SANE A Exam 164 Questions with Verified Answers
The four core disciplines that comprise a SART are... - CORRECT ANSWER Law enforcement, SANE, advocacy,
... [Show More] 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 [Show Less]