[36.11 A 42-year-old woman presents to your office for evaluation of chronic abdominal pain. She has been to see you multiple times for this complaint. but the work-up has always been negative. On examination today, she also is found to have a black eye, which she says that she got by bumping into a door. Which of the following statements is true?
A. You should ask your patient about physical abuse and report your suspicions to the local police.
B. You should ask your patient about physical abuse, make an assessment of her immediate danger, and provide her with information about local support services.
C. You should only discuss abuse if she brings up the topic.
D. You should refer the patient to a psychiatrist for further evaluation and treatment.
[36.2] A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by climbing onto a chair and then jumping off. Which of the following statements is true regarding this situation?
A. You cannot report this to child protective services because the history provides a legitimate possible mechanism of injury other than abuse.
B. The father can sue you if you report this to the authorities and they determine that no abuse occurred.
C. You should anonymously report the abuse to the authorities.
D. You can be held legally liable for failing to report child abuse.
[36.3] Which of the following injuries is most likely to be caused by abuse of a toddler?
A. Three or four bruises on the shins and knees
B. Spiral fracture of the tibia
C. A displaced posterior rib fracture
D. A forehead laceration
[36.11 B. It is appropriate to discuss your concerns in a nonaccusatory, non-judgmental fashion with your patient. Waiting for her to bring up the subject may result in her suffering further abuse. The reporting of the abuse of competent adults (not elders) is not mandated by law in most states. You should offer assistance, evaluate her safety, and provide her with information regarding available services in the area.
[36.2] D. This injury is highly suspicious for abuse. It is the type of injury often associated with abuse and the history given is inconsistent with the developmental abilities of a 7-month-old child. The law in every state requires that child abuse be reported and a physician who fails to report abuse could be held legally liable.
[36.3] C. A posterior rib fracture is often the result of grabbing and squeezing the chest violently. It is very suspicious for abuse. A spiral fracture of the tibia is known as a "toddler's fracture" and is a common injury that is often confused with abuse, but not often caused by abuse. Bruises on the shins and knees and forehead injuries are common from falls while learning to walk.
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