06/27/2017

Forensic medicine mci screening test and indian medical pg examz high yield important topics study tips

By Live Dr - Wed Feb 11, 3:43 am

Forensic medicine

TYPES OF INQUEST
Police inquest

Magistrate’s /Coroner’s inquest

Medical examiners inquest (Best system of inquest)

MAGISTRATE’S INQUEST IS DONE IN
Prison death

Police custody death

Police firing death

Dowry death

Exhumation

Police interrogation death

DYING DEPOSITION DYING DECLARATION
Recorded by magistrate Recorded by magistrate or doctor
Recorded under oath No oath necessary
Presence of accused and it’s lawyer necessary Not necessary
Superior Inferior

Types of consent

Implied consent When the conduct of the person indicates that he has given permission for the act to be done, without expressing it verbally or in writing.
Expressed consent When the person is asked for the consent for an act, , then he expresses his consent
Informed consent Consent has been given after knowing all the pros and cons of the act for which the consent is being taken.
Res ipsa loquitor Evidence speaks for itself.
Novus actus interveniens A doctor is not responsible for the harm caused by the interference during the course of treatment, by any other person, not related with the treatment of person.
Respondent superior An employer is responsible for the negligent acts of his employee, provided it is done under the direct supervision of the employer.
Res judicata When a judgement delivered by a court of law in a particular case is used as a precedent in another case of similar nature.
Compos mentis Sound state of mind.

*Calculated risk- Res ipsa loquitor should not be applied when the injury complained is of a type that may occur even though reasonable care has been taken.

It is an important defence to the doctor sued for professional negligence, who can produce expert evidence of statistics to shows that the accepted method of treatment he employed had unfavorable risks.

quote corner

I can not do everything, but I can do something. I must not fail to do the something that I can do.- Helen keller

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Accuracy in sexing adult skeletal

Entire skeleton 100%
Pelvis 95 %
Skull alone 90%
Pelvis plus skull 98 %
Long bones alone 80%

DIFFERENT METHODS OF IDENTIFICATION OF AN INDIVIDUAL

Cheiloscopy /Figura linearum labiorum Study of lip prints
Poroscopy (Locard’s method) Identification by examination of pores on the ridges of fingers and hands
Dactylography (Henry-Galton system) / Dermatoglyphics Study of finger prints
Gustafson’s method Age estimation of adults over 21 years of age by studying the physiological changes in each of the dental tissues
Portrait parle / Bertillon’s method Scientific indexing and filing of the physical descriptions of a person for the purpose of his future identification.

Time table of teeth eruption

DECIDUOUS TEETH ERUPTION            PERMANENT TEETH ERUPTION

TEETH AGE OF ERUPTION IN MONTHS
Lower central incisor

6

Upper central incisor

7

Upper lateral incisor

8

Lower lateral incisor

9

First molar

12

Canines

18

Second molar

24

TEETH AGE OF ERUPTION IN YEARS
First molar

6

Central incisor

7

Lateral incisor

8

First premolar

9

Second premolar

10

Canines

11

Second molar

12

Third molar

17-30

TRIVIAL TRUTH

The arrow-poison frog is so venomous that some South American tribes dip arrows into the poison to make them more deadly.A frog 2.5 cm long makes poison for 50 arrows.

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PHYSICAL FEATURES OF FETUS AT DIFFERENT GESTATIONAL AGES

INTRAUTERINE MONTHS FEATURES HEIGHT WEIGHT

1

Mouth cleft, black spot for eye

1 cm

2.5 gm

2

Limb buds appear

4cm

10

3

Neck, nail present

9 cm

30

4

Lanugo hair

16 cm

125

5

Scalp hair

25 cm

400

6

Vernix caseosa

30 cm

800

7

Eyebrows, eyelids separate

35 cm

1200

8

Left testis in scrotum

40 cm

1600

9

Bilateral testis in scrotum

40 cm

1600

10

Nails beyond tips

60 cm

3-3.5 kg

Post-mortem lividity

Colour Cause
Cherry red Hydrocyanic acid
Pinkish Carbon monoxide
Bright red Cold
Dark brown Phosphorus
Brown Potassium cyanide

sodium cyanide

Deep blue Aniline,

Carbon dioxide.

Greenish blue Hydrogen sulphide
Red Drowning.
POSTMORTEM CALORICITY IS SEEN IN
Sunstroke

Cholera

Septicemia

Tetanus

Alcohol poisoning

Strychnine poisoning

Rabies

*Taches Noire – brownish discolouration on the exposed sclera due to formation of cellular debris and dust settling there on. Seen in sclera within 3 hours of death if the eyes remain open

*Casper’s dictum states that a body decomposes in air twice as rapidly as in water, and eight times as rapidly as in earth.

*In India,

Average heat loss is

0.5-0.7 degree Celsius per hour

*First voluntary muscle to develop rigor mortis is eyelid muscle

Last voluntary muscle to develop rigor mortis is muscles of fingers and toes

QUOTE CORNER

If you wish success in life, make perseverence your bosom friend, experience your wise counselor, caution your elder brother and hope your guardian genius.-Joseph Addison

eleventh HOUR F.M.                                                                                                                               94

*Cadaveric spasm/ Instantaneous rigor

Stiffening of muscles immediately after death without being preceded by primary relaxation

Seen when the muscles of the body were in a state of strong contraction immediately before death.

*Currant jelly with supernatant yellow chicken fat appearance is seen in post-mortem clots.

GRIEVOUS HURT (SEC 320 IPC)
Emasculation

Permanent privation / loss of sight of either eye

Permanent privation / loss of hearing of either ear

Privation of any member of any joint

Destruction or permanent impairing of power of any member of joint

Permanent disfiguration of head or face

Fracture or dislocation of bone or tooth

Any hurt which endangers the life or which causes the sufferer to severe bodily pain or Makes him unable to follow his ordinary pursuits for a period of 20 days.

Colour changes in bruise

DAYS COLOUR CAUSE
0 Red Blood
Few hours- 3 days Blue
4 Bluish-black to brown Hemosiderin
5-6 Green Hematoidin
7-12 Yellow Bilirubin
14 Normal
TESTS USED FOR BLOOD STAINS
Benzidine

Phenolphthalein (Kestle-Mayer)

Takayama’s hemochromatogen

Teichmann,

Hemin

Spectroscopic

Leucomalachite green

Luminal

TESTS USED TO DETECT SEMINAL STAINS
Barberio’s test

Florence test

Acid phosphatase test

Creatinine phosphokinase

Semen specific glycoprotein

ELISA (SEMA assay for seminal vesicle specific antigen)

TRIVIAL TRUTH

A human head remains conscious for about 15 to 20 seconds after it is been decapitated.

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Penetrated wound Wound terminates inside a body cavity or viscus
Perforated wound Part of the weapon passes through and through the whole thickness of any part of the body
Punctured wound Tip of the weapon terminates inside the body.

DIFFERENT METHODS OF ASPHYXIA

Throttling Strangulation by hands
Garroting Strangulation by thin ligature thrown around the neck and constricted of unaware victims.
Mugging Strangulation of neck by compressing it in the knee joint or elbow joint
Bansdola Strangulation by compressing the neck between two bamboo sticks
Palmar strangulation Strangulation by compressing the neck with the base of the palm
Traumatic asphyxia Forceful compression of the chest, which prevents respiratory movements
Choking Air passage is occluded either by some foreign material introduced in the air tract or in surrounding structure.
Gagging Cloth is pressed inside the oral cavity to cause asphyxia
Burking Combination of smothering, palmar strangulation ad traumatic asphyxia.
Café coronary Choking by a food bolus in an intoxicated person, this presents with symptoms of heart attack.
Lynching Homicidal hanging done by public

*Tardieu spots are seen in death due to asphyxia.

Sure sign of antemortem hanging is dribbling of saliva at the angle of mouth.

Six penny bruises-

Bruises found in a case of throttling on the neck, due to finger tips.

*Le facies sympathique-

In some cases of hanging, the right eye remains open with dilated pupil, whereas the left eye is closed with pupil less dilated as compared to right.

*Dry drowning

Immediate sustained laryngeal spasm

Immersion syndrome-cardiac arrest due to vagal inhibition due to diving in very cold water

Post immersion syndrome / secondary drowning – death occurs due to sequelae of drowning, like lung infection

QUOTE CORNER

You always pass failure on the way to success.- Mickey Rooney

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*Paltauf’s hemorrhage

Shining, pale bluish red and may be minute or 3-5 cm in diameter, subplerual hemorrhage seen due to alveolar rupture in drowning.

*Arborescent burn/ filigree burn/ Lichtenberg’s flowers – burns due to lightning.

*Joule burns – burns due to electrocution.

Crocodile skin – high voltage electrocution.

*Air embolism

10-20 ml of air can death.

SEXUAL PERVERSIONS AND UNNATURAL SEXUAL OFFENCES.

TERMINOLOGY EXPLANATION (PERSON GETS SEXUAL SATISFACTION BY)
Fetishism Seeing/ touching  organs or clothes of opposite gender
Transvestism (Eonism) Wearing dresses of opposite gender
Peeping Tom Secretly observing others’ sexual act
Troilism Inducing one’s wife for sexual intercourse with another man and then observing them
Scopophilia Seeing a nude woman in bathroom.
Voyeurism More perversive than Scopophilia
Undinism Seeing a woman micturiating
Sadism (Algolagnia) Torturing the sexual partner
Bobbitt syndrome Female amputes penis
Lust murder Killing the sexual partner
Necrophagia Eating the body parts of killed sexual partner
Masochism (passive Algolagnia) Being tortured or abused by sexual partner
Exhibitionism Exposing private parts in public
Frotteurism Rubbing private parts against a female’s body.
Necrophilia Having sexual act with a dead body
Satyriasis Excessive sexual drive in male
Nymphomania Excessive sexual drive in the female
Fellatio (buccal coitus) Male organ sucked by female
Cunnilingus (buccal coitus) Female organ sucked by male
Sodomy (Buggery) Anal coitus
Pederasty Sodomy with a child (Catamite) as a passive agent
Gerontophilia Sodomy with the old person acting as a passive agent
Lesbianism(Tribadism) Female homosexuality
Bestiality Sexual intercourse with an animal

TRIVIAL TRUTH

Nutmeg is extremely poisonous; if injected intravenously, it can kill.

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*Masochism is opposite of Sadism

Scopophilia is opposite of Exhibitionism.

Buccal coitus is also known as sin of Gomorrah.

Hijrah are castrated males / hermaphrodites / intersex / transsexuals.

Jenanas are cross-dressing males who are not castrated

Flasher is a male exhibitionist

Butch / Dyke is an active lesbian

Femme is a passive lesbian.

*Abasiophilia is a psychosexual attraction to people with impaired mobility, especially those who use orthopedic appliances such as leg braces, orthopedic casts, spinal braces, or wheelchairs.

*Autoassassinophilia is the paraphilia where a person becomes sexually aroused by fantasizing their own death in the hands of another.

Rape

CRITERIA OF RAPE IN INDIA
Unlawful intercourse by a man-

With his wife under age of 15 years

With any woman under 16 years
With any other woman above 16 years, against her will

*In case of rape-semen sample should be collected within 2 days

Black Gun powder Smokeless gun powder
Sulphur + potassium nitrate+ charcoal Nitrocellulose/ nitroglycerine
Tandem bullets/ Piggyback bullet Bullets ejected one after another, as the previous one was stuck in the barrel.
Dumdum bullet Nose cut off.
Ricochet Before striking the aim, strikes some other object, to get rebound and hit the target.
Frangible bullets Designed to fragment upon impact, often to the point of disintegration.
ENTRY WOUND EXIT WOUND
Smaller than the diameter of bullet Larger than diameter of bullet
Inverted edges Everted edges
Abrasion present Abrasion absent
Grease collar present Grease collar absent

QUOTE CORNER

Goals are the fuel in the furnace of achievement.-Brian Tracy, ‘Eat that Frog’.

eleventh HOUR F.M.                                                                                                                             98

TABLE CONTINUED…

ENTRY WOUND EXIT WOUND
Burning, singing, tattooing, blackening present in close shot wounds Burning, singing, tattooing, blackening absent
Bleeding and tissue extrusion are less Bleeding and tissue extrusion are more
Contraindication for emesis Contraindication for gastric lavage
Corrosive, irritant, convulsive, volatile, comatose, Heart disease, pregnant women. Very old, corrosive, convulsants, unconsciousness, heart disease, peptic ulcer.

*Gastric lavage is contraindicated in poisoning with mineral acids like sulphuric acid, nitric acid, hydrochloric acid, hydrofluoric acid

It can be done in cases of organic acids like aspirin, oxalic acid, carbolic acid, picric acid, acetic acid, tartaric ac id, citric acid

HEMODIALYSIS IS USED IN CASES OF POISONING BY FOLLOWING HEMODIALYSIS IS NOT USEFUL IN
Barbiturates

Salicylates

Methanol

Boric acid

Glutethemide

Thiocyanates

Digoxin

Kerosene

Benzodiazepines,

OPC

Characteristic smells in poisoning

Bitter almond Cyanide
Garlic odour Arsenic poisoning
Fruity odour Ethyl alcohol
Kerosene odour Kerosene, OPC
Rotten eggs Hydrogen sulphide
Fishy Zinc phosphide
Burnt rope Cannabis
UNIVERSAL ANTIDOTE
Activated charcoal- 2 parts

Magnesium oxide- 1 part

Tannic acid- 1 part

trivial truth

Snakes are immune to their own poison.

eleventh HOUR F.M.                                                                                                                             99

Urine Colour in poisoning

Brownish-green Carbolic acid
Golden Barbiturates
Brown Nitric acid

*Smoky stool syndrome- found in phosphorus poisoning, the stools show luminescent fumes

*In copper sulphate poisoning, vomitus is bluish green.

ANTIDOTES OF SOME POSISONS

Acids Weak noncarbonated alkalies
Alkalies Weak vegetable acids- citric acid, acetic acid.
Silver nitrate Sodium chloride
Mercuric chloride Egg albumin
Arsenic poisoning Freshly prepared ferric oxide
Opium Potassium permanganate

naloxone

Dhatura Neostigmine
Strychnine Barbiturate
Oxalic acid Calcium gluconate
Phenol/carbolic acid 20% alcohol for gastric lavage
Aspirin Stomach wash with magnesium oxide
Yellow phosphorus Stomach wash with 0.1 % solution of copper sulphate
Lead Stomach wash with magnesium or sodium sulphate, calcium disodium edta  iv
Mercury Egg albumin, bal or penicillamine iv.
opc Atropine, oximes

IDEAL POISONS

Ideal homicidal poison Aconite
Ideal suicidal poison Opium
Ideal infanticide Opium
Ideal judicial poison (death sentence) Cyanide (gas chamber)
Ideal date-rape drug Ketamine
LILY’S KIT- ANTIDOTE FOR HCN POISONING
Amyl nitrite

Sodium thiosulphate

Sodium nitrite

QUOTE CORNER

No great man ever complains of want of opportunities.- Ralph Waldo Emerson

eleventh HOUR F.M.                                                                                                                             100

POISON ACTIVE PRINCIPLE REMARKS
Abrus precatorius/ Rati Abrin Used by jewelers in olden days to measure gold and silver.

Local effect similar to viper snake bite.

Ricinus communis / castor Ricin. Castor oil (Erandel oil) purgative
Croton tiglium/ purging croton/ Jamaalgota Crotin and Crotonoside Purgative
Semicarpus anacardium/ marking nut/ Semicarpol  and Bhilawanol Used in laundries for marking on clothes.
Calotrpois/ madar Calotropin, Calotoxin, Gigantin, Uscharin.
Capsicum annum Capsicin, Capsaicin.
Aconite/ Mitha vish Aconitine Pupils show hippus reaction (alternate constriction and dilatation)

*Chronic arsenic poisoning

Raindrop pigmentation.

Mee’s line (White transverse bands on nail plate)

Acute dhatura poisoning

Signs and symptoms
Flushed skin (red as beet)

Hyperthermia(hot as hare)

Inhibition of secretions (dry as bone)

Dilation of pupils  with loss of accumulation (blind as bat)

Restlessness, delirium (mad as wet hen)

Cold turkey-describes the withdrawal symptoms in chronic intoxication by opiates.

Symptoms are-

Cold clammy skin (hyperhydrosis)

Cutis anserine (gooseflesh)

Tremors, shivering,

Restlessness,

Muscular cramps

Rhinorrhoea

Hyperlacrimation

Yawning

TRIVIAL TRUTH

Every person has a unique tongue print.

eleventh HOUR F.M.                                                                                                                            101

POISON TYPE
Dhatura Deliriant poison
Alcohol Inebriant poison
Opium Somniferous poison
Arsenic Irritant poison
Viper Vasculotoxic
Cobra Neurotoxic (convulsions and paralysis)
Krait Neurotoxic (paralysis)
Sea-snake Myotoxic
Coral Neurotoxic

*Neostigmine is used to treat cobra venom

COLLOQUIAL / STREET NAMES OF SOME SUBSTANCES OF ABUSE

NAME REMARKS
Mitha vish ( sweet poison) Aconite
Siddhi / Bhang Leaves and stems of cannabis sativa ( 2% cannabinol)
Majun Sweetmeat preparation of Bhang
Ganja flowering tops of female plants of c. sativa (5-10% cannabinol)
Reefer cigarette preparation of Ganja
Charas resinous extract from leaves and flowers of c. sativa (20-50% cannabinol)
Blue pill LSD
Kasoomba Opium decoction
Madak / Chandu Opium vapours
Bhujri Fried ripe capsule of poppy plant
Angel dust , Elephant Phencyclidine
Crack Cocaine
Speed ball

Brown sugar

Smack

Heroin
XTC / Ecstasy / Football Amphetamine
Heavenly blue Morning glory seeds
School boy Codeine
Speed ball Mixture of heroine and cocaine
Sukhi sharaab/ dry liquor Methaqualone

QUOTE CORNER

Never mistake knowledge for wisdom. One helps you make a living; the other helps you make a life.-Sandra Carey

eleventh HOUR F.M.                                                                                                                             102

Viscera preservation

Saturated solution of salt All poisonings, including( carbolic acid) except acids
Rectified spirit Acid  poisoning (except carbolic acid)
10% formalin Preservation for histopathological examination
Potassium oxalate + sodium fluoride Blood preservation in alcohol poisoning case
Sodium citrate + sodium fluoride Blood preservation in oxalic acid , ethylene glycol poisoning case
Potassium oxalate + sodium nitrite Blood preservation in fluoride poisoning case
Layer of liquid paraffin over blood column Blood preservation in carbon monoxide poisoning case

*Body packers / mules/ swallowers/ stuffers

Drug smugglers who swallow cocaine or heroin filled packets and retrieve them at a later date from their stools, or orally

Rupture of packet can lead to severe toxicity and death

*Magnan’s syndrome / formication/ cocainomania / cocaine bugs-

Hallucination of insects crawling on skin, seen in cocaine addicts

*Alcohol and nicotine are called gateway drugs, i.e. they lead to the misuse of other drugs.

Mellanby effect-

Intoxicating effectes of alcohol are greater when the blood alcohol level is rising than when it is falling.

TRIVIAL TRUTH

Between the time of death and the onset of rigor mortis in a human body, the contraction of the muscles can cause the body to turn over on its side.

eleventh HOUR F.M.                                                                                                                             103

Torture techniques

Falanga/ Falaka/ Bastinado Hitting soles of feet
El telefone Slapping with the palms on both ears, leading to rupture of tympanic membrane
El quirafano Hitting on the abdomen, while lying on table with upper half of body unsupported
La bandera Suspending a person by wrists
Murcielago Suspending by ankles
Parrots perch/ Jack/ Pau de arara/ Bombay cuff Suspending from a pole placed under the knees, with the wrists bound to the ankles.
Wet submarine With eyes strapped, hood on head and limbs tied, person is dipped in a tank of oil containing ammonia, urine, excreta, sea water till the person can’t hold his breath.
Dry submarine Tying of plastic bag on the head
El planton Prolonged standing
Black slave Insertion of hot metal rod into the anus
Water boarding Detainee is strapped down, dunked under water and made to believe that he might be drowned
Palestinian hanging/ crucifixion. Binding the prisoner’s hands behind his or her back. As fatigue sets in the person falls forward, putting full body weight on the shoulders, this impairs breathing, leading to death.
Sweatboxes Prisoner is locked in a small, hot room, without ventilation.
Aeroplane treatment The accused is hung upside down, leading to congestion of head, this is then followed by beating of soles
Roller method Prisoner is forcibly laid on his back and then a round poleis rolled over his legs and body, sometimes with torturers standing on either end of it and rolling it up and down
Cog needle A thin rod is inserted through the umbilicus or up the anus
Bellary A stick smeared with red or green chilly paste is thrust into the anus

QUOTE CORNER

Courage and perseverence have a magical talisman, before which difficulties disappear and obstacles vanish into air.-John Quincy Adam.

eleventh HOUR F.M.                                                                                                                            104

4 Comments

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