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FORENSIC MEDICINE
MLI = medico legal importance
PM = post mortem
LEGAL PROCEDURE & MEDICAL LAW AND ETHICS
Long questions: ‐
•What is inquest? Explain about all the types of inquest (*Cr.P.C. S174, 176)
•write in details about all types of courts, their powers and the power of different types of
magistrates
• Procedure of record of evidence in a court
•Indian Medical council and its functions
Notes (5mrks)
●subpoena / summons (CrPC 61‐69)
•difference between dying declaration (sec 32 IEA) and dying deposition
•Perjury (IPC 191,193), Hostile witness, expert witness
•conduct and duties of the doctor at the scene of crime
•warning notices
• Penal erasure/professional death sentence (dichotomy, adultery, covering)
•Professional misconduct (6 A’s –adultery, advertising, abortion, addiction, alcohol,
association)
•Privileged communication
•difference between criminal & civil negligence (4D’s – duty, dereliction, direct causation,
damage)
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•difference between professional negligence & infamous conduct
•types & rules of consent (3C’s‐ communication, comprehension, No coercion)
•Res judicata
•Res Ispa Loquitur
•Novus Actus Interveniens
●chain of custody
● Difference between examination in chief & cross examination
● Criminal courts in India
• Euthanasia –definition & its types
Extra viva / Distinction questions –
• Difference between forensic medicine & medical jurisprudence (must know for viva)
• Difference in IPC, CrPC, IEA (viva)
● list the circumstances requiring magistrate inquest
• conduct money
• Cognisable offence
• Father of legal medicine, forensic medicine
•types of witnesses
•medico legal Masquerades
•therapeutic misadventure
•loco parentis
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●contributory, composite & corporate negligence
●vicarious liability
● The transplantation of Human Organs Act (THOA, 1994) – rarely asked
Few other imp. IPC for viva
*IPC 300‐ murder definition, 302‐ murder punishment
304 A – dowry death
306,309 – Suicide
299,304‐ culpable homicide
46‐death
IDENTIFICATION
Notes (5mrks)
•Sex chromatin
•Intersex
•Gustafson’s Method (* most reliable criteria is root transparency)
•medico legal importance( MLI ) of age (specially 7yrs,12yrs, 18yrs,21year,25 year)
•age of foetus (haase rule)
•Dactylography‐ types, its MLI
•Tattoo marks – dyes used, its MLI
•application of X-rays in forensic medicine
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● Use of radiology in the detection of crime
•MLI of scars
●MLI of teeth
● Difference between temporary and permanent teeth
• Difference between animal hair & Human hair
• Skull photo superimposition
Extra viva / Distinction questions ‐
• Poroscopy • cheiloscopy (viva)
• charting of teeth‐universal,FDI,modified FDI
●super added teeth (total 12 )
●corpus delicti
●carl Pearson formula
● Cephalic index
*between 6‐11 years, total no. of teeth = 24
* Formula to calculate no. of permanent teeth= (age‐)*
* Best bone to determine the sex & age of a person – pelvic bone
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MEDICOLEGAL AUTOPSY, DEATH & POSTMORTEM CHANGES
Long questions: ‐
● What are the changes occur in somatic and cellular death. How you diagnose a brain
death (criteria & Tests to confirm it). What is the significance of brain death ?
● Definition of autopsy and its objective & types of autopsy
(clinical,patho,virtual,psychological,medicolegal ).What is the MLI of autopsy?
● Differential diagnosis of rigor mortis. How it is differentiated from cadaveric spasm?
Condition stimulating rigor mortis. MLI of rigor mortis
Notes (5mrks)
●Exhumation (*No time limit for exhumation in India)
•Difference between obscure and Negative autopsy
• Sudden death- define, causes, MLI
•suspended animation – signs and MLI
•Algor mortis /post‐mortem cooling
•post‐mortem caloricity
●Post mortem lividity
● Difference between post‐mortem hypostasis & congestion. MLI of lividity.
●describe the PM changes occurring within the 24hours of death
●Adipocere / saponification (*do not occur in brain & foetus less than 7months)
●mummification
●entomology of the cadaver / MLI of study of maggots
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●changes in the eye after death‐ IOP‐zero, tache noir, potassium increase, tram‐track
appearance (Kevorkian sign)
● Dissection of heart during autopsy
● What is asphyxia? What are its types? PM appearance in asphyxia
●rule of 12 / March of rigor
●casper dictum – 1:2:8, air:water:soil
●short note on embalming ‐3 goals ( sanitation,presentation,preservation )
Extra viva / Distinction questions –
●difference between mode and manner of death (viva)
●asphyxial stigmata
●Muscular changes after death
●Thalantology
●marbling – due to staining of superficial veins with sulpha‐methemoglobin
●culpable homicide
● Define syncope and coma
● Bacterial agents responsible for putrefaction, estimation of time since death through
putrefaction
● Presumption of death & survivorship
* Prostrate resist putrefaction for a long time & virgin uterus is the last organ to putrefy.
Both resist to fire to a marked degree.
*best sample to estimate the time of death‐ examination of vitreous fluid
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INJURY, FIREARM, WOUNDS
Long questions: ‐
• define injury (S44 IPC) & classify injuries (mechanical, thermal, chemical, physical,
explosions)
● describe about all the types of fractures occurring in skull.
● All the types of injuries/ fractures caused to a pedestrian meeting an accident with car
● enumerate all the intracranial haemorrhages & differentiate between extradural and
subdural haemorrhage.
Notes (5mrks)
●pressure abrasion
●difference between ante mortem & post‐mortem abrasion
●difference between ante mortem & post‐mortem bruise
● Difference between hypostasis & bruise
● Difference between artificial & true bruise
●lacerations‐ definition,types (*tissue bridges are seen in laceration)
●abrasions‐ definition,types
●importance of tailing of wound
●avulsion
●hesitation marks
●difference between suicidal & homicidal wounds
●defence wounds
●stab / puncture wounds
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●fabricated wounds
●draw labelled diagram cartridge of shotgun / rifle
●what is rifling? What are its MLI?
●difference between entry & exit wound
●features of contact wound from a shot gun
●ricochet bullet, tandem bullet & dum‐dum bullet
●Grievous hurt (IPC320)
●difference between ante mortem & post‐mortem wounds
● Injuries caused by a shot gun at a distance of 30 cm
● Significance of lucid interval in head injury. How it is different from lucid interval of
insane
●coup & counter coup injury/fracture
●abrasion collar
●boxer’s haemorrhage / punch drunk
● Epidural haemorrhage & heat hematoma
Extra viva / Distinction questions –
●ectopic bruising
●MLI of bevelling
● Impact abrasion & patterned bruise
●choking of shotgun
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● Definition of contusion
● Definition of forensic ballistics (viva )
● Firing range of pistol,shot gun,revolver,rifle (viva)
● What is the calibre of a firearm?
● What are the primary and secondary markings on the bullet?
●What is crime bullet & exhibit bullet?
●What do you understand by point black?
● What is metallic fowling?
● What is blast lung ?
● Cerebral concussion
● kennedy phenomenon
● How will you determine the age of the bruise
● fractures a la signature & comminuted fracture
● Which is the common skull fracture found in children
● What is the commonest cause of sub dural haemorrhage
● What is the commonest cause of intra cerebral haemorrhage
● Difference between incised and lacerated wounds
● Difference between drunkenness & concussion
● Whiplash injury & railway spine
● types of gunpowder and their composition (black & smokeless powder)
● define assault & dangerous weapon
●Define homicide and its type
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*in bomb blast injury organs affected are – tympanic membrane,lung,intestine
Rarely asked viva Qs/ just for interest
●types of torture {rarely asked}‐ felanga (bastinado), telefono,parrot perch,cattle
prod,chepuwa,sham
execution,dunking
●priming agents in cartridge
●tests done to detect gun powder
●gutter fracture – from oblique bullet wound
●brush burn – it is a graze abrasion
●sparrow foot mark type of lesion on face – by windshield seen in car accident
●six penny bruise‐ neck due to throttling
●under taker fracture – @ C6‐C7
●rat‐hole entry wound ‐ seen in close range fire of shotgun
●back burn
●hara‐kiri
●puppe’s rule
●other different bullet types – yawning bullet, frangible bullet, tumbling bullet, incendiary
bullet, tracer bullet
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BURNS, STARVATION & ASPHYXIA
Long questions: ‐
•classify burns & estimate the percentage of burn. What are the causes of death due to
burn (rule of 9)
●types of hanging and post‐mortem findings in a case of ante mortem hanging.
●4 Types of drowning – wet (primary), dry, secondary & Immersion syndrome
- Mech. of froth in respiratory passage in drowning
-Difference between wet & dry drowning
-difference in fresh water and sea water drowning, mech. of death & its PM findings
Notes (5mrks)
●pugilistic attitude/ boxing attitude
●difference between extradural haematoma due to burn and due to blunt force
●difference between ante mortem & post mortem burns
● Scalds‐ degrees & MLI
● Difference between dry and moist heat burns
● Electrocution‐ local effects & post‐mortem findings
(Wax drippings, zenker’s degeneration and crocodile flash burn)
● Post mortem (PM) finding in a case of starvation
●difference between hanging & strangulation
● Types of hyoid bone fractures (in hanging, throttling, etc )
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● café coronary
● Getter’s test
● Lynching
● Diatoms & their MLI
● Sexual asphyxias
● Judicial hanging – cause of death?
● Partial hanging
●washer woman hands
●cutis anserine
Extra viva / Distinction questions –
● Heat ruptures, heat cramps & heat hyper pyrexia
● Joule burn
● Trench foot /immersion foot
● Frost bite
● Lightning stroke
● Le facie sympathique and its MLI
● Fracture of cricoid is seen exclusively in which type of mechanical asphyxia
● distinguish between external haematoma due to burns & blunt force
● Define smothering, suffocation, strangulation, choking, gagging & throttling
● Burking
● Cause of death in electrical injury
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● paltauf’s haemorrhages
●Pseudo‐strangulation
● Important terminology for viva –
throttling,garrotting,burking,mugging,bandsola,smothering,gagging
●filigree burn/lichtenberg’s flower
● Thermal fractures of skull
● Current pearl/burn pearl
● overlaying
● Traumatic asphyxia
● Emphysema & oedema aquosum
● conditions where temporal bone haemorrhage is seen
*definite sign of ante mortem hanging is drooling of saliva
STERILITY, VIRGINITY, PREGNANCY, ABORTION, SEXUAL OFFENCES
Long questions: ‐
●artificial insemination (AI) – types, indications, precautions, complications & MLI of AI
●define rape & classify sexual offences
●MTP –act, indications, rules & methods (imp. in OG also)
● Examination of rape accuse / victim (imp. For forensic practical aslo)
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Notes (5mrks)
●third party reproduction
●surrogate motherhood
●MLI of quickening during pregnancy
●MLI of legitimacy of a child
●MLI of pregnancy
● MLI of virginity
● Presumptive, probable & confirmatory signs of pregnancy (imp. In OG also)
●signs & symptoms of a recent delivery
●difference between parous & nulliparous uterus
● corrobotive signs of rape
● Perianal findings in a catamite
● tests to detect seminal stain/fluid & it’s MLI
● Complications of criminal abortions with labelled diagram
● causes of sterility & impotence & their MLI
● doctors duty in criminal abortion
Extra viva / Distinction questions –
● define impotency, frigidity & sterility
● Which is the most valuable physical sign of early pregnancy
● Posthumous child
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● Types of sterilization
● What is artificial insemination husband
●difference in superfecundation & superfoetation
● What is legitimacy & it’s MLI
●supposititious child
● Temporary impotence
● Methods of determining paternity
● causes of rupture of hymen
● define virgin & defloration
●Quad Hoc
●Pseudo virgin
● Difference between virginity & defloration
● Difference between natural & criminal abortions
● Florence test & barberio test
● Lust murder
● Phantom pregnancy
● Custodial rape
● Statutory rape
*CrPC 416 – conversion of death sentence of a pregnant lady to life imprisonment
* All the Terminologies in sexual offence chapter is very important for viva
e.g‐ sodomy,incest,sin of Gomorrah,adultery,peeping
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tom,frotteurism,transvestism,bondage,sadism,masochism
* Length of spermatozoa 50 – 55 microns
*HYMEN
‐Thickness ‐ 1mm
‐Most common ‐semilunar/crescentic
‐ Anterior tear‐ masturbation, posterior – sexual intercourse
‐difference between annular & frimbiated type
INFANTICIDE, BLOOD, FORENSIC PSCHIATRY, ARTEFACTS
Long questions:‐
• define delirium & delusion. What are the types of delusion and its MLI?
● Define hallucination & Illusion. What are the types of hallucination and what are the
MLI of illusion?
● Ways to restrain an insane
● define artefacts & what are the different types of artefacts
Notes (5mrks)
●signs of death birth
● Signs /tests done for live birth
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● Difference in lung before & after respiration
● Hydrostatic test
● caffey’s syndrome / battered baby syndrome
● Infantile whiplash syndrome
● munchausen’s syndrome
● tests to detect blood stains
● Sudden infant death syndrome (SIDS)/ crib death / cot death – causes
● Difference between lucid interval of insanity & head injury
● Difference between real insanity & feigned insanity
● Testamentary capacity of an insane
● Mc naughten rule
● Difference between Mc naughten rule & IPC 84
●civil responsibility of an insane
● Disputed paternity & maternity
● spadling sign & maceration
● differentiate neurosis & psychosis
● Testamentary capacity
● Somnambulism
● MLI of caul birth
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Extra viva / Distinction questions –
●definition of still birth
●how to differentiate human blood from others
●difference between ante‐mortem and post‐mortem blood stain
●DNA fingerprinting & its MLI
● define forensic psychiatry
● Durrham rule
● post epileptic insanity
● MLI of automatism
● locards principle of exchange
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TOXICOLOGY
Long questions: ‐
● define poison and classify poisons into corrosives, irritants, systemic & Misc. what are
the different laws of poison in legislature.
● OP poisoning – clinical symptoms & sign, diagnosis, management & PM findings
● Signs and symptoms of chronic alcohol intoxication? MLI of alcoholic hallucination
(alcohol gaze nystagmus , Mc evan sign, disulfiram reaction , treatment of acute & chronic
alcohol poisoning , korosakov’s pyschosis, wernicke’s encephalopathy , define
drunkenness )
● Datura poisoning‐ clinical symptoms & sign (8D’s) , diagnosis, management , PM findings
& it’s MLI
● Clinical features & management of sulphuric acid poisoning. Write about its autopsy
findings & cause of death.
● Clinical features & management of plumbism (Pb poisoning). Write about its autopsy
findings also.
● Carbolic acid poisoning (phenol)‐sign & symptoms , treatment,PM findings ,carboluria,
ochronosis
● Differential diagnosis of opium poisoning (pin-point immobile pupil, stertorous
respiration, slow pulse)
● classify barbiturates. Sign & symptoms of its poisoning, cause of death
Notes (5mrks)
● Ideal homicidal poison
● Laws of poisoning
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• Manner of sample collections (blood, urine & viscera) in case of poisoning
● Duties of a doctor in case of poisoning case
● Gastric lavage‐ indications, method & contraindication
● Differential diagnosis of white colour powder poison
● Difference between arsenic poisoning & cholera
● Snake bite (identification of snake through history, lesion, clinical sign and symptoms) &
its management
●difference between poisonous and non‐ poisonous snake
● short note on snake venom
● Clinical feature of cobra & viper bite
● Delirium tremens and its MLI
● Fatal dose of aspirin. Autopsy finding in NSAIDS poisoning
● Enumerate steps in the management of benzodiazepines poisoning
● Street poison – stupefying poison
● Difference between drug addiction & drug habituation
● Drug dependence
●Body packer syndrome & it’s MLI
● Withdrawal symptoms
● Difference between strychnine poisoning & tetanus. Antidote of strychnine poisoning
● cebera thevetia (yellow oleander poisoning)
●Food poisoning – define, types, sign & symptoms, treatment
●Arsenic poisoning (king of poison)
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●postmortem appearance in paraquat poisoning
● Sign and symptoms of oxalic acid poisoning (used in forgery of documents/bleach), its
antidote
● Copper poisoning – verdigris, clinical features, antidote. Where copper is used as
antidote?
● Mercury poisoning (minamata disease – pink disease/acrodynia )
● Methyl alcohol poisoning – sign & symptoms, eye manifestations & management
● Chloral poisoning –its clinical features & forensic importance, knock out drops, Mickey
Finn
● Cyanide poisoning – MOA, & its treatment
● CO poisoning- causes, pink lividity, CO automatism, treatment, PM findings, MLI
● Differential diagnosis for poisons showing constricted pupil
●Vitriolage (sec326 A IPC) & Clinical features of vitriol poisoning
●Hyper pyrexia – differential diagnosis and treatment
● In case of poisoning death, give reasons for chemical analysis report to come as
negative.
Extra viva / Distinction questions –
●coma‐cocktail
● henery’s law
● Name some organic irritants
● Abortifacients . Examples -
● Define drunkenness
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● Diaphoretics
●chelating agents
● Name some corrosive poisons
● Household emetics
● Plant Penicillin
● Physiological antidote
●universal antidote
●Xanthoproetic reaction
●phossy jaw‐ lead
● What is toxalbumen /Phytotoxin ? give examples .
● mercuria lentis & its significance
●difference between seeds of chilly (capsicum) and datura
● Difference between common cobra, king cobra, krait & viper ( russel and sand )
●speed ball = cocaine + heroin
● Magnan symptoms
● list all the asphyxiants
● Hippus – aconite poisoning
● Yellow atrophy
● Active agent of abrus, cannabis, strychnine, white & yellow oleander
● Run amok
●opisthotonus
●risus sardonicus
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● Difference in white & red phosphorus
* Father of toxicology‐ Mathieu orfila
*garlic odour‐ phosphorous, arsenic, OP,thallium
* Rotten egg odour‐Hydrogen sulphide, * burnt rope odour‐ cannabis
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Important topics for forensic practical
• Manner of sample collections (blood, urine & viscera) in case of poisoning
● Duties of a doctor in case of poisoning case
• Examination & certification of alcoholic
• Examination accused in sexual offence (CrPC 53A)
• Examination victim in sexual offence (IPC 164)
• Medical certificate of cause of death
• wound certificate
●Cluster of bone examination‐ identifying bone as of male/female, its age,stature
•age of foetus
●certificate for impotency
●ossification centres‐ X‐Ray
●dentition for age
●identifying the type of wound by seeing photograph
●identifying the weapon and the possible injury caused by it.
● identify the type chemical poisons /snake/scorpion
● identify all the plant poisons, their seed & learn their active agents
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