The current legal definition of rape in England and Wales is restricted to the following non-consensual act(s):

• a)
  

  Penetration of the vagina by penis only.

  
  
• b)
  

  Penetration of female vagina, anus or mouth by penis only.

  
  
• c)
  

  Penetration of male or female vagina, anus or mouth by penis only.

  
  
• d)
  

  Penetration of male or female vagina, anus or mouth by penis or digit.

  
  
• e)
  

  Penetration of male or female vagina, anus or mouth by penis or digit or object.

A male complainant of rape experienced an erection, ejaculation, or both during the assault. Which of the following does this indicates?

• a)
  

  The complainant gave his consent, therefore no offence was committed.

  
  
• b)
  

  The complainant may not have given his consent but enjoyed the experience.

  
  
• c)
  

  The complainant is likely to be homosexual.

  
  
• d)
  

  That erection and ejaculation are physiological responses that are not fully under conscious control and can be provoked by high anxiety and anal stimulation.

  
  
• e)
  

  That it is not possible to achieve an erection during rape because of the fear and therefore the complainant is lying.

The following statement(s) is/are true about sexual violence:

• a)
  

  Sexual violence is an unusual crime because the victim is often to blame for the act.

  
  
• b)
  

  A man cannot rape his wife if rape in marriage is not illegal.

  
  
• c)
  

  Boys and men may be victims of sexual violence from men and women.

  
  
• d)
  

  Most rapes are not reported to the police.

  
  
• e)
  

  The most accurate prevalence measures are from research that has questions asking about behaviourally specific acts.

The following statement(s) is/are true findings from research on the prevalence of sexual violence:

• a)
  

  In some countries and settings, more than one in two women have been raped by their husband or boyfriend.

  
  
• b)
  

  Population-based estimates from the USA are that nearly one in five women have been raped in their lifetime.

  
  
• c)
  

  Male rape by other men is mostly a problem for gay men.

  
  
• d)
  

  Except in war, sexual violence always most commonly occurs between intimate partners.

  
  
• e)
  

  First sex forced by male partners is chiefly a problem for women.

The following statement(s) is/are true findings from research on sexual violence:

• a)
  

  It is not possible to learn the population prevalence of perpetration of sexual violence.

  
  
• b)
  

  Gang rape, or rape by more than one man, is a phenomenon confined to criminal gangs.

  
  
• c)
  

  Prevalence estimates are sensitive to the methods used in the research and training and support given to interviewers.

  
  
• d)
  

  Questions on sexual violence must ask specifically about experience with intimate partners and non-intimate partners.

  
  
• e)
  

  In countries where women are secluded, they are protected from rape.

The following statement(s) is/are true for research on child sexual abuse:

• a)
  

  It is difficult to estimate reliably and comparably the proportion of the population who ever experience abuse during childhood without interviewing children.

  
  
• b)
  

  Repressed memory of acts of child sexual abuse causes prevalence estimates to be under-estimates.

  
  
• c)
  

  Sexual violence in schools is an important problem globally.

  
  
• d)
  

  Most child sexual abuse is reported to police and social services.

  
  
• e)
  

  If school students willingly have sexual relationships with teachers it is not called abuse.

The following statement(s) is/are true about taking skin swabs:

• a)
  

  Ultraviolet light causes all body fluid types to fluoresce so should always be used to identify the sample site.

  
  
• b)
  

  Swabs used for clinical purposes are suitable for forensic skin swabbing.

  
  
• c)
  

  Cotton swabs are the most suitable to recover trace evidence from skin.

  
  
• d)
  

  The double-swabbing technique is widely recognised as a successful method for recovering trace evidence from skin.

  
  
• e)
  

  The Forensic Science Provider does not require the Forensic Medical Practitioner (FMP) to take background control swabs when sampling skin.

The following statement(s) is/are true in relation to the seizing of clothing from a complainant of sexual assault:

• a)
  

  Clothing worn by the complainant at the time of the alleged assault is rarely seized.

  
  
• b)
  

  Viewing the complainant in torn clothing may provide the FMP with points of reference to injuries on the body.

  
  
• c)
  

  The attending staff should be instructed to remove the complainant’s clothing before the FMP assesses them.

  
  
• d)
  

  It is acceptable for the FMP to cut through points of existing damage when examining a patient.

  
  
• e)
  

  Record photography of clothing in situ is not required.

Ideally, the woman should have the following ability(ies) for optimal competence in terms of choice:

• a)
  

  The ability to communicate choices.

  
  
• b)
  

  The ability to keep information confidential.

  
  
• c)
  

  The ability to understand relevant information upon which the choice is made.

  
  
• d)
  

  The ability to appreciate the situation according to the patient’s own values.

  
  
• e)
  

  The ability to weigh various values to arrive at a decision.

Exceptions to the rule of informed consent are acceptable in the following situation(s):

• a)
  

  During an emergency where the woman cannot communicate her wishes to you.

  
  
• b)
  

  When exercising the therapeutic privilege.

  
  
• c)
  

  When the woman’s husband requests a waiver of consent on her behalf.

  
  
• d)
  

  When the woman who is capable of giving consent requests a waiver.

  
  
• e)
  

  When the woman’s family usually make decisions on her behalf.

Which of the following reasons is/are true with regard to why confidential information should be treated with the utmost care:

• a)
  

  To ensure the woman is cared for compassionately.

  
  
• b)
  

  To exclude unauthorised people from being privy to this information.

  
  
• c)
  

  The information could be embarrassing to the patient.

  
  
• d)
  

  To preserve the privacy of the patient.

  
  
• e)
  

  To facilitate the sharing of sensitive information with the goal of helping the patient.

Which of the following is/are sources from which confidentiality draws such a high value:

• a)
  

  Benevolence.

  
  
• b)
  

  Autonomy.

  
  
• c)
  

  Trust.

  
  
• d)
  

  Respect for persons.

  
  
• e)
  

  Malfeasance.

The specific evidentiary examination component ‘trace evidence and biological material collection’ has to be carried out:

• a)
  

  Less than 72 h after the alleged assault.

  
  
• b)
  

  With consent.

  
  
• c)
  

  Using colposcopy.

  
  
• d)
  

  After police reporting.

  
  
• e)
  

  Under standardised conditions.

The forensic examination has to be interpreted and documented in a written legal report. Which of the following is/are true?

• a)
  

  Interpretations of findings are a specialist skill.

  
  
• b)
  

  Age of injuries and mechanism and force of injury infliction are key issues.

  
  
• c)
  

  Standard terminology is essential.

  
  
• d)
  

  Conjunctival petechiae with neck injury may be consistent with strangulation.

  
  
• e)
  

  Conjunctival petechiae of any aetiology, is a marker of life-threatening injury.

Which of the following is/are true about the effect of forensic evidence on legal outcomes in sexual violence?

• a)
  

  It is significantly associated with injuries.

  
  
• b)
  

  The correlation to conviction is the best predictor of a proper forensic examination.

  
  
• c)
  

  A reduction in negative health consequences for the victim would be an appropriate end point for research as well as conviction rates.

  
  
• d)
  

  Forensic examination is carried out to prosecute and convict the alleged assailant.

  
  
• e)
  

  Forensic examination is carried out to protect the alleged assailant.

A 45-year-old woman has made an allegation of vaginal rape, saying that the assault has happened 4 h ago. Which of the following is/are true about the genital examination?

• a)
  

  Absence of injury indicates that the allegation is not true.

  
  
• b)
  

  Vaginal bleeding is conclusive evidence of the rape.

  
  
• c)
  

  Even if she has had consensual intercourse within 24 h, then a genital examination may be warranted.

  
  
• d)
  

  This should routinely be done in the left lateral position.

  
  
• e)
  

  The posterior fourchette is the site most likely to sustain an injury.

Which of the following is/are true about external female genitalia?

• a)
  

  The labia minora contain sebaceous glands.

  
  
• b)
  

  The vagina is lined by simple columnar epithelium.

  
  
• c)
  

  The fossa navicularis sits distal to the clitoris and anterior to the hymen.

  
  
• d)
  

  The lower vagina is formed from the paramesonephric ducts.

  
  
• e)
  

  Lacerations are very rare after sexual assault.

Which are the following is/are true about conducting a genital examination after an assault:

• a)
  

  Toluidine blue dye is not good at detecting bruises.

  
  
• b)
  

  Photographic images of the genitalia should be discarded if no injuries are seen.

  
  
• c)
  

  A catheter balloon can be used to visualise the hymen edges.

  
  
• d)
  

  Stranger rapes are more likely to result in genital injuries than acquaintance rapes.

  
  
• e)
  

  The legal definition of the vagina has it as the distal end starting with the vulva.

A 23-year old woman has been examined after an allegation of rape. Which of the following is/are true?

• a)
  

  A vaginal laceration is more likely with an anteverted uterus.

  
  
• b)
  

  A vaginal laceration is likely to be due to a sharp object being inserted.

  
  
• c)
  

  Injuries to her body surfaces are more likely than genital injuries.

  
  
• d)
  

  Intoxication with alcohol by the girl makes her less likely to have sustained genital injuries.

  
  
• e)
  

  The risk of blood-borne viruses is unrelated to genital trauma.

The following statement(s) is/are true about emergency contraception after sexual assault.

• a)
  

  An intrauterine device (IUD) is the most reliable form of emergency contraception.

  
  
• b)
  

  Most victims of sexual assault prefer to take oral forms of emergency contraception such as: Levonelle or Ella One.

  
  
• c)
  

  Levonelle (Norgestrel) is licensed to be given for up to 5 days after unprotected sexual exposure in females under or over the age of 16 years.

  
  
• d)
  

  Ella One (Ulipristal) is a new oral emergency contraception that is licensed in women aged 16 years or older for up to 72 h after unprotected sexual exposure.

  
  
• e)
  

  The victim should be offered a pregnancy test before taking emergency contraception to reduce the chance they are already pregnant with their partner’s child.

The following statement(s) about human immunodeficiency (HIV) post-exposure prophylaxis (PEPSE) is/are true:

• a)
  

  HIV PEPSE should be considered in vaginal penile penetration and high-risk assailants.

  
  
• b)
  

  HIV PEPSE is recommended in anal penile penetration and high risk assailants.

  
  
• c)
  

  HIV PEPSE can be started for up to 5 days after unprotected sexual exposure.

  
  
• d)
  

  HIV PEPSE has no side-effects and is generally well tolerated.

  
  
• e)
  

  HIV baseline tests are not required before administration of HIV PEPSE.

During an examination of a pre-pubertal girl in the supine position and using separation of the labia, you are unable to see the hymenal edge. Which of the following is/are acceptable ways to manage this?

• a)
  

  Do nothing and say these were normal findings.

  
  
• b)
  

  Use traction.

  
  
• c)
  

  Put the girl in knee chest position.

  
  
• d)
  

  Use a Foley catheter.

  
  
• e)
  

  Use general anaesthesia to examine her.

An adolescent girl alleges rape. At examination, the hymen is folded and fleshy. There are no apparent tears, lacerations or bruises. Which of the following is/are acceptable ways to manage this?

• a)
  

  Do nothing: state the hymen was normal and there were no injuries to be seen.

  
  
• b)
  

  Use a moistened swab to separate the folds.

  
  
• c)
  

  Examine in the knee chest position.

  
  
• d)
  

  Use a Foley catheter.

  
  
• e)
  

  Use general anaesthesia to examine her.

A pre-pubertal child alleges penetration of genitalia by her uncle 4 weeks previously. At examination, there are no clinical findings. What can you reasonably conclude in this situation?

• a)
  

  Normal clinical findings do not support the allegation.

  
  
• b)
  

  The majority of children alleging sexual abuse have no injury so this is expected.

  
  
• c)
  

  There may have been signs initially but healing has occurred.

  
  
• d)
  

  There may not have been penetration.

  
  
• e)
  

  These findings neither support nor negate the allegation.

Peri-orbital bruising (black eye) may be caused by:

• a)
  

  Compression of the neck.

  
  
• b)
  

  Blows to the frontal region of the scalp.

  
  
• c)
  

  Nasal bone fractures.

  
  
• d)
  

  Occipital skull fracture.

  
  
• e)
  

  Forceful hair pulling.

Tram-line bruising is typically associated with:

• a)
  

  The application of a ligature to the wrists.

  
  
• b)
  

  Self-inflicted injury.

  
  
• c)
  

  Beating with a rod-like weapon.

  
  
• d)
  

  Fingertip pressure.

  
  
• e)
  

  Whipping with a chain.

The following is/are true concerning sexual assault?

• a)
  

  The lifetime rate of sexual assault for women with mental health difficulties is higher than the general population.

  
  
• b)
  

  The lifetime risk of being raped for women in the UK is about 20%.

  
  
• c)
  

  If a woman is raped by a stranger, rather than someone she knows, she will have less difficulty re-establishing intimate relationships.

  
  
• d)
  

  If a woman is raped by someone she knows, rather than a stranger, she will have less difficulty re-establishing intimate relationships.

  
  
• e)
  

  For a formal diagnosis of PTSD to be made, the symptoms must be present for 6 months.

Which one of the following statements is/are true about the prevention of post-traumatic stress disorder (PTSD)?

• a)
  

  Cognitive–behavioural therapy is effective for preventing PTSD.

  
  
• b)
  

  Individual psychological debriefing has been found to reduce the onset of PTSD.

  
  
• c)
  

  Symptoms of PTSD can be prevented by using venlafaxine.

  
  
• d)
  

  Eye-movement desensitisation and reprocessing therapy is effective for preventing PTSD.

  
  
• e)
  

  Expressive writing has been found to be effective in preventing PTSD.

Studies have found that women who suffer from sexual abuse are at greater risk of developing HIV because:

• a)
  

  They use condoms inconsistently.

  
  
• b)
  

  They have risky sexual partners.

  
  
• c)
  

  They tend to have more sexual partners.

  
  
• d)
  

  They are more likely to reuse needles when using injectable drugs.

  
  
• e)
  

  They are more likely to become involved in transactional sex.

Which one of the following statements is/are true about the health consequences of sexual violence against women?

• a)
  

  Women suffering from intimate partner sexual and physical abuse have the same risk of experiencing health problems as women who experience physical abuse alone.

  
  
• b)
  

  Mental health symptoms do not improve spontaneously.

  
  
• c)
  

  Women who have experienced sexual violence are found to use preventive health services more frequently.

  
  
• d)
  

  PTSD is diagnosed when symptoms are present for at least 2 weeks.

  
  
• e)
  

  Eating disorders, including overeating, have been found to be associated with sexual violence.