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FORENSIC MEDICINE - EXAM ANSWER BANK

Based on Narayan Reddy's Textbook (36th Edition)

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LONG ANSWER QUESTIONS (15 Marks)

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Q1 & Q5 & Q7 & Q11 & Q34 & Q35: Professional Negligence - Definition, Civil vs Criminal, Precautions

1. Duty - Existence of a duty of care by the doctor
2. Dereliction - The physician must deviate from the standard of care
3. Direct causation - The deviation must directly cause injury
4. Damage - Actual damage must result

1. Civil
2. Criminal
3. Corporate
4. Contributory

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• Arises when a patient brings a suit in Civil Court for compensation
• Or when a doctor brings a civil suit for recovery of fees
• The standard is: "A doctor is bound to exercise the standard of care of an ordinary competent man exercising that particular skill"
• Remedy: Compensation/damages
• Governed by Consumer Protection Act, 2019 - patients are consumers
• Bolam Test: A doctor is not negligent if he acts in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art

• Arises when negligence is of a very high degree showing gross lack of care
• Requires mens rea (guilty mind) - rashness or recklessness
• Punishable under Sec 304A IPC (now BNS equivalent): "Causing death by rash or negligent act not amounting to culpable homicide" - imprisonment up to 2 years + fine
• Also under Sec 337 (hurt) and Sec 338 (grievous hurt) IPC
• Key Landmark Case: Jacob Mathew vs State of Punjab (2005) - Supreme Court held: "A simple lack of care will constitute civil liability, but for criminal liability the standard of negligence must be much higher - gross negligence or recklessness"

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1. Proper consent - Informed, written consent for all major procedures
2. Record keeping - Maintain detailed, legible case records; never alter records
3. Communication - Keep patient and relatives informed at all times
4. Do not abandon patient - Ensure proper referral or transfer before leaving
5. Follow standard protocols - Adhere to established treatment guidelines
6. Competence - Practice within your area of competence; refer when needed
7. Prescriptions - Write clearly, avoid abbreviations that can be misread
8. Second opinion - Take in doubtful cases
9. Confidentiality - Maintain medical secrecy
10. Professional indemnity insurance - Cover against malpractice claims
11. Do not guarantee results - Never promise cure
12. Avoid criticism of colleagues - Do not discuss other doctor's treatment with patients
13. Emergency care - Never refuse emergency treatment (Good Samaritan)

• The doctor violated the duty of care (Dereliction)
• By going out of station without informing/transferring the patient, he committed abandonment
• This amounts to criminal negligence under Sec 304A IPC
• He also violated Precautions 4 and 5 above

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Q2 & Q6 & Q8 & Q20 & Q25 & Q26 & Q36: Death, Gordon's Classification, Early Postmortem Changes, Rigor Mortis vs Cadaveric Spasm

• Legal definition (BNS Act / S.46 IPC): Death denotes death of a human being unless contrary appears from context
• Registration of Births and Deaths Act 1969, S.2(b): Permanent disappearance of all evidence of life at any time after livebirth
• Irreversible permanent stoppage of vital functions = Death

1. Somatic/Clinical death - Stoppage of heartbeat, respiration, loss of consciousness; partially reversible
2. Molecular/Cellular death - Individual cells die after somatic death; irreversible

1. Loss of skin elasticity
2. Changes in the eye
3. Cooling of body (Algor mortis)
4. Postmortem lividity (Hypostasis)
5. Postmortem rigidity (Rigor mortis)
6. Cadaveric spasm
7. Gastric changes

1. Putrefaction
2. Adipocere formation
3. Mummification
4. Maceration

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• Body cools at approximately 1.5°F (0.83°C) per hour under average conditions
• Affected by: clothing, body build, environment temperature, humidity, wind
• Henssge nomogram used for accurate time of death estimation
• Body temperature = rectal temperature; thermometer placed 8-10 cm into rectum

• Due to gravitational settling of blood in dependent vessels
• Appears as dark purplish-red discoloration in dependent areas
• Appears: 1-2 hours after death; fully developed: 6-12 hours
• Fixed (non-shifting): after 8-12 hours - cannot be changed by pressure
• MLI: Indicates position of body after death, time of death, whether body was moved

• Stiffening of muscles after death
• Mechanism: Depletion of ATP → actin-myosin cross-bridges cannot be broken → muscles stiffen
• Stages:
  • Primary flaccidity: 1-2 hours (ATP still present)
  • Rigor mortis sets in: 3-6 hours after death
  • Complete: 12 hours
  • Persists: 12-24 hours
  • Passes off (secondary flaccidity): after 24-48 hours
• Order (Nysten's law): Begins at jaw → neck → trunk → upper limbs → lower limbs
• Passes off in the same order
• MLI: Estimating time of death; position of body

• Temporary rise in body temperature just after death due to continued chemical reactions
• Seen in: tetanus, septicemia, strychnine poisoning, pontine hemorrhage

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Q3: Brainstem Death & Cadaveric Spasm

• Irreversible loss of all brainstem functions
• The brainstem controls vital functions: respiration, cardiac regulation, consciousness

1. Unreceptivity and unresponsivity - no response to stimuli
2. No spontaneous movements - no breathing for at least 1 hour (3-minute apnea test)
3. No reflexes:
   • No pupillary response to light
   • No ocular movement (no doll's eye movement)
   • No corneal reflex
   • No pharyngeal reflex
4. Isoelectric (flat) EEG - confirmed on two occasions 24 hours apart

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Q4 & Q32 & Q33: Section 375 IPC (Rape) and Related Sections

1. Against her will
2. Without her consent
3. With consent obtained by putting her in fear of death or hurt
4. With consent when she is intoxicated/unsound mind
5. With consent when she is below 18 years of age (statutory rape)
6. When she is unable to communicate consent

• Minimum 10 years rigorous imprisonment, extendable to life imprisonment + fine
• Gang rape (Sec 376D): Each person - 20 years to life
• Rape of woman under 12 yrs (Sec 376AB): Minimum 20 years to life/death
• Repeat offenders: Life imprisonment or death

• Physical contact and advances involving unwelcome explicit sexual overtures
• Demand/request for sexual favors
• Showing pornography against her will
• Punishment: 1-3 years imprisonment + fine

• Assault/use of criminal force to disrobe a woman
• Punishment: 3-7 years + fine

• Watching/capturing image of woman engaging in private act without her consent
• First offence: 1-3 years; Subsequent: 3-7 years + fine

• Following a woman, contacting her repeatedly despite disinterest
• First offence: Up to 3 years + fine; Subsequent: Up to 5 years + fine

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Q9: Courts of India and Their Powers

1. Supreme Court - Apex court; hears appeals from High Courts; original jurisdiction in disputes between states
2. High Court - One in each state/UT; appellate jurisdiction; original jurisdiction in some matters
3. District Court - Headed by District Judge; hears civil suits above Sub-Judge's limit
4. Sub-Judge/Civil Judge (Sr. Division)
5. Munsif/Civil Judge (Jr. Division) - Lowest civil court

1. Supreme Court - Final appellate criminal court
2. High Court - Appellate; can award any punishment prescribed by law
3. Sessions Court/District Court - Tries serious offences (sessions cases); can award death, life imprisonment, fine
4. Chief Judicial Magistrate (CJM) - Can sentence up to 7 years
5. Judicial Magistrate First Class - Sentence up to 3 years; fine up to ₹10,000
6. Judicial Magistrate Second Class - Sentence up to 1 year; fine up to ₹5,000
7. Executive Magistrate - Administrative, inquest duties (Sec 174 CrPC)

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Q10: Inquest and Its Types

• Conducted by Police Sub-Inspector or above
• Mandatory for: Suicide, suspected homicide, accident, unknown causes
• Police makes a report to magistrate
• Doctor not mandatory; body examined to ascertain cause of death
• PM examination done at discretion of police/magistrate

• Conducted by Executive/Judicial Magistrate
• Mandatory for: Death in police custody, death in jail, dowry deaths, exhumation
• More formal and thorough than police inquest
• Can summon witnesses and doctors

• Was conducted by Coroner (a quasi-judicial officer)
• Still exists in Mumbai under the Coroners Act 1871
• Has power to summon jury

• Establishes identity of deceased
• Determines cause/manner of death
• Helps in criminal investigation
• Documents evidence for court proceedings

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Q18: Organophosphorus (OP) Poisoning (Farmer with miosis, froth, kerosene smell)

• S - Salivation
• L - Lacrimation
• U - Urination
• D - Defecation
• G - GI distress (cramps, vomiting, diarrhea)
• E - Emesis; also: Bronchospasm, bradycardia, miosis, sweating, froth

• Muscle weakness, twitching, fasciculations
• Tachycardia (early), hypertension
• Weakness leading to paralysis
• Hypertension → hypotension

• Low plasma/RBC cholinesterase activity (key diagnostic test)
• Blood, urine for OP compounds

1. ABC - Airway, Breathing, Circulation
2. Decontamination: Remove clothes, wash skin with soap and water; gastric lavage (if within 1-2 hrs)
3. Atropine - Specific antidote for muscarinic effects: 2-4 mg IV, repeat every 5-10 min until drying of secretions (atropinization); up to 20-100 mg may be needed
4. Pralidoxime (2-PAM) - Reactivates cholinesterase; 1-2 g IV over 15-30 min; most effective within 24-48 hours (before "aging")
5. Diazepam - For convulsions
6. Supportive care - Ventilation if needed

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Q19: Mechanical Injuries & Epidural Haemorrhage

1. Abrasion - Friction against rough surface
2. Contusion (Bruise) - Blunt force, no break in skin
3. Laceration - Tearing of tissue by blunt force
4. Incised wound - Sharp-edged weapon
5. Stab/Puncture wound - Sharp-pointed weapon
6. Chop wound - Heavy sharp weapon (e.g., axe)
7. Firearm wounds - Entry, exit wounds

• Site: Between skull bone and dura mater
• Cause: Usually rupture of middle meningeal artery (after temporal bone fracture)
• Mechanism: Blow to temporal region → fracture → arterial tear → rapid hematoma

1. Blow to head → brief unconsciousness (concussion)
2. Lucid interval - Patient regains consciousness (minutes to hours)
3. Deterioration - increasing headache, vomiting, hemiplegia (opposite side), anisocoria (ipsilateral dilated pupil), then coma, death

• Lucid interval is key - victim may appear normal and then die suddenly
• Wrongly accused person may claim victim was alive after fight
• Courts accept "lucid interval" as explanation for delayed death
• Governed by Sec 300 Exception 1 IPC (contributory negligence in provocation)

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Q23 & Q26 (Hanging, PM findings):

1. Typical - Point of suspension directly above, knot at back of neck
2. Atypical - Point of suspension or knot not in typical position
3. Complete - Whole body suspended (feet off ground)
4. Incomplete (partial) - Some part of body touching ground
5. Judicial hanging - Execution method

1. Asphyxia - Compression of airway (most common in incomplete hanging)
2. Cerebral venous congestion and ischemia
3. Carotid artery compression → cerebral anemia
4. Vagal inhibition - Carotid body stimulation → cardiac arrest (quick death)
5. Fracture-dislocation of cervical spine (in judicial hanging; C2-C3)

• Ligature mark - Oblique, incomplete groove, pale, parchment-like (tough, leathery)
• Located above thyroid cartilage
• Mark is highest at point opposite the knot
• Dribbling of saliva on chest (continuous secretion from parotid after death)
• Face - Congested, cyanosed (in incomplete); pale (in complete, rapid death)
• Petechiae - in conjunctiva and face (in slow death)
• Protrusion of tongue - tip may be visible
• Priapism - penile erection in males
• Involuntary discharge of urine/feces

• Fracture of hyoid bone and thyroid cartilage (in complete hanging)
• Fracture of C2 (Hangman's fracture) in judicial hanging
• Hemorrhage in strap muscles of neck (ecchymosis)
• Lungs: congested, edematous
• Heart: right side full, left side empty
• Brain: congested

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SHORT ANSWER QUESTIONS (6 Marks)

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Postmortem Appearances in Thermal Burns:

• Pugilistic (boxer's) attitude - flexion of all limbs due to heat coagulation of muscles
• Skin splits (heat tears) - clean, regular margins; may resemble incised wounds
• Heat haematoma - epidural collection of blood (from boiling of blood in vessels; brown-reddish, not dark like antemortem)
• Burning stops at natural orifices
• Charred remains: bones calcined (white, brittle)
• Absence of vital reaction (soot in airways) means death before fire
• MLI: Vital reaction (soot below glottis, carboxyhemoglobin in blood) confirms alive during fire

Battered Baby Syndrome (Caffey's Syndrome):

• Child abuse causing multiple injuries at different stages of healing
• Features: Multiple fractures (especially metaphyseal "corner fractures," periosteal elevation), subdural hematoma, retinal hemorrhages (shaken baby syndrome), cigarette burns, torn frenulum
• Age: Mostly under 3 years
• Perpetrators: Usually parents/caretakers
• "Sentinel injuries": bruises, burns, fractures with inconsistent history
• MLI: Must be reported to police; mandatory reporting law

Civil Responsibility of Insane (Mentally Ill):

• Under civil law, a contract by an insane person is void (Section 11-12 Indian Contract Act)
• He can sue and be sued through guardian (next friend)
• Tort liability: Person of unsound mind can be held liable for unintentional torts
• Delirious/unconscious person: Not responsible
• Sec 23 Mental Healthcare Act 2017: Guardian/legal representative can act on behalf

Difference between Poisonous and Non-Poisonous Snakes:

Gustafson's Method:

• Dental age estimation in adults
• Six criteria scored 0, 1, 2, 3:
  1. Attrition (A) - wearing of occlusal surface
  2. Secondary dentine (S) - deposition in pulp chamber
  3. Paradental (P) - periodontal disease
  4. Cementum apposition (C) - on root
  5. Root resorption (R)
  6. Transparency (T) - of root
• Formula: Age = 11.43 + 4.56 × Total score
• Can estimate age ± 3-4 years

Wounds from Shotguns:

• Multiple pellets spread from single cartridge
• At close range (<1m): single punched-out wound with blackening, tattooing, wad
• At medium range (1-3m): central wound + surrounding pellet wounds (peppering)
• At distance (>3m): multiple discrete pellet wounds; spread increases with distance
• Wad (paper/plastic) visible in close shots; absent at range
• Useful for estimating range of firing

Management of OP Poisoning: (See Q18 above - same content, condensed for 6 marks)

• Decontamination, Atropine 2-4 mg IV (titrate to dryness), Pralidoxime 1-2g IV, Supportive

Postmortem Appearance in Hanging: (See Q23 above - condensed version)

DNA Fingerprinting:

• Principle: DNA is unique for each individual (except identical twins)
• Method: RFLP (Restriction Fragment Length Polymorphism) or PCR-based STR analysis
• Steps: DNA extraction → Restriction enzyme digestion → Gel electrophoresis → Southern blotting → Hybridization with radiolabelled probes → Autoradiography
• Uses in Forensic Medicine:
  • Identification of criminals from bloodstains, semen, hair roots
  • Paternity/maternity disputes
  • Identification of disaster victims
  • Immigration cases
  • Exhumation cases

Duties of Medical Practitioner in Poisoning:

1. Treat the patient first (emergency care takes priority over medicolegal formalities)
2. Secure stomach washings, vomitus, urine as evidence
3. Seal containers, label, and send to FSL with proper requisition
4. Send intimation to police (medicolegal case)
5. Maintain detailed case records
6. If patient dies: inform police, conduct postmortem; preserve viscera for chemical analysis

Difference between Hypostasis and Bruise:

Aluminum Phosphide (Rice/Wheat Tablet Poison):

• Most common suicidal poison in rural India
• Releases phosphine gas (PH3) when in contact with moisture/HCl in stomach
• Smell: "rotting fish" / garlic-like
• Features: Vomiting, cough, pulmonary edema, hypotension, cardiovascular collapse, renal failure
• No specific antidote
• Treatment: Supportive - activated charcoal, IV fluids, inotropes, magnesium sulfate (antioxidant)
• High mortality
• Avoid using aluminum vessels; no gastric lavage with water (releases more phosphine)

Signs of Live Birth:

1. Hydrostatic test (Raygat's test): Lungs float in water → breathed; sink → did not breathe
2. Lustre/texture of lungs: Aerated lungs - pink, crepitant, fill chest; unaerated - dark red, liver-like
3. Stomach-bowel test: Air in stomach/intestines confirms swallowing (breathing occurred)
4. Gastrointestinal tests: Breslau's second life test - air in stomach/bowel
5. Weight of lungs: Aerated = 2 oz (57g) each; unaerated = 1 oz each
6. Milk in stomach - indirect sign (survived and fed)
7. Vernix caseosa on skin
8. Docimasia test: Diatomaceous earth in lungs if drowned baby breathed

Postmortem Appearances in Freshwater vs Saltwater Drowning:

Causes of Impotence in Male:

1. Psychogenic: Anxiety, depression, marital problems
2. Organic:
   • Vascular: atherosclerosis, venous leak
   • Neurological: spinal cord injury, peripheral neuropathy (diabetes)
   • Endocrine: hypogonadism, hyperprolactinemia, hypothyroidism
   • Local: Peyronie's disease, priapism sequelae
3. Drug-induced: Antihypertensives (beta-blockers), antidepressants, alcohol
4. Aging
5. Acquired: Post-trauma, post-surgery (prostatectomy)

Dying Declaration:

• A statement made by a dying person regarding the cause of his death or circumstances leading to it
• Admissibility (S.32(1) Evidence Act): Admissible if: (1) Person was dying; (2) Statement relates to cause of death; (3) Person was in expectation of death
• Does NOT require the person to actually die - but must be in expectation of death
• Can be recorded by anyone - magistrate, doctor, police, relative
• Magistrate's declaration is most reliable; doctor should certify fitness
• Nemo moritur cum mendacio - "No one dies with a lie on his lips"
• Not required to be on oath; no cross-examination
• Multiple dying declarations - court takes the most reliable one

Antidotes:

MTP (Medical Termination of Pregnancy) Act 1971 (amended 2021):

• Gestation limit: Up to 20 weeks - one doctor; up to 24 weeks - two doctors
• Grounds for termination:
  1. Pregnancy endangers woman's life or physical/mental health
  2. Foetal abnormality incompatible with life
  3. Pregnancy from rape or contraceptive failure
  4. Category of women for up to 24 weeks: rape survivors, minors, differently abled, women with changed marital status (widows/divorcees), disasters/emergencies
• No gestational limit if foetal abnormality diagnosed by medical board
• Consent: Woman's own if ≥18 yrs and of sound mind; guardian's consent if minor or unsound mind
• Registered institution (MTP-approved)

Chronic Lead Poisoning (Signs and Symptoms):

• Burton's line (lead line) - blue-black line at gum margin
• Colic - colicky abdominal pain (lead colic)
• Peripheral neuropathy - wrist drop, foot drop
• Anemia - microcytic hypochromic + basophilic stippling of RBCs
• Encephalopathy - headache, memory loss, convulsions, intellectual deterioration
• Blue line on nails
• Radiological: Lead lines (dense metaphyseal bands) on X-ray long bones in children
• Plumbism = chronic lead poisoning
• Treatment: DMSA (dimercaptosuccinic acid), D-penicillamine, BAL

Conduct and Duties of Doctor in Witness Box:

1. Attend court on time; dress professionally
2. Take oath/affirmation
3. Answer only what is asked; be clear and concise
4. Do not volunteer information beyond the question
5. Maintain professional dignity; do not argue with lawyers
6. Never change testimony under cross-examination unless genuinely correcting an error
7. Admit limitations of knowledge; say "I don't know" rather than guess
8. Speak to the judge/magistrate, not to lawyers
9. Quote from standard textbooks when asked about standard of care
10. Receive conduct money (witness fee) - not bribery

Harvard Criteria for Brain Death: (See Q3 above)

Types of Skin Incisions in Medico-Legal Autopsy:

1. I-shaped incision - Single midline from chin to pubis; most common
2. Y-shaped incision - From each shoulder to xiphisternum, then midline down; preferred in medicolegal autopsies
3. Unilateral flap incision - Not commonly used
4. T-shaped - Horizontal from shoulder to shoulder, then midline

• In suspected homicide/rape: perineal incision also made

Dactylography (Fingerprinting):

• Study of fingerprints for identification
• Basis: Fingerprints are unique to each individual and do not change throughout life
• Types of patterns (Galton Henry classification):
  1. Arches (5%) - plain arch, tented arch
  2. Loops (65%) - ulnar loop, radial loop
  3. Whorls (30%) - plain whorl, central pocket, double loop
  4. Composite - accidental
• Points of similarity (Galton's details): 16 matching points = identity confirmed
• Uses: Criminal identification, disaster victim identification, civil identification
• Latent prints enhanced by iodine fuming, ninhydrin (amino acid reaction), cyanoacrylate fuming
• In India: Fingerprint Bureau established 1897 (first in world)

Postmortem Artifacts:

• Changes occurring after death that may be confused with antemortem injuries
• Natural: Putrefaction, adipocere, mummification, maceration
• Animal: Insect, rodent, bird activity - scattered bones, gnaw marks
• Autopsy artifacts: Incision marks, rib fractures from CPR, intubation injuries
• Handling artifacts: Bruise-like marks from handling, cool storage marks
• Environmental: Thermal artifacts in burns (pugilistic attitude, heat tears, heat hematoma)
• MLI: Important not to confuse artifacts with actual injuries/wounds

Cadaveric Spasm: (See Rigor Mortis section for differences)

• Instantaneous rigidity at moment of death
• Due to extreme nervous exhaustion/excitement
• Particular muscle group affected
• Cannot be broken or reproduced artificially
• Objects held tightly at moment of death remain fixed
• MLI: Differentiates suicide (victim holds weapon firmly) from homicide (weapon placed afterwards)

Punishment for Rape: (See Section 376 above)

S.320 IPC (Grievous Hurt):

1. Emasculation
2. Permanent privation of sight of either eye
3. Permanent privation of hearing of either ear
4. Privation of any member or joint
5. Destruction or permanent impairing of any member or joint
6. Permanent disfigurement of head or face
7. Fracture or dislocation of a bone or tooth
8. Any hurt endangering life, or causing severe bodily pain for 20 days

Causes of Death in Burns:

1. Shock - Hypovolemic (fluid loss from burn surface)
2. Toxemia - Toxins from burnt tissue
3. Asphyxia - Inhalation of smoke, CO, hot gases
4. Septicemia - Secondary infection (most common delayed cause)
5. Acute renal failure - Myoglobinuria, hemoglobinuria
6. Pulmonary complications - ARDS, pneumonia
7. Curling's ulcers - Stress ulcers of duodenum → hemorrhage

Medico-Legal Aspects of Pregnancy:

• Confirmation: HCG test, USG - for age estimation, MLC
• Amenorrhea is suggestive but not conclusive
• Relevance in: Rape (impregnation), paternity disputes, insurance, criminal abortion, infanticide, MTP Act, maternity leave
• Positive signs: FHR on auscultation, fetal movements felt by examiner, USG

Complications of Criminal Abortion:

• Immediate: Hemorrhage, shock, air embolism (most dangerous), uterine perforation
• Septic: Peritonitis, septicemia, septic shock
• Late: Infertility, chronic PID, Asherman syndrome
• From methods used: Chemical burns (instruments), poisoning
• Death - which constitutes a crime under Sec 312/313 IPC

Pedestrian Injuries:

• Vehicle runs over pedestrian
• Primary impact injuries (bumper/hood): fractures of tibia/fibula at bumper height
• Secondary injuries: Head hits bonnet/windshield
• Tertiary injuries: Ground impact when thrown
• Waddell's triad (child pedestrian): (1) Femur fracture (2) Intrathoracic/abdominal injury (3) Head injury
• MLI: Pattern helps reconstruct accident, speed of vehicle

Adipocere Formation:

• Postmortem change where body fat converts to grave wax (saponification)
• Mechanism: Hydrolysis and hydrogenation of body fat → fatty acids (saponin)
• Material: White, waxy, soapy substance; characteristic rancid smell
• Conditions: Warm, moist, anaerobic environment (buried in wet soil, submerged in water)
• Time: Weeks to months to form; may persist for decades
• MLI: Preserves body contour and helps in identification; indicates time since death, environment of disposal

Testamentary Capacity:

• Legal ability to make a valid will
• Requirements (Sec 59 Indian Succession Act):
  1. Person must be of sound mind at time of making will
  2. Must be 18 years or older
  3. Must understand the nature of the act (making a will)
  4. Must know the nature and extent of property
  5. Must know the persons who might expect to benefit
  6. No insane delusion affecting the will
• Doctor's role: Certify mental fitness at time of will-making

Types of Skull Fractures:

1. Linear (fissured) - Simple crack, most common
2. Depressed - Fragment pressed inward; dangerous if >5mm
3. Comminuted - Multiple fragments
4. Pond - Infantile skull; depressed without full fracture
5. Contra-coup - Fracture opposite side of impact
6. Ring/Basal - Around foramen magnum; from fall on feet/head
7. Bursting - Central impact; stellate pattern
8. Gutter - Tangential blow; groove on outer table

Signs and Symptoms and Treatment of Carbon Monoxide Poisoning:

• Mechanism: CO binds Hb with 200-300× affinity of O2 → carboxyhemoglobin → tissue hypoxia
• Signs/Symptoms:
  • 10-20%: Headache, dizziness
  • 20-40%: Nausea, vomiting, confusion
  • 40-60%: Convulsions, coma

  • 60%: Death

  • Cherry-pink coloration of skin and mucosae (classic sign)
• Treatment:
  • Remove from exposure
  • 100% oxygen by non-rebreather mask (reduces CO half-life from 5 hours to 90 minutes)
  • Hyperbaric oxygen for severe cases (COHb >40%, unconscious, pregnant)
  • Supportive care, treat seizures

Conditions Affecting Rate of Putrefaction:

• Warm temperature
• High humidity
• Superficial burial / no burial
• Obesity
• Septicemia at time of death
• Injuries/wounds on body

• Cold temperature
• Dry conditions
• Deep burial
• Immersion in water (initial delay)
• Arid environment
• Embalming, antiseptics
• Cause of death: Arsenic poisoning retards putrefaction

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VERY SHORT ANSWER QUESTIONS (3 Marks)

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• First 5 months: Crown-heel length = month² (in cm); e.g., 3rd month = 9 cm
• After 5th month: Crown-heel length = month × 5 (in cm); e.g., 8th month = 40 cm

• Dolichocephalic (long head): <75 - Europeans
• Mesocephalic: 75-80
• Brachycephalic (broad head): >80 - Mongoloids
• Used in racial identification

• Head = 9%; Each arm = 9%; Chest = 9%; Abdomen = 9%; Upper back = 9%; Lower back = 9%; Each thigh = 9%; Each lower leg = 9%; Perineum = 1%
• Total = 100%

• Freshwater drowning: Left heart chloride < Right heart chloride
• Saltwater drowning: Left heart chloride > Right heart chloride

• Mees' lines - transverse white lines on nails
• Rain-drop pigmentation (leukomelanosis) - alternating hypopigmented and hyperpigmented patches on trunk
• Keratosis - hyperkeratosis of palms and soles
• Peripheral neuropathy - glove-and-stocking sensory loss
• Alopecia
• GI: chronic diarrhea, abdominal pain
• Anemia
• "Arsenical cancers" - skin (Bowen's disease), lung, bladder

1. Autonomy - Patient's right to decide
2. Beneficence - Do good to patient
3. Non-maleficence - Do no harm
4. Justice - Fair treatment

• To be not guilty by reason of insanity, at the time of the act, the accused must: (1) Not know the nature/quality of the act, OR (2) If he did know it, he did not know it was wrong
• Test is still used in Indian courts under Sec 84 IPC

1. Corrosive acid/alkali poisoning
2. Kerosene/petroleum products
3. Convulsions (risk of aspiration)
4. Comatose patient (without intubation)
5. Aluminum phosphide poisoning (produces more phosphine gas with water)
6. More than 4-6 hours after ingestion (for most poisons)

• Cardiovascular: CAD/MI, aortic dissection, pulmonary embolism, cardiac tamponade
• Neurological: Subarachnoid hemorrhage, massive intracerebral bleed, epilepsy
• Respiratory: Pulmonary embolism, acute asthma
• Café coronary (food bolus)
• Anaphylaxis
• Electrolyte imbalance
• In infants: SIDS (Sudden Infant Death Syndrome)

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MULTIPLE CHOICE ANSWERS

1. b - Arsenic (can be detected from burnt bones)
2. a - Contact shot (stellate wound from gases)
3. b - 12,000-13,000 cc of gas per gram of smokeless powder
4. d - Extradural hematoma (classic lucid interval)
5. b - Electrical torture (picana = electric cattle prod torture)
6. a - Sec 185 of MVA (drunken driving)
7. a - 1st part of duodenum (Curling's ulcer)
8. c - Lightning (Lichtenberg figures)
9. b - Suicidal (tentative/hesitation cuts = self-inflicted)
10. a - Algae (diatoms are microscopic algae)
11. a - Submersion of the unconscious (immersion syndrome = death on contact with cold water due to vagal inhibition)
12. c - When fetal heart rate is 160/min at 5th month (this is NORMAL, not a ground for PNDT)
13. b - Alveolar duct membrane (this is NOT a sign of live birth; vernix, jaundice, milk in stomach are)
14. b - Advertising (examining without consent is NOT infamous conduct - implied consent in emergency; advertising IS infamous conduct)
15. c - 304A IPC (causing death by negligence)
16. b - 270 IPC (making environment noxious / public health offence)
17. d - Urinary bladder (not used for transplant from cadaver)
18. b - Doctrine of implied consent (operating on unconscious to save life)

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1. Medical Negligence (Civil vs Criminal, Precautions)
2. Death and Postmortem Changes (Rigor Mortis, Cadaveric Spasm)
3. Hanging
4. Rape/IPC Sections
5. Brainstem Death