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A 25-year-old female presents to the emergency room for the fourth time in the last week. She has vague complaints of extremity pain. Physical examination by a male ER resident has been limited each visit because she is terrified of the pain that the clinician may cause. On physical examination, she is withdrawn and frightened. Regions of ecchymosis are noted throughout chest and abdomen. She has requested multiple radiographs, MRI and CT scans. Today's imaging (radiographs, MRI, CT scan) has been unrevealing. What is the most likely diagnosis?
Complex regional pain syndrome
Intimate partner violence
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Risk factors for intimate partner violence after musculoskeletal injury includes all of the following EXCEPT?
Shorter length of relationship
History of prior divorce
A 29-year-old healthy Caucasian female presents to the emergency department with her boyfriend with a left anterior shoulder dislocation and several facial abrasions after tripping in the shower approximately three hours prior to arrival. She is 5’7’’ and weights 120 lbs (BMI 18.8). The patient notes that she has not had a menstrual period in three months and that she is training for a long-distance triathlon. Physical examination reveals no other obvious injuries. Basic serum laboratory values are unremarkable. A urine pregnancy test is positive. In addition to treating her shoulder dislocation, the orthopaedic surgeon should
Perform a skeletal survey to evaluate for other fractures or dislocations
Question the patient in private about the specific details of this injury and her sense of safety in the home
Refer the patient to a nutritionist given the patient’s BMI of 18.8
Obtain additional laboratory studies and admit the patient to the hospital for treatment of anorexia nervosa
Obtain advanced imaging of the shoulder to evaluate for underlying pathologic lesions
Which of the following is true regarding intimate partner violence (IPV)?
Most patients do not have a fear of domestic retaliation upon reporting
Victims of IPV rarely have a history of injury during the previous 12 months
Interdisciplinary collaboration yields positive outcomes
Emotional abuse is easily identifiable in patients suffering from IPV
Victims of IPV feel comfortable discussing their issues to male physcians
Regarding the role of the orthopaedic surgeon in addressing domestic and family violence, all of the following statements are true EXCEPT:
Report all cases of child abuse, as this is required by all states
Report all cases of adult spousal or intimate partner abuse, as this is required by all states
Hospitalize elderly victims who are in immediate danger and help develop a plan to ensure their safety
Advocate for appropriate legislation and public policy on violence and abuse related to health care
Orthopedic surgeons are responsible for knowing the reporting laws and procedures for suspected abuse
An 78-year-old woman who lives in a nursing home sustains an injury to her left forearm. Radiograph is shown in Figure A. It is determined that the injury occurred as the result of elder abuse. All of the following are considered risk factors for elder abuse EXCEPT?
Disruptive behavior by the victim
Poor physical health of the victim
Each of the following are guidelines for management of a domestic violence victim EXCEPT:
Socioeconomic status should not preclude evaluation for domestic violence
Interview the patient outside the presence of other non-medical personnel
Federal law mandates photographs be taken of injuries
Document your opinion if the patient’s injuries are not consistent with the offered explanation
Physicians should check requirements to see if there is mandatory reporting statute in their state