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Self-Assessment and Quiz

  1. Most physical methods of torture result in characteristic, acute and chronic lesions.
    1. True
    2. False
  2. Physicians who conduct medical evaluations of physical evidence of torture should:
    1. Always conduct a complete physical examination
    2. Always conduct a directed physical examination (pursuit of pertinent positive and negative findings)
    3. Conduct a complete physical examination unless the allegations of torture are limited and there is no history of loss of consciousness or neurological or psychological symptoms that may affect recall of torture allegations.
    4. Conduct an examination which focuses on positive physical findings since pertinent negative finding are not necessary in medico-legal cases
  3. Which of the following forms of historical information may be useful in correlating practices of torture with individual allegations of abuse
    1. Descriptions of torture devices
    2. Body positions
    3. Methods of restraint
    4. Descriptions of acute or chronic wounds and disabilities
    5. Identifying information about perpetrators and places of detention
    6. All of the above
  4. A 38 year-old man alleges that he was detained on suspicion of harboring terrorists. He explains that soon after being detained he was beaten, but does not elaborate further. Which of the following questions would be most appropriate at this time?
    1. What kind of physical symptoms and injuries resulted?
    2. What were your thoughts and emotional reactions at the time?
    3. Can you tell me more about what happened?
    4. Who did this to you?
    5. Do you have any scars from the torture?
  5. In addition to location, size, shape, and color, which of the following should be included in clinical descriptions of skin lesions?
    1. Surface texture
    2. Periphery of the lesion
    3. Extent of demarcation
    4. Level in relation to surrounding skin
    5. All of the above
  6. Lacerations are caused by sharp objects like a knife, bayonet, or broken glass that produce a more or less deep, sharp and well-demarcated skin wound.
    1. True
    2. False
  7. A 32 year-old man alleges that he was beaten with a police baton. On physical examination, you observe the following:

    [Courtesy of Amnesty International, The Netherlands.]

    How would you describe the level of consistency between the allegation of abuse and the findings on physical examination?

    1. Not consistent
    2. Consistent
    3. Highly consistent
    4. Virtually diagnostic
    5. Proof of torture
  8. Which of the following are true about contusions?
    1. The extent and severity of a contusion is related to the amount of force applied, and the vascular structures affected
    2. Deep contusions should be re-examined 1 to 2 days after the alleged injury
    3. The color of the bruise can be used to determine the age of the contusion
    4. Sometimes the shape of the bruise helps to identify the shape of the blunt instrument that caused the injury
    5. All of the above
  9. Which of the following statements about scars are true?
    1. Wounds that heal by secondary intention are generally smaller than those that heal by primary intention
    2. Scars related to self-inflicted injuries are generally superficial and within easy reach of the dominant hand
    3. The location and presence of multiple scars may help to distinguish intentional vs. accidental injuries
    4. Post-inflammatory hyperpigmentation may result from contusions and abrasions
    5. All of the above
  10. A 30 year-old man states that he lost consciousness while he was suspended. When he awoke some time later in his cell, he noted a painful, red blister on his left torso which took several weeks to heal. You conduct a medical evaluation for asylum 2 years after the alleged injury. Bases on the photographic information below, what is the most likely cause of the scar?
    [Courtesy of Amnesty International, The Netherlands.]

    1. Electric shock
    2. Burn with a heated instrument
    3. Beating with a police baton
    4. Striae Distinsae
    5. None of the above
  11. Which of the following is the most likely cause of the scars in the photograph below?

    < [Courtesy of Alejandro Moreno, MD, JD.]

    1. Abrasions
    2. Incisions
    3. Lacerations
    4. Burns
    5. Electric shock
  12. Which of the following is the most likely cause of the scar in the photograph below?

    [Courtesy of Alejandro Moreno, MD, JD.]

    1. Abrasion
    2. Incision
    3. Laceration
    4. Burn
    5. Electric shock
  13. Which of the following is the most likely cause of the scars in the photograph below?

    [Courtesy of Alejandro Moreno, MD, JD.]

    1. Abrasions
    2. Incisions
    3. Lacerations
    4. Burns
    5. Electric shock
  14. Which of the following is the most likely cause of the scars in the photograph below?
    [Courtesy of the Human Rights Foundation of Turkey.]

    1. Striae Distensae
    2. Contact dermatitis
    3. Whipping with an electrical wire
    4. Shock baton
  15. What is the most likely cause of the findings in the following photograph?

    [Courtesy of the Human Rights Foundation of Turkey.]

    1. Abrasions
    2. Incisions
    3. Lacerations
    4. Burns
    5. Electric shock
  16. Which of the following statements are true about medical examinations of women alleging sexual assault?
    1. The examination should be performed by an expert in documenting sexual assault
    2. A thorough physical examination should be performed
    3. It is rare to find any physical evidence when examining female genitalia more than one week after an assault
    4. Refusal to consent to a genital examination is a strong indication of false allegations of rape
    5. All of the above
  17. Which of the following statements are true about genital examination of men?
    1. Individuals who were subjected to scrotal torture may suffer from chronic urinary tract infection, erectile dysfunction or atrophy of the testes
    2. Symptoms of PTSD are not uncommon
    3. In the chronic phase, it may be impossible to distinguish between scrotal pathology caused by torture and that caused by other disease processes
    4. Failure to discover any physical abnormalities on full urological examination suggests that urinary symptoms, impotence or other sexual problems may be explained on psychological grounds
    5. Scars on the skin of the scrotum and penis may be very difficult to visualize. For this reason, the absence of scarring at these specific locations does not demonstrate the absence of torture. On the other hand, the presence of scarring usually indicates that substantial trauma was sustained
    6. All of the above
  18. Perianal examinations findings are generally non-specific. When scars are observed out of the midline (i.e. not at 12 or 6 o’clock), they may be an indication of rectal tears associated with penetrating trauma.
    1. True
    2. False
  19. If a camera is available, it is better to take poor quality photographs than to have no photographs at all.
    1. True
    2. False
  20. In general, diagnostic tests should be obtained whenever possible for medical evaluations of torture and ill treatment because:
    1. They are generally inexpensive and readily available
    2. They often provide the evidence needed to prove torture allegations
    3. Their diagnostic value nearly always outweighs their cost
    4. Their reliability and specificity for specific torture is well documented
    5. None of the above