Domestic Violence

Chapter 14 Domestic Violence




Clinical Case Problem 1: A 25-Year-Old Woman with Pelvic Pain, Low Back Pain, Insomnia, and Fatigue


A 25-year-old woman comes to the office for a new patient visit. Her complaints are 6   months of constant pelvic pain and low back pain, intermittent myalgias, insomnia for “many years,” and feeling tired. When you ask about bruises of varying ages on arms, legs, and face, she notes that she is clumsy and bumps into things a lot. Her husband accompanies her to the visit and refuses to leave the room for the physical examination. On pelvic examination, purulent cervical discharge is noted, along with cervical motion tenderness. Her husband inquires as to why you are using so many tubes for laboratory specimens.



Select the best answers to the following questions




1. Which of the following should be considered to be part of the differential diagnosis in this patient?


a. intimate partner violence (IPV)

b. pelvic inflammatory disease

c. pregnancy

d. a bleeding disorder

e. all of the above

2. What is the estimated lifetime prevalence of IPV in the United States?


a. 1 in 100 women

b. 1 in 50 women

c. 1 in 25 women

d. 1 in 10 women

e. 1 in 3 or 4 women

3. Which of the following is not a characteristic of IPV?


a. the association of violence with alcohol intake by the perpetrator, the victim, or both

b. violent behavior in the family of origin of either or both victim and batterer

c. high risk of suicide attempt or gesture in the victim

d. results in nearly 2 million injuries and 1300 deaths in the United States

e. association of this disorder with poverty

4. Which of the following is not a common presenting symptom or complaint in a victim of IPV?


a. back pain

b. abdominal pain

c. headache

d. dyspareunia

e. IPV itself


Clinical Case Problem 2: Clues to Domestic Violence


A 31-year-old African American woman with 6   years of education post high school presents at the emergency department with bruises, severe pain in the left forearm, and symptoms of depression. When the emergency department calls you regarding the patient’s presence, you recall that she has had three appointments on your calendar but all three have been canceled at the last minute. Her husband is a laborer and often will not allow her to keep a physician’s appointment unless he can accompany her. You indicate you will come in to see the patient.



5. Which of the following statements about screening by primary care physicians is true?


a. only 15% of primary care physicians routinely screen their patients for IPV

b. evidence is clear that routine screening of patients for IPV leads to improved health outcomes

c. screening tools such as HITS (Hurt, Insulted, Threatened, Screamed at), the Partner Abuse Interview, and the Women’s Experience with Battering (WEB) scale have good internal consistency and have been validated against measurable health outcomes

d. clinicians should be alert to physical and behavioral signs and symptoms associated with abuse or neglect in all patients

e. evidence is clear that batterer intervention programs are effective in reducing rates of domestic violence

After discussion and examination, you are convinced that this patient is a victim of IPV and recommend that she make a police report.



6. Which pair of IPV type/rate of report to police is correctly matched?


a. IPV rape or sexual assault—20%

b. physical assault—50%

c. stalking—80%

d. all of the above

e. none of the above

7. When women without symptoms are screened by clinicians for IPV


a. the majority become angry or express being offended

b. the risk of harm to the affected patient is increased when screening is done in the presence of the abusive partner

c. few women believe that screening is of benefit or that it makes getting help easier

d. posters, brochures, and other materials in an office with culturally sensitive information about IPV can lead to more victims providing information to clinicians when asked about IPV

e. all of the above

8. After discussion of involvement of the police, you discuss possible alternatives for the patient, including


a. referral to a shelter because such referrals significantly reduce the likelihood of further physical injury

b. confrontation of her husband and referral of him to counseling because evidence strongly supports such intervention

c. allowing you to take photographs in case she later decides to press charges

d. purchase of a gun to protect herself in case of another attack

e. none of the above


Clinical Case Problem 3: Intimate Partner Violence in Pregnancy


A 19-year-old primigravida at 32   weeks’ gestation comes to the office complaining of abdominal pain. Examination shows the cervix to be closed; no contractions are apparent, but bruising is present on the abdominal wall at the umbilical line.



9. With regard to IPV during pregnancy


a. 4% to 8% of pregnant women are abused at least once during pregnancy

b. pregnant women who are being abused usually show no concern for the health of the unborn child

c. sudden increase or decrease in frequency of office visits is not related to risk of being abused

d. abusive partners accompany the patient to office visits rarely, if at all

e. same-sex intimate partners are never involved in abuse of a pregnant woman

10. Pregnancy-related IPV


a. decreases as the pregnancy progresses

b. stops after delivery of the baby

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  4. Illustrated Review

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Domestic Violence

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