peter90036
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1.
a 13yo child was raped by a stranger in a back alley on the way back from school.
Arriving at home she reluctantly tells this to the mother, who immediately takes the child to the hospital.
Now the mother wants the child examined, but the child refuses.
What do you do next? (for a usmle exam setting)
2.
If upon examination the pregnancy test comes back (+) positive(yes same day...magic sperm), the mother is not in the room and you inform the 13yo girl- who doesn't want mother to know,
Do you tell mother or not?
Edited by peter90036 on 04/10/08 - 08:56 PM
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| inkspot
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1) rape is a crime . so yes examine photograph take cultures document. ( whether the mother wants or not. in this case she does. child is minor and he cant comprehend rape ) which again is crime ( if it was intentional sex then i think no would have been the answer)
2- dont tell the mother. if the child wants abortion do it. and always advise about the contraception methods to teenagers
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| kleovoulos
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1. I think that even in the case of consensual sex, it would probably be considered a ''statutory rape'' , since the child is 13yo (<16-18y.o depending on the State law)
2. agree with inkspot 
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| peter90036
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is sedation an option ?
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| DrVirgo
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1.
13yo child raped mother wants examined,
child refuses
what do you do next? (for a usmle exam setting)
-I hope I'm understanding this right... The 13 year old child raped the mother? And the mother wants the child to be examined but the child refuses? Or the mother wants you to examine her, but the child refuses?
-Either way, you should examine BOTH mother and child... Child is a minor and has no say. This is a crime and you have to take samples, comb pubic hair,and things like that.
2.
pregnancy test +
the child doesnt want mother to know,
do you tell mother or not?
-No, you don't have to tell the mother.
I believe in the cases of : prenatal care, drug abuse treatment, and STD treatment, you DO NOT have to tell the parents.
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| inkspot
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DrVirgo wrote:
1.
-I hope I'm understanding this right... The 13 year old child raped the mother? And the mother wants the child to be examined but the child refuses? Or the mother wants you to examine her, but the child refuses?
could not help laughing ! no offence though. but i think the child was raped and mother wants him to be examined 
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| peter90036
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 yup, i forgot this: ,
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| DrVirgo
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inkspot wrote:DrVirgo wrote:
1.
-I hope I'm understanding this right... The 13 year old child raped the mother? And the mother wants the child to be examined but the child refuses? Or the mother wants you to examine her, but the child refuses?
could not help laughing ! no offence though. but i think the child was raped and mother wants him to be examined
LOL... I know -this case sounded a little off... I wasn't sure if it said:
13yo child raped mother [Period] wants examined, OR
13yo child raped [PERIOD] mother wants examined,
-I guess its the second one! 
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| DrVirgo
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ALSO: I think after you do the examination, you also have to report this case to child protective services since the child is a minor and has been sexually abused. It's mandatory reportable.
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| inkspot
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yeah its the same thing as my nick
whether it is inks - pot or ink - spot lol
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| arlete
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Remember, for the test purpose, any choice that says "encourage the child to tell the mother" is the right one. Unless it says "or you'll tell it yourself". 
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| inkspot
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thanks arlete you r an inspiration
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| DrVirgo
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arlete wrote:Remember, for the test purpose, any choice that says "encourage the child to tell the mother" is the right one. Unless it says "or you'll tell it yourself".
Encourage the child to tell the mother? -In what case -if he was raped?
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| arlete
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If the child was raped, the doctor needs to contact the parent and the authorities, because it's a crime. Even if it was consensual, if the partner is not a minor, it's considered rape.
On the second case, if the child is pregnant, you have to incentivate dialogue with the parent for emotional reasons, but never tell it yourself.
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| arlete
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inkspot:
Thank you... You're very kind!
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| Justice
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What I don't get caught is a pregnant child qn...
What is the age of the child? 13, as in a first qn? Peter, please make sure that you give a bit more details in your qn!!! It's a middle school level, sex (even consensual) with this kid is a CRIME in all states!!! and why shouldn't I inform the parent to make at least sure that parents provide enough support to a pregnant child? In Wisconsin definitions of emancipation are very strongly formulated, and none of those say that Dr should not tell the parents... Of course, doctor should not right away call parents and blame them/blame their child for what happened, but he shouldn't send child home as well with a promise to speak to mom/dad about bump in the belly...
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| peter90036
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its for the exam - it doesnt cover individual state laws and regulations.
i made up the Qs while reading 2ck peds sex abuse, but i guess its a common question-here's kaplan's answer:
"A minor is typically considered to be an “emancipated minor” and capable of making
independent medical decisions if they become pregnant or have a sexually
transmitted disease, therefore breaching confidentiality is incorrect. "
from Kaplan step 3 released items 2007: http://tinyurl.com/5lhwmv
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| inkspot
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ok now its getting a little tricky?
if the minor has sex with another partner is it rape?
i have seen many questions in kaplan or UW in which the minor asks doctor for contraception. If at all it is a crime he should report. but the answer to all those questions have been " provide em with information abt contraception and STD's without involving the other partner or parents or guardians.
now the question is when do we report? I am sure there is an age bracket beyond which it would be criminal to have even consentual sex ( considered as rape ) and while other teen agers can have sex.
remember most of teenagers loose thier virginity in US by 16 years of age and no FBI is hunting for them .
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| peter90036
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there, i "improved" the questions to relieve some of the confusion...
age limit child-adult = 18
any sexual contact child + adult = sexual abuse
rape is rape = forcefully forcing someone against their will to have sexual activity
here's a discussion on 'consensual sex' between minors: http://www.aafp.org/afp/20020501/curbside.html -- its not USMLE exam specific but maybe it helps...
laws are laws and differ for each state, we will have enough time to examine particular state laws when we're residents and must follow the laws in the state we practice.
http://www.enotes.com/everyday-law-encyclopedia/t...
http://www.enotes.com/everyday-law-encyclopedia/d...
we should focus on the reading material specific for these silly exams.
Edited by peter90036 on 04/10/08 - 09:53 PM
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| arlete
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OK, so sexual abuse is different from rape. Gotcha! I used as synonims.
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| peter90036
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well, in lawyerspeak depending on state laws sex child-adult(maybe older child) might be called "statutory rape" ...
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