Important Questions -- Forensic Medicine & Toxicology

[Dr. M. Sreenivasan, Professor of FMT, Chettinad Academy of Research & Education, Chennai]

FORENSIC MEDICINE
[Bold → Most Important]
INTRODUCTION

1 Mark/2 Marks:

Define: Forensic Medicine, Medical Jurisprudence, Medical Ethics, Medical Etiquette

LEGAL PROCEDURE

1 Mark / 2 Marks:

Define Inquest, Types; Executive Magistrates, Circumstances where Magistrate’s Inquest done;
Panchas, Panchanama; Coroner’s inquest, Medical Examiner’s system; Criminal courts of India;
Powers of Sessions court [Death sentence should be confirmed by High court], Powers of Judicial
Magistrates; Cognizable Offences; Conduct Money; Compos mentis; Dying Deposition; Exceptions
to oral evidence; Hostile witness; Perjury; Leading question, where it is allowed, when leading
question allowed in Direct examination; Standard of Proof

5 Marks / Essay:

Inquest; Subpoena; Dying Declaration; Cross Examination; Conduct & Duties of Dr. in witness
box

MEDICAL LAW & ETHICS

1 Mark / 2 Marks:

Penal Erasure/Professional death sentence; Adultery; Dichotomy; Covering; Red cross

emblem; Res Ipsa Loquitur; Novus Actus Interveniens; 304-A IPC; Res judicata; Contributory
negligence; Vicarious liability; Euthanasia & Types; Consent – definition & types; Informed
consent; Loco Parentis

5 marks / Essay:

Functions of Indian Medical Council; Functions of State Medical Council; Warning Notice;
Duties of Medical Practitioners [esp. with respect to consultation]; Privileged communication
with Examples; Differences between Civil & Criminal negligence; Rules of Consent; Consumer
Protection Act [CPA/COPRA]; Transplantation of Human Organs Act [THOA]
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IDENTIFICATION

1 Mark / 2 Marks:

Corpus Delicti; Sex chromatins [Barr & Davidson Body]; Medullary index of bones; Incremental
lines of Boyde; Rule of Haase; Anthropometry/Bertillon system [Limitation: Applicable only for
adults above 21 yrs]; Poroscopy [Locard’s Test/Method]; Latent, Visible & Plastic fingerprints;
Podogram; Palatoprints; Cheiloscopy; Methods of Erasure of Tattoo marks; Pink Teeth

5 Marks / Essay:

Identification in mass disaster; Intersex states [Newer Term: Disorders of Sexual

Development]; Gustafson’s Formula with drawbacks; Age changes in pubis symphyis;
Kidnapping; Dactylography [Fingerprints/Dermatoglyphics/Galton system]; Superimposition;
Tattoo Marks; Bite marks; Medicolegal importance of hair; Cephalic index

MEDICO-LEGAL AUTOPSY

1 Mark / 2 Marks:

Skin incision types; Virchow’s, Letulle, Rokitansky & Ghon’s methods of viscera removal
[Evisceration Techniques]; Undertaker’s fracture; Method of Scalp incision & skull cap removal;
Psychological autopsy; Virtopsy / Digital autopsy; Viscera preserved; Formulae for Stature
estimation from long bones; Method of heart dissection.

5 Marks / Essay:

Exhumation; Objectives & rules of medico-legal autopsy

DEATH & ITS CAUSE

1 Mark / 2 Marks:

Types of death; Bishop’s Tripod of life; Moment of Death; Types of Brain death; Diagnosis of
Brain-stem death; 3 Modes of death; 4 types of Anoxia [esp. histotoxic anoxia]; Petechial
haemorrhages/Tardieu spots/Ecchymoses]; Asphyxial stigmata; Manner of death; Agonal
period; Drug Idiosyncrasy; Cardiac Tamponade/Haemopericardium [MLI: Sudden Death]

5 Marks / Essay:

Asphyxia—Definition, Types, Findings; Vagal Inhibition; Sudden Death – Definition, Causes

[esp. cardio-vascular & Respiratory]; Obscure & Negative autopsy

POST-MORTEM CHANGES

1 Mark / 2 Marks:

Suspended animation; Tache noir; Kevorkian sign/Trucking/Shunting; Algor-mortis; Shape of

curve in Algor-mortis [S or Sigmoid shaped]; Sites of Body temperature measurement;
 Contd…

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Post-mortem caloricity; Post-mortem hypostasis [post-mortem staining; suggilations; vibices;

livor mortis; darkening of death]; Contact pallor/flattening; Fixation of Post-mortem staining;
Primary flaccidity; Rigor-mortis [Death stiffening/cadaveric rigidity]; “March of Rigor”—
Proximo-distal progression of Rigor-mortis; Cadaveric spasm [Instantaneous rigor/Cataleptic
rigidity]; “Rule of 12” [Rigor affects whole body in first 12 hrs after death; Persists for next 12
hrs; Passes off in next 12 hrs]; Marbling with MLI; Post-mortem purge; First & last internal
organ affected in decomposition; Honeycomb/Foamy Liver; Casper’s dictum—Body
decomposes in air twice as rapidly as in water & eight times as in earth; Forensic Entomology;
Myiasis; Presumption of Death; Presumption of survivorship; Commorientes

5 Marks / Essay:

Classification: Immediate. Early & Late Post-mortem changes; Changes in the Eye; Post-
mortem hypostasis with MLI; Rigor-mortis; Conditions simulating Rigor-mortis; Differences
between Rigor-mortis & Cadaveric spasm; 3 Characteristic features of Decomposition;
Adipocere with MLI; Mummification with MLI; Estimation of PM interval

MECHANICAL INJURIES

1 Mark / 2 Marks:

Injury [S.44 IPC]; Classification of Mechanical & Thermal injuries; Shear strain; Graze/Brush/
Friction Burn; Patterned abrasions; Difference between AM & PM abrasions; Differential
Diagnosis of Abrasions; Black Eye -- Ectopic bruising/Percolated/Migratory contusion; Railway
line or Tram line Bruise; Delayed/Come-out Bruise; Difference between Hypostasis & Bruise;
Incised-looking lacerations [Scalp, Iliac crest, shin]; Lacerated looking incised wounds [Axilla,
Scrotum]; Flaying/Avulsion lacerations; Tissue bridges; Hesitation marks/Tentative cuts/Trial
wounds; Chop wounds; Punctured, penetrating & Perforating Stab wounds, Fishtailing;
Concealed Puncture wounds; Shape of external wound by single & double edged knife; Hara-
kiri; Defence wounds; Self-inflicted/Fabricated wounds; Firearm—Definition & Classification;
“Rifling”; Calibre/Guage determination of Rifled weapon & Shot gun; “Choking” in case of
Firearm; Rifled slugs; Composition of Black powder, Smokeless & Semi-smokeless powder; Copy
Recoil abrasion; Blackening/Smudging/Fouling; Tattooing/Stippling/Peppering];
Abrasion/Contusion collar; Grease/Dirt collar; Puppe’s Rule; “Shored” exit wound; Yawning
bullet; Tumbling bullet; Ricochet Bullet; Tandem bullet/ Piggyback bullet; Souvenir bullet;
Duplex/Tandem cartridge; Primary & Secondary markings on a bullet; Kennedy phenomenon;
Tests for firearm residues [Dermal nitrate test]

5 Marks / Essay:
Abrasions; Contusions/Bruises; Difference between Incised, Lacerated & Stab wounds;
Wounds from Shotguns; Wounds from Revolvers & Pistols; Difference between Entrance &
Exit gun-shot wound

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REGIONAL INJURIES

1 Mark / 2 Marks:

Signature #; Pond #; Gutter #; Coup & contrecoup lesions; Shear strain; Concussion of Bran;
Diffuse Axonal injury; Retraction balls; Lucid Interval in Head injury; Berry aneurysm;
Whiplash injury; Railway spine; Flail/stove-in Chest; Types of Liver laceration; Primary impact,
Secondary impact & Secondary/Tertiary injuries; Hinge/motorcyclists #; Boxer’s haemorrhage;
Punchdrunk syndrome

5 Marks / Essay:

Types of Skull #; Various Types of Intracranial haemorrhages

MEDICO-LEGAL ASPECTS OF WOUNDS

1 Mark / 2 Marks:

S.44 IPC; S.304-A IPC; S.319 IPC; Dangerous weapons; S.304-B IPC; Falanga/Falaka/Bastinado;
Telefono; Crush syndrome; Stains used for detecting Fat embolism; Vital Reaction; Enzyme
histochemistry;

5 Marks / Essay:

S.320 IPC; Difference between ante-mortem & Post-mortem wounds

ANAESTHETIC & OPERATIVE DEATHS

1 Mark / 2 Marks:

Complications of Spinal anaesthesia

THERMAL INJURIES

1 Mark / 2 Marks:

Frost-bite; Trench/Immersion foot; Paradoxical undressing; Hide & Die syndrome; Rule of 9;
“SOOT”; Pugilistic attitude; Heat Rupture; Heat haematoma; Difference between ante-mortem
& Post-mortem burns; Joule burn; Crocodile flash burn; Bone pearls/Wax drippings; Cause of
death in electrocution; Arborescent burns/Filigree burns/Lichtenberg’s flowers;

5 Marks / Essay:

Wilson’s classification of Burns, Causes of Death, P.M. features & MLI of deaths due to Burns

STARVATION
1 Mark / 2 Marks:

Loss of 40 % of body weight is fatal; causes of death; Fatal period; Organ distended; Article 21
of constitution of India; Criteria to start forceful feeding

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MECHANICAL ASPHYXIA

1 Mark / 2 Marks:

Le facie sympathique; Lynching; Types of Hyoid bone #; Bansdola; Garrotting; Mugging;

Gagging; Overlaying; Burking; Café coronary; Traumatic asphyxia & its diagnosis; Cutis
anserine/Gooseflesh; Washerwoman’s hands & feet; Emphysema aquosum; Paultauf’s
haemorrhages; Gettler’s Test; Sexual asphyxia

5 Marks / Essay:

Hanging & Drowning: Definition, Types, Cause of Death, P.M. features& MLI; Difference
between Hanging & Ligature strangulation; Diatoms

IMPOTENCE & STERILITY

1 Mark / 2 Marks:

Impotence, Sterility, Frigidity; Quoad hanc; Vaginismus; Surrogate mother

5 Marks / Essay:

Causes of Impotence & Sterility in Males; Artificial insemination: Definition, Types,

Indications, Precautions & Legal problems

VIRGINITY, PREGNANCY & DELIVERY

1 Mark / 2 Marks:

Difference between Divorce & Nullity of marriage; Types of Hymen; False virgin; Quickening &
MLI; Pseudocyesis/spurious/phantom pregnancy; Superfecundation; Superfoetation;
Legitimacy; Atavism; Lochia

5 Marks / Essay:

Presumptive, Probable & Positive signs of Pregnancy

SEXUAL OFFENCES

1 Mark / 2 Marks:

Classification, Exception to S.375 IPC; Statutory Rape; Marital Rape; Lugol’s Iodine test;
Smegma & MLI; Incest; Sodomy/Buggery/Gerontophilia/Pedophile/Paederasty/Catamite;
Hijrahs; Zenana; Tribadism; Nymphomania; Satyriasis; Bestiality; Define Sexual perversion;
Sadism [Active algolagnia]; Lust murder; Masochism [Passive algolagnia]; Necrophagia;
Necrophilia; Fetichism; Voyeurism/Scoptophilia; Oedipus complex; Electra complex; Indecent
Assault; Acid phosphatase Test

5 Marks / Essay:

S.375 IPC; S.376 IPC Subsection 1 & 2; Tests for Semen

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ABORTION

1 Mark / 2 Marks:

Define Abortion; Ecbolics & Emmenagogues; Cupping; Duties of Dr. in a case of criminal
abortion; Causes of death in criminal abortion

5 Marks / Essay:

MTP Act [Indications & Rules]; Methods of MTP in I, II & III Trimester

INFANT DEATHS

1 Mark / 2 Marks:

Define Infanticide, Stillbirth, Deadbirth; Maceration & its earliest sign; Spalding’s sign;
Livebirth; When the Hydrostatic test not required; Vagitus uterinus; Vagitus vaginalis;
Precipitate labour; Abandoning of infants; Concealment of Birth; Infantile whiplash syndrome;
Nobbing #;

5 Marks / Essay:

Signs of Live Birth; Hydrostatic Test; Battered Baby syndrome/Non-accidental injury of

childhood/Caffey syndrome/Child abuse syndrome; Sudden Infant Death syndrome [SIDS]

BLOOD STAINS

1 Mark / 2 Marks:

Difference between Menstrual blood/Haematemesis/Haemoptysis; Benzidine Test; Difference

between RBCs of mammals/camels/birds,fishes; Precipitin Test; “Secretors”; Hazards of blood
transfusion; Define DNA fingerprinting; Restriction endonucleases/Restriction
enzymes/Enzyme cutters; Applications of DNA fingerprinting

5 Marks / Essay:

Tests for Blood; Hazards of Blood Transfusion; DNA fingerprinting

FORENSIC PSYCHIATRY

1 Mark / 2 Marks:
Delirium; Define: Delusion, Illusion & Hallucination; Erotomania; Impulse & Types,
Obsession/Obsessive compulsive neurosis; Lucid Interval; Idiocy, Imbecility &
Feeblemindedness [Moron]; Define Schizophrenia; Mens rea; Actus reus; Mc Naughten Rule-
S.84 IPC; Automatism; Somnambulism & MLI; Somnolentia & MLI

Contd…

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5 Marks / Essay:

Delusion & Types; Admission & Discharge of mentally ill person in Psychiatric Hospital;
Testamentary Capacity

ARTEFACT

1 Mark / 2 Marks:

Define Artefact; Agonal artefact

FORENSIC SCIENCE LABORATORY

1 Mark / 2 Marks:

Locard’s Exchange principle; Truth serum drugs; Brain fingerprinting

5 Marks / Essay:

Lie Detection – Various methods

TOXICOLOGY
GENERAL CONSIDERATIONS

1 Mark / 2 Marks:

Define Poison; Characters of Ideal Homicidal & Suicidal poison with examples; Stupefying
agents; Arrow poisons; Aphrodisiacs; Drugs having both local & remote action; Drug
Idiosyncracy; Parasuicide; Poisons detected by Smell; Drug automatism; Universal antidote;
Poisons causing constriction/dilatation of pupils & nystagmus; Poisons acting on Enzymes

5 Marks / Essay:

Failure to detect Poison; Duties of Dr. in a case of suspected poisoning; Treatment of

poisoning; Gastric lavage procedure with contra-indications; Antidote—Definition, Types with
examples; Chelating agents

AGRICULTURAL POISONS
1 Mark / 2 Marks:

Chromolachryorrhoea; Difference between OPC & Carbamate poisoning; “Plant penicillin”;

Weed killers; Rodenticides

5 Marks / Essay:

OPC—Compounds, Action, Clinical features, Treatment; Aluminium phosphide poisoning

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CORROSIVES

1 Mark / 2 Marks:

Vitriolage & MLI; Xanthoproteic reaction; Treatment of Oxalic acid poisoning; Carboluria;
Oochronosis; Difference between Acid & Alkali poisoning

HEAVY METALS

1 Mark / 2 Marks:

Arsenic: Differences with Cholera; Raindrop type pigmentation; Aldrich-Mees lines; Permissible
level in ground water; Arsenophagists; Mercury: Hydrargyrism; Danbury tremors;
Hatter’s/Glassblower’s shakes; Concussio mercurialis, Mercurial erethism, Mercurialentis,
Acrodynia/Pink disease; Minimata disease; Lead: Plumbism/Saturnism; Punctate
basophilia/Basophilic stippling; Burtonian Line; Treatment of Copper sulphate poisoning;
Antidote for Iron poisoning

5 Marks / Essay:

Arsenic / Mercury / Lead Poisoning

INORGANIC IRRITANTS

1 Mark / 2 Marks:

Phossy jaw; Chemical antidote for Phosphorus poisoning; Iodism; Iodide mumps; Ioderma

ORGANIC IRRITANTS

1 Mark / 2 Marks:

Toxalbumen/Phytotoxin with examples; F.D.[Fatal Dose] of Ricinus communis; Abrus

precatorius--Active priniciple, “Suis”; Marking Nut with Active principles & MLI[Artificial
bruise]; Calotropis: MLI; Cantharides/Blister beetle/Spanish fly: Active priniciple & MLI;
Families of poisonous snakes; Difference between poisonous & non-poisonous snakes;
Difference between Cobra & Viper, Nature of Venom of Cobra,Viper, Krait & Sea snakes;
Ophitoxaemia; Fatal dose of Snake venoms; Fatal period of Cobra & Viper bites; Diagnostic
Investigations for Snake bite; Treatment of Scorpion sting

5 Marks / Essay:

Clinical features & Treatment of Snake bite

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CNS DEPRESSENTS

1 Mark / 2 Marks:

Ethyl Alcohol:-- “Proof spirit”; % in different beverages; Safe limits for drinking; Mc Ewan Sign;
F.D., Alcoholics Anonymous; Define Drunkenness; Widmark formula;
Breathanalyser/Breathalyser/Alcometer/Drunkometer; Delirium Tremens; Wernicke’s
Encephalopathy; Korsakoff psychosis; Methyl alcohol:-- Eye manifestations, F.D.& Antidotes
[Ethanol & 4-Methylpyrazole/Fomepizole]; Opium/Papaver somniferum:-- Opium alkaloids,
Classification & Antidote; Barbiturates:-- Classification, F.D., “Barbiturate blisters”, Barbiturate
automatism

5 Marks / Essay:

3 Stages of Alcoholic intoxication & Treatment; Clinical features & Treatment of Opium
poisoning; Clinical features & Treatment of Barbiturate Poisoning

PSYCHOTROPIC DRUGS

1 Mark / 2 Marks:

Define Psychedelics / Hallucinogens with examples; LSD:-- “Trip”, Flash-back phenomenon

MISCELLANEOUS POISONS

1 Mark / 2 Marks:

Reye’s syndrome; F.D. & Antidote for Paracetamol poisoning; Insulin:-- Non-insane automatism

DELIRIANTS

1 Mark / 2 Marks:

Datura: Active principles, Difference from chilli seeds, “Road”/ “Railway poison”;
Cannabis sativa:-- Different forms with % of Active principle [Delta-1-Tetrahydracannabinol] in
each, “Reefer/Joint”, “Run-amok”; Cocaine:-- “Snorting”; “Speedball”, Magnan
symptom/Cocaine bugs/Formication/Tactile hallucination;

5 Marks / Essay:

Datura poisoning: Clinical features, Treatment & MLI

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DRUG DEPENDENCE

1 Mark / 2 Marks:

Define Drug; Difference between drug addiction & habituation; drugs causing addiction &
habituation; “Hot shot”; “Crack”; Body packer & Body stuffer syndromes; Huffing; Bagging,
Glue-sniffing; “Mainliners”

5 Marks / Essay:

Autopsy approach of Drug Abuse deaths

SPINAL POISONS

1 Mark / 2 Marks:

Strychnos nux vomica:-- Active principles, Action, Risus sardonicus, Opisthotonus, F.D.,
Differences from Tetanus

CARDIAC POISONS

1 Mark / 2 Marks:

Nicotiana tabacum:-- Active principles, F.D., Fatal period [rapidly acting poison next to
cyanide], Antidote; Nerium odorum:-- Active principle, F.D.& MLI; Cerbera Thevetia:-- Active
principles, F.D.; Aconite [Monk’s hood]:-- Active principles, Difference from Horse-radish root,
Hippus, F.D. & MLI

ASPHYXIANTS

1 Mark / 2 Marks:

Hydrogen sulphide:-- “Sewer gas”, Mechanism of Action & Treatment; “Laughing gas”; “Marsh
gas”; Lacrimators/Tear Gases; Biological warfare; Hydrocyanic acid:-- 3 forms, Action, F.D.,
Fatal period, Antidotes

5 Marks / Essay:
Cyanide poisoning: Clinical features & Treatment

FOOD POISONING

1 Mark / 2 Marks:

Botulism:-- Constipation, Intoxication—Not an infection, F.D.; Ptomaines; Leucomaines;

Lathyrism; Poisonous varieties of Mushrooms, Muscaraine, Deadly agaric / Death cap;
Epidemic dropsy

5 Marks / Essay:

Bacterial food poisoning