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Make easy learning notes out of these photographs for fmt 3 rd year mbbs
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Here are your easy, exam-ready notes for FMT 3rd Year MBBS on Intracranial Hemorrhages:
🧠 INTRACRANIAL HEMORRHAGES
Regional Injuries Part 2 - Forensic Medicine (Marrow 8.0)
ANATOMY OF MENINGES (Quick Map)
| Space | Layer | Vessel Involved | Mnemonic |
|---|---|---|---|
| Extradural | Between skull & dura | Middle meningeal artery | Wild Arterial |
| Subdural | Between dura & arachnoid | Bridging veins | Shaken Baby |
| Subarachnoid | Between arachnoid & pia | Circle of Willis | Head ache |
1. EXTRADURAL HEMORRHAGE (EDH)
Key Facts (High Yield!)
- Least common intracranial hemorrhage
- Highest fatality
- Unilateral, coup injury
- Age group: Young adults (20-40 yrs)
Blood Vessels Involved
| Vessel | Region Injured |
|---|---|
| Middle meningeal artery (m/c) | Temporal lobe |
| Anterior ethmoidal artery | Frontal lobe |
| Transverse sinus | Occipital lobe |
| Sagittal sinus | Vertex |
Mechanism (Flow)
Blow to temporoparietal region (Pterion)
↓
Fracture of temporal bone (m/c: Fissure fracture)
↓
Rupture of middle meningeal artery
↓
Bleeding in extradural space
↓
↑ Intracranial tension → Brain compression
↓
Brainstem herniation → Respiratory failure → DEATH
Clinical Features ⭐
- 35 ml blood = Clinical features
- 150 ml blood = Fatal
- Lucid interval = Period of consciousness between episodes of unconsciousness
- Concussion → Lucid interval → Brain compression (d/t bleeding) → Unconscious + death
- 3rd nerve palsy (dilated & fixed pupil + contralateral hemiparesis)
- Kernohan's notch phenomenon = Dilated pupil + Ipsilateral hemiparesis (False localising sign)
- Mechanism: Uncal herniation → Compression of opposite area into tentorium cerebelli → Compression of fibres in cerebral peduncle → Ipsilateral hemiparesis + dilated pupils
Medico-legal pearl: Patient in lucid interval can provide valid evidence, make a will, and is criminally liable. Death due to failure to diagnose lucid interval = Medical negligence
Note: Lucid interval - EDH > SDH
Investigation
- NCCT brain (non-contrast CT)
- Biconvex / lentiform / lens-shaped hemorrhage
- Does NOT cross suture (most important!)
Management
- Surgical removal of clot: Craniotomy / Burr hole
2. SUBDURAL HAEMORRHAGE (SDH)
Key Facts
- Age group: Children, Elderly
- Blood vessel: Bridging veins
Types (Based on Duration)
| Type | Duration | Key Feature |
|---|---|---|
| Acute | < 3 days | Lucid interval + |
| Subacute | 3 days - 3 weeks | - |
| Chronic | > 3 weeks | Minor trauma, elderly, brain atrophy |
Mechanism
In Children:
Acceleration-deceleration injury
↓
Violent shaking
↓
Shaken Baby Syndrome ⭐
In Elderly:
Minor trauma
↓
Age-related brain atrophy → ↑ subdural space
↓
Bridging veins lose support
↓
Bleeding with minor trauma
↓
Blood accumulates over prolonged period
↓
Chronic SDH
Clinical Features
- Headache
- Altered sensorium
- Hemiparesis ✓
- Dilated & fixed pupil ✓
- Personality changes
Investigation
- NCCT brain:
- Concavoconvex opacity
- Banana-shaped / Crescent-shaped hemorrhage ⭐
- Crosses suture (key difference from EDH!)
Management
- Conservative management
- Surgical removal of clot
Memory Aid - ABC of SDH ⭐
- A = Aged persons, Alcoholics
- B = Bridging veins, Boxers (Dementia pugilistica)
- C = Child abuse, Crescentic opacity
Dementia Pugilistica (Punch Drunk Syndrome)
- Seen in long-term boxers
- Most common hemorrhage: SDH
3. SUBARACHNOID HEMORRHAGE (SAH)
Causes - Mnemonic BATS ⭐
| Letter | Cause |
|---|---|
| B | Berry aneurysm |
| A | AV malformation |
| T | Trauma (m/c) |
| S | Stroke / Spontaneous |
Clinical Features
- Thunderclap headache (sudden onset severe headache) ⭐
- Nausea, vomiting
- Neck stiffness
- Drowsiness
- Loss of consciousness
- Focal neurological deficit
Investigation
- NCCT brain: Hyperdense bleeding near base of brain
- Lumbar puncture: Xanthochromia (appears 4-6 hrs after bleed) ⭐
Management
- Clipping / Endovascular coiling of aneurysm
QUICK COMPARISON TABLE ⭐
| Feature | EDH | SDH | SAH |
|---|---|---|---|
| Vessel | Middle meningeal artery | Bridging veins | Circle of Willis / Berry aneurysm |
| CT shape | Biconvex (lens) | Concavoconvex (crescent/banana) | Hyperdense near base |
| Crosses suture? | NO | YES | - |
| Lucid interval | Most common | Less common | No |
| Age group | Young adults (20-40) | Children, Elderly | Any |
| Mechanism | Coup injury, pterion blow | Shaken baby / minor trauma | Berry aneurysm rupture |
POSTMORTEM DIFFERENTIATION: SDH vs SAH ⭐
Pour water on the specimen:
- SDH → Hemorrhage washed away
- SAH → Hemorrhage persists (in sulci/subarachnoid space)
FINAL EXAM QUICK-RECALL
- EDH = Lens shaped, doesn't cross suture, lucid interval most common, m/c vessel = middle meningeal artery
- SDH = Banana/crescent shaped, crosses suture, shaken baby, bridging veins
- SAH = Thunderclap headache, xanthochromia on LP, BATS mnemonic
- Kernohan's notch = False localising sign (ipsilateral hemiparesis despite contralateral lesion)
- Dementia pugilistica = Punch drunk syndrome = SDH = long-term boxers
In tabulated form
INTRACRANIAL HEMORRHAGES - Complete Tabulated Notes
Forensic Medicine | 3rd Year MBBS
TABLE 1: OVERVIEW COMPARISON
| Feature | EDH | SDH | SAH |
|---|---|---|---|
| Full name | Extradural Hemorrhage | Subdural Hemorrhage | Subarachnoid Hemorrhage |
| Frequency | Least common | Common | Common |
| Fatality | Highest | Moderate | High |
| Age group | Young adults (20-40 yrs) | Children, Elderly | Any age |
| Vessel involved | Middle meningeal artery (m/c) | Bridging veins | Circle of Willis / Berry aneurysm |
| Space | Between skull & dura | Between dura & arachnoid | Between arachnoid & pia |
| Injury type | Unilateral, coup injury | Acceleration-deceleration / minor trauma | Spontaneous / trauma |
| Lucid interval | Most prominent ⭐ | Present in acute only | Absent |
TABLE 2: BLOOD VESSELS INVOLVED IN EDH
| Vessel | Region of Injury |
|---|---|
| Middle meningeal artery (m/c) | Temporal lobe |
| Anterior ethmoidal artery | Frontal lobe |
| Transverse sinus | Occipital lobe |
| Sagittal sinus | Vertex (top of skull) |
TABLE 3: MECHANISM
| Type | Mechanism Steps |
|---|---|
| EDH | Blow to pterion → Fissure fracture of temporal bone → Rupture of middle meningeal artery → Bleeding in extradural space → ↑ ICP → Brain compression → Brainstem herniation → Respiratory failure → Death |
| SDH (Children) | Acceleration-deceleration injury → Violent shaking → Shaken Baby Syndrome |
| SDH (Elderly) | Minor trauma → Age-related brain atrophy → ↑ subdural space → Bridging veins lose support → Bleeding → Blood accumulates → Chronic SDH |
| SAH | Berry aneurysm rupture / AV malformation / Trauma (m/c) / Stroke / Spontaneous |
TABLE 4: TYPES OF SDH
| Type | Duration | Key Feature |
|---|---|---|
| Acute | < 3 days | Lucid interval present |
| Subacute | 3 days - 3 weeks | Intermediate |
| Chronic | > 3 weeks | Minor trauma, elderly, brain atrophy |
TABLE 5: CLINICAL FEATURES
| Feature | EDH | SDH | SAH |
|---|---|---|---|
| Headache | Yes | Yes | Thunderclap (sudden onset severe) ⭐ |
| Lucid interval | ✅ Most prominent | ✅ Acute SDH only | ❌ |
| Blood volume | 35 ml = symptoms; 150 ml = fatal | - | - |
| Pupil changes | Dilated & fixed (3rd nerve palsy) | Dilated & fixed | - |
| Hemiparesis | Contralateral | Present | Focal neurological deficit |
| Neck stiffness | ❌ | ❌ | ✅ |
| Nausea/Vomiting | Sometimes | Sometimes | ✅ |
| Altered sensorium | ✅ | ✅ | ✅ |
| Personality changes | - | ✅ | - |
| Loss of consciousness | ✅ | ✅ | ✅ |
TABLE 6: KERNOHAN'S NOTCH PHENOMENON (EDH)
| Aspect | Detail |
|---|---|
| Also called | False localising sign |
| Sign | Dilated pupil + Ipsilateral hemiparesis |
| Mechanism | Uncal herniation → Compression of opposite area into tentorium cerebelli → Compression of fibres in cerebral peduncle → Ipsilateral hemiparesis + dilated pupil |
| Why "false"? | Lesion is contralateral but signs appear ipsilateral |
TABLE 7: INVESTIGATION
| Investigation | EDH | SDH | SAH |
|---|---|---|---|
| CT scan (NCCT) | ✅ | ✅ | ✅ |
| Shape on CT | Biconvex / Lentiform / Lens-shaped ⭐ | Concavoconvex / Crescent / Banana-shaped ⭐ | Hyperdense bleeding near base of brain |
| Crosses suture? | ❌ NO | ✅ YES | - |
| Lumbar puncture | Not needed | Not needed | Xanthochromia (after 4-6 hrs) ⭐ |
TABLE 8: MANAGEMENT
| Type | Management |
|---|---|
| EDH | Surgical removal of clot - Craniotomy / Burr hole |
| SDH | Conservative management OR Surgical removal of clot |
| SAH | Clipping / Endovascular coiling of aneurysm |
TABLE 9: CAUSES OF SAH - BATS Mnemonic
| Letter | Cause |
|---|---|
| B | Berry aneurysm |
| A | AV malformation |
| T | Trauma (m/c) |
| S | Stroke / Spontaneous |
TABLE 10: ABC OF SDH (Memory Aid)
| Letter | Associations |
|---|---|
| A | Aged persons, Alcoholics |
| B | Bridging veins, Boxers (Dementia pugilistica) |
| C | Child abuse, Crescentic opacity on CT |
TABLE 11: MEDICO-LEGAL POINTS (FMT Exam Favourite!)
| Point | Detail |
|---|---|
| Lucid interval significance | Patient is conscious, can give valid evidence, make a will, is criminally liable |
| Medical negligence | Failure to diagnose lucid interval → Death = Medical negligence |
| Lucid interval comparison | EDH > SDH |
| Postmortem: SDH vs SAH | Pour water on specimen - SDH: hemorrhage washed away; SAH: hemorrhage persists |
| Dementia pugilistica | AKA Punch drunk syndrome; seen in long-term boxers; m/c hemorrhage = SDH |
| Shaken Baby Syndrome | SDH in children due to violent shaking (acceleration-deceleration) |
TABLE 12: FINAL HIGH-YIELD SUMMARY
| Parameter | EDH | SDH | SAH |
|---|---|---|---|
| Vessel | Middle meningeal artery | Bridging veins | Berry aneurysm / Circle of Willis |
| CT shape | 🔷 Lens / Biconvex | 🌙 Crescent / Banana | Hyperdense at base |
| Crosses suture | ❌ No | ✅ Yes | - |
| Lucid interval | ✅✅ Most common | ✅ Acute only | ❌ |
| Age | 20-40 yrs | Children + Elderly | Any |
| Special sign | Kernohan's notch | Shaken baby | Thunderclap headache |
| Special test | NCCT | NCCT | LP → Xanthochromia |
| Treatment | Craniotomy / Burr hole | Conservative / Surgery | Clipping / Coiling |
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Answers
This is a July 2026 university exam paper. Let me give you all the answers with explanations.
SET-A | Paper Code 11041 | July 2026
MBBS 3rd Professional | Forensic Medicine & Toxicology
MCQ ANSWERS WITH EXPLANATIONS
| Q.No | Question | Correct Answer | Explanation |
|---|---|---|---|
| 1 | Flaying is seen in which type of lacerated wound | (C) Avulsion | Avulsion = skin torn/peeled away from underlying tissue = flaying |
| 2 | Most common site of berry aneurysm | (A) Posterior communicating artery | ACoM is most common overall in general surgery, but in FMT - PCoA is standard answer; check your notes - both A and B are debated. PCoA = most common per Marrow FMT |
| 3 | Virchow's triad - all EXCEPT | (D) Decrease in blood pressure | Virchow's triad = Hypercoagulability + Injury to vessel + Slowing of circulation. BP not included |
| 4 | Pralidoxime is NOT given in | (A) Carbamyl poisoning | Pralidoxime ineffective in carbamyl (carbamate) poisoning as carbamyl-cholinesterase bond ages rapidly. Given in organophosphate (Malathion, Parathion, Dyflos) |
| 5 | Professional death sentence given by | (D) State Medical Council | License to practice is issued & cancelled by State Medical Council |
| 6 | Burden to prove defence lies with doctor in | (B) Res ipsa loquitur | "Thing speaks for itself" - negligence presumed, burden shifts to doctor to disprove |
| 7 | Poison that retards putrefaction | (B) Carbolic acid | Carbolic acid (phenol) is a preservative/antiseptic - retards/prevents putrefaction |
| 8 | Corpus Delicti means | (B) Essence of crime | Corpus Delicti = "Body of the crime" = essential facts proving a crime was committed = Essence of crime |
| 9 | Number of ossification centers at birth | (B) 450 | 450 ossification centers present at birth (standard FMT answer) |
| 10 | Extensive abrasions on pedestrian - cause | (D) Secondary injury | Extensive abrasions on pedestrian body = Secondary injury (when body hits road after primary impact) |
| 11 | Male child 15 yrs, mental age 9. IQ? | (B) 60 | IQ = Mental age / Chronological age × 100 = 9/15 × 100 = 60 |
| 12 | Judge can ask questions | (D) Any time during trial | Under Section 165 IEA - Judge can ask any question, to any witness, at any time during trial |
| 13 | Cognisable offence means | (C) Arrest without warrant | Cognisable = Police can arrest WITHOUT warrant. Non-cognisable = warrant needed |
| 14 | Lowest court that can give death sentence | (A) Additional sessions court | Sessions court & Additional Sessions court can award death sentence (subject to HC confirmation) |
| 15 | Complication of kerosene poisoning | (B) Hemoptysis | Kerosene inhalation → Chemical pneumonitis → Hemoptysis. Most dangerous complication |
| 16 | Micky finn refers to | (B) Chloral hydrate | Mickey Finn = Chloral hydrate added secretly to alcohol = "knockout drops" |
| 17 | Road poison is | (D) Datura | Datura (Dhatura) = classic road/highway poison used by criminals to stupefy victims |
| 18 | Most common substance of abuse in India | (C) Tobacco | Tobacco is the most common substance of abuse in India |
| 19 | Dead born fetus doesn't show | (B) Adipocere formation | Dead born fetus shows maceration, rigor mortis at birth is absent, mummification can occur. Adipocere needs months of decomposition - NOT seen at birth |
| 20 | Center of ossification for fetal viability | (B) Distal end of femur | Distal femoral epiphysis (Béclard's nucleus) appears at 36 weeks = proof of fetal viability |
QUICK IQ FORMULA (for Q.11)
IQ = (Mental Age ÷ Chronological Age) × 100 = (9 ÷ 15) × 100 = 60
| IQ Range | Classification |
|---|---|
| > 130 | Very superior |
| 110-129 | Superior |
| 90-109 | Normal |
| 70-89 | Dull normal |
| 50-69 | Mild MR (Moron) |
| 60 | Mild MR / Imbecile border |
SECTION A - LONG ANSWER (Q.1) | 10 Marks
Scenario: 30-year-old woman sexually assaulted & stabbed. You are part of investigation team.
(a) Documents required before postmortem | 2 marks
| Document | Details |
|---|---|
| Inquest report | Police inquest (Section 174 CrPC) / Magistrate inquest |
| Requisition letter | Written request from police/magistrate to CMO/doctor |
| FIR copy | First Information Report |
| MLO form | Medico-legal register entry |
| Identity of body | Identification by police/relative |
| Dead body challan | Transfer document from police |
(b) Samples at Scene of Crime + During PM Examination | 5 marks
AT SCENE OF CRIME:
| Sample | Purpose |
|---|---|
| Blood stains (floor/wall) | DNA, blood group |
| Semen stains | DNA profiling of assailant |
| Hair (loose) | DNA, comparison |
| Fingernail scrapings | Assailant's skin/DNA |
| Weapons (knife) | Trace evidence, fingerprints |
| Clothing of victim | Trace evidence, seminal stains |
| Soil samples | Comparison evidence |
DURING POSTMORTEM:
| Sample | Purpose |
|---|---|
| High vaginal swab | Spermatozoa, DNA of assailant |
| Cervical swab | Seminal fluid analysis |
| Blood (cardiac/femoral) | DNA, toxicology, alcohol |
| Urine | Toxicology, drug screening |
| Nail clippings | Assailant DNA |
| Pubic hair (combings) | Foreign hair identification |
| Bite mark swabs | Salivary DNA |
| Wound swabs | Trace evidence from knife wounds |
| Viscera | Poison analysis |
| Histology samples | Vital reaction, injury timing |
(c) Definition of Rape - Criminal Law Amendment Act, 2013 | 2 marks
Under Section 375 IPC (amended 2013), a man is said to commit rape if he:
Penetrates his penis, or inserts any object/body part, or manipulates any part of body of a woman, or applies mouth - into vagina, urethra, anus or any body part against her will, without consent, or with consent obtained by:
- Fear of death/hurt
- Fraud/impersonation
- Intoxication/unsoundness of mind
- Woman under 18 years of age (even with consent)
Key changes in 2013 amendment:
- Expanded definition beyond peno-vaginal penetration
- Included oral sex, use of objects
- Minimum punishment: 7 years (up to life)
- Gang rape: minimum 20 years to life
- Rape causing death/vegetative state: death penalty possible
(d) Shape of Stab Wounds - Single Edge Knife vs Screwdriver | 1 mark
Single Edge Knife:
___________
/ \
/ Sharp end \___ ← One end sharp/pointed
\ /
\____________/
Blunt end (squared)
- One end sharp/slit-like
- Other end blunt/squared
- Shape: Triangular / fish-tail at blunt end
Screwdriver:
| |
| |
___| + |___
| cross |
|_____________|
- Cruciate / cross-shaped (+) wound
- All four ends are blunt
- Shape: Plus (+) or cruciate entry wound
| Weapon | Wound Shape | Ends |
|---|---|---|
| Single edge knife | Slit with one sharp, one blunt end | One pointed, one squared/tailed |
| Double edge knife | Clean slit, both ends sharp | Both pointed |
| Screwdriver | Cruciate / cross (+) shaped | All blunt |
| Poker/rod | Oval/circular punched-out | - |
Exam tip: Q.2 (berry aneurysm site) - Anterior communicating artery (ACoM) is the most common site overall per most neurosurgery sources, but many FMT Marrow editions list Posterior communicating artery. Check your specific textbook/notes and go with what your professor taught.
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