapsed urethra - CORRECT ANSWER Non specific finding. Can occur with use of depo and monpause Suspect exams - CORRECT ANSWER Requested by police not by SANE Search warrant or patient consent Collect standards (blood, buccal, pubic or head hair) Expert Witness - CORRECT ANSWER person possessing more knowledge on topic than average person Fact Witness - CORRECT ANSWER Testifies to what was documented. Doesn't testify to things they didn't do themselves and doesn't draw conclusions or critically evaluate the evidence Role of SANE in courtroom testimony - CORRECT ANSWER -Account for what was observed and documented during SANE exam -Educate the jury on injury findings (expert) -Non biased medical testimony Why is patients history of assault collected? - CORRECT ANSWER Medical purposes Fossa Navicularis - CORRECT ANSWER cavity anterior to the posterior fourchette; seperates hymen from fourchette Posterior Fourchette - CORRECT ANSWER A tense band or fold of mucous membrane at the posterior commissure of the vagina, connecting the posterior ends of the labia minora. Called posterior commissure in prepubescence Voir dire - CORRECT ANSWER Jury selection; identifying jurors who can be both fair and impartial in hearing the case For an attorney to know the SANES professional background, the SANE should be prepared to bring... - CORRECT ANSWER An updated CV that catalogs professional accomplishments subpoena duces tecum - CORRECT ANSWER A legal document requiring the recipient to bring certain written records to court What federal rule describes expert witness testimony - CORRECT ANSWER Federal rule 702 What is the primary focus of SANE/SAFE? - CORRECT ANSWER On healthcare needs of patient What is primary prevention? - CORRECT ANSWER Activities to bbn prevent SA What is secondary prevention? - CORRECT ANSWER immediate response to SA What is tertiary prevention? - CORRECT ANSWER long term response to SA What is sexual violence? - CORRECT ANSWER all forms of Sexual Assault What is rape? - CORRECT ANSWER forced penetration What is IPSV? - CORRECT ANSWER Intimate Partner Sexual Violence What are the characteristics of those at right for IPSV? - CORRECT ANSWER •low economic class •rural area •immigrant •traditional sex roles What are the risk factors for IPSV? - CORRECT ANSWER •increased attachment to male peer •substance abuse •pregnancy women who are ill •separation/divorce What race is at the highest risk of SA, and more likely to be injured? - CORRECT ANSWER American Indian and Alaskan Women What are the effects of Child SA? - CORRECT ANSWER •early onset puberty •depression •obesity •PTSD •revictimization •premature deliveries •substance abuse In what cases is a minor viewed as an adult? - CORRECT ANSWER • Homeless/ Living on Own • In Military • Emancipated • Married • Is a Parent • Pregnant What is Just Detention International (JDI)? - CORRECT ANSWER Agency to hold government accountable for prison rape. What is the Prison Rape Elimination Act? - CORRECT ANSWER Zero tolerance for prison sexual abuse What is National Prison Rape Elimination Commission Standards? - CORRECT ANSWER Guidance for addressing Sexual Assault behind bars and initiated using Sexual Assault Response Teams What is Sexual Orientation? - CORRECT ANSWER Sexual Attraction What is Sexual Identity? - CORRECT ANSWER "I identify as..." (male/female) What is gender non-comforming? - CORRECT ANSWER Out gender doesn't match bio gender What is "questioning" is relation to sexual identity? - CORRECT ANSWER When learning of true identity What is SOFFA? - CORRECT ANSWER Significant Other, Friend, Family, Alli What are the Belmont Guiding Principals of Ethical Decision Making? - CORRECT ANSWER • Autonomy • Justice • Beneficience • Non-Malfeasance What is Vicarious/Secondary Trauma? - CORRECT ANSWER Trauma resulting from empathetic engagement What are the Vicarious ABC's? - CORRECT ANSWER • Awareness • Balance • Connectedness What are major needs of victims? - CORRECT ANSWER • Feel Safe • Express Emotion • Information on Next Steps • Increase Sense of Control by. Allowing Victim to Make Decisions What is the role of the advocate? - CORRECT ANSWER • Ensure victim's interests, wishes, and rights are upheld. • Support victim and family • Be present during exam, questioing, or procedures if requested by victim. What is Privileged Communication? - CORRECT ANSWER •attorney/client •husband/wife ***Duty to Report over rules Privileged Communication*** What is Law Enforcement's Response in an Acute Disclosure? - CORRECT ANSWER • first response • safety of victim • initial interview • identify suspect • secure scene What is Law Enforcement's Response in a Delayed Disclosure? - CORRECT ANSWER • initial interview • identify suspect, scene, and evidence • forensic exam