AIIMS MD Entrance Exam November 2009

Autopsy of AIIMS MD EXAM November 2009:

"After autopsy it has been revealed beyond doubt that the following questions could be answered from the 3rd Edition of Review of Forensic Medicine ROFM "

1 . HATTERS SHAKE IS ASSOCIATED WITH ( Page 185 ROFM 3rd Edition)

· ARSENIC
· LEAD
· MERCURY
· COPPER

Explanation Notes :

Symptoms: Acid metallic taste, hoarse voice, greyish white coating of tongue, blood-stained stool, circulatory collapse, necrosis of jaw, membranous, colitis, proximal renal tubular necrosis.*

Acrodynia*(Acro-Limbs Odynia-Pain) is seen in mercury poisoning (Pink’s Disease),It is Pain,swelling and parasthesia of Limbs

Mimimata disease—Contamination of fish with mercury, at a place called Minimate Bay in Japan.

Chronic Poisoning: (Hydrar gyrism)

• The symptoms are salivation, sore mouth and throat, fine tremors of the tongue, hands, arms, anemia.

• Shaking palsy is associated with Hg poisoning.

Mercurial tremors are also called hatter’s shakes or glass blower’s shake.(Danbury Tremors)

• Mercurial erethism** is seen in persons working with mercury in mirror manufacturing firms. Erethism is characterized by shyness, timidity, irritability, loss of confidence, mental depression, loss of memory and insomnia. (Psychological symptoms).

• Mercurialentis is a peculiar eye change due to brownish deposit of mercury through the cornea on the anterior lens capsule (Brown-Malt Reflex*). It is bilateral and has no effect on visual acuity

2. DRIED SEMEN ON CLOTHS CAN BE DETECTED BY ( Page 108 )



· INFRA RED
· SPECTROSCOPY
· MAGNIFYING LENS
· ULTRAVIOLET RAY


Explanation Notes:

Seminal Fluid

• Seminal stains have to be detected in cases of rape or attempted rape, sexual murder of the female, sodomy and bestiality.

• Fertility of fluid has to be proved in disputed paternity.

• Seminal fluid choline is originated from Leyding cells.

• Smegma: If the smegma is present around glans of penis, it is suggestive of the fact that an individual did not have sexual intercourse in last 24 hours.

CHEMICAL EXAMINATION

a. Florence test: (Choline Per. Iodide cystols)

• The stain is extracted by 1% hydrochloric acid and a drop is placed on a glass slide.

• A drop of Florence solution (Postassium iodine, iodine and water) is allowed to run under the cover slip.

• If semen is present, dark-brown crystals of choline iodide appear immediately.

• They are rhombic crystals resembling haemin.

• A negative test means the fluid is not semen.

b. Barberio’s test:

• A saturated aqueous or alcoholic solution of picric acid* when added to spermatic fluid, produces yellow needle shaped rhombic crystals of spermine picrate.

• In Barberio’s test, presence of spermine in semen is detected.

• Spermine picrate crystals are seen.

c. The Acid phosphatase test:

• The prostatic secretion element of seminal fluid contains a very much higher percentage of acid phosphatase.

• This test is conclusive in the absence of demonstrable sperms or in aspermia.

d. Creatine phosphokinase: Level of CPK is high in seminol fluids, can be detected in old stains of 6 months.

e. Ammouium molybdate test:

• For semen stains, detect presence of phosphorous.

f. Glycoprotein P₃₀: This test has replaced the quantitative analysis for acid phosphatase.

g. MHS-S1 is also positive and a highly reliable test for semen.

h. Serological typing of the semen is possible by precipitin method.

i. Dried Semen can be detected by UV rays.

101. SECTION 377 DEALS WITH( Page 270)

· RAPE
· ADULTRY
· INCEST
· UNNATURAL SEXUAL OFFENCE

Explanatory Notes:

Medico-legally Important Sections/Acts

Medico-legal Important Sections

Indian Penal Code

• Sec 44 Injury

• Sec 84 Act of a person of unsound mind/McNaughtens Rule

• Sec 85 Act of a person who is intoxicated against will

• Sec 191 & sec 193 definition and Punishment of perjury

Offence Affecting Human Body

Sec 299 to Sec 377

• Sec 299 Culpable Homicide

• Sec 300 Murder

• Sec 302 Punishment of murder/infanticide*

• Sec 304 Culpable Homicide not amounting to murder

• Sec 304 A Causing death by negligence*

• Sec 304 B Dowry Death

Sections Related to Criminal Abortion

• Sec 312 to Sec 316

Abandonment of Child under 12 years

• Sec 317

Concealment of birth

• Sec 318

Hurt

Sec 319

Grievous Hurt

• Sec 320

Assault

• Sec 351

Assault to Outrage the Modesty of Women

• Sec 354

Rape

Definition Sec 375

Punishment Sec 376

Unnatural Sexual offense

Sec 377

Criminal Procedure Code

Sec 174 Police Inquest

Sec 176 Magistrate’s Inquest

Indian Evidence Act

Sec 32 Dying Declaration

Medico-legal Important Acts

1. Drugs and Cosmetics Rules 1945

(Framed under: Drugs Act, 1940)

• Classification of drugs in schedules:

– C– Biological and special products.

– E– Poisons.

– F– Vaccines and Sera.

– G– Hormonal preparations.

– H–Drugs/poisons to be sold prescription of RMP.

– J– Diseases for cure of which no drug should be advertised.

– L– Antibodies, Antihistaminic, chemothera- peutic agents.

2. Employees State Insurance Act 1948

3. Indian Medical Council Act 1956

Schedule 1—India

Schedule 2—Outside India

4. The Medical Termination of 1971,

Pregnancy Act (Amend 1975)

5. The Narcotic Drugs & 1985

Psychotropic Substance Act

6. Consumer Protection Act 1986

7. Mental Health Act 1987

8. Organs Transplantation of Human Act 1994

9. Prenatal Diagnostic Technique 1994(Amend in 2000)





4. A TEACHER SLAPPED A GIRL STUDENT ,SHE SUFFERED FROM 25%HEARING LOSS WHICH RESOLVED ON SURGERY WHAT KIND OF INJURY THIS IS ( Page 68 )



· SIMPLE
· GRIEVIOUS
· DANGEROUS
· PUNISHMENT

Medico-legal Importance Of Injuries

Important Definitions

1. Injury: Any harm whatever illegaly caused in Body, Mind, Reputation or Property (Memory Aid ® BMR is an important concept of Physiology)

• Section Forty four (44), IPC.

2. Murder: Definition is under section 300 IPC and punishment under Section 302 IPC.

3. Hurt:

• Section 319 (IPC)

• Bodily pain, Disease or Infirmity caused to a person (BID).

4. Grievous Hurt

• According to S 320 I.P.C(Only Defines*) any of the following injury is grievous: The eight clauses of grievous injury can be remembered with the help of sentence—“Every Student Has reMEMBERed Injury’s Definition and Forgot it within 20 days of Passing Exams”.

1. Emasculation (Impotency/ sterility).

2. Permanent privation (loss) of Sight of either eye.

3. Permanent privation of Hearing of either ear. ( Permanence is in ordinary course of nature , irrespective of medical treatment)

4. Privatation of any Member or joint.

5. Destruction or permanent Impairing of the power of any member or joint.

6. Permanent Disfiguration of the head and face.

7. Fracture or dislocation of a bone or tooth.(Discontinuity till medullary Cavity is considered grievous)

8. Any hurt which Endangers life or, which causes the victim to be in the severe bodily Pain or unable to follow his ordinary pursuits (not mere hospitalization) for a period of 20 days.

5. Dangerous Weapon*(Sec 324 &Sec 326 IPC)

Any weapon used for Stabbing Shooting or Cutting(S.S.C),or is likely to cause death


163. CAUSTIC POISON ERODES MUCOSA BECAUSE



· HYGROSCOPIC IN NATURE
· IT HAS GLUE LIKE ACTION
· IT IS BEING PROGRAMMED TO STICK
· IT HAS AFFINITY FOR MUCOSA


Alkalis include sodium, potassium, and ammonium hydroxide and are bases and hygroscopic in nature thus they dissolve in water. They all contain a positive radical and a hydroxyl group. Alkalis produce a liquefaction necrosis when they come in contact with mucosa and penetrate deeply with full thickness burns common.

Acids cause coagulation necrosis; an eschar forms, limiting further damage. Acids tend to affect the stomach more than the esophagus.

Alkalis ( more damage than acids) cause rapid liquefaction necrosis; no eschar forms, and damage continues until the alkali is neutralized or diluted. Alkalis tend to affect the esophagus more than the stomach, but ingestion of large quantities severely affects both.


165. FEATURES OF ANTE MORTEM BURN ARE All /Except ( Page 127- 128 )



· VESICLE WITH HYPERAEMIC BASE
· RED LINE
· VESICLE WITH AIR

. VITAL REACTION PRESENT

Explanation

• Difference between Anti-mortem and Post- mortem burns

Trait Ante mortem Post- mortem
burns

1. Line of redness i. Present i. Absent

2. Blister ii. Contains serous ii. Contains air only.
fluid with Base is dry hard
proteins and and yellow
chlorides. Base
is inflamed

3. Vital reaction iii. Present iii. Absent

4. Enzymes iv. Increase in iv. Does not show
enzyme reaction increase in
and SH group. enzyme reaction.

5. CO Hb v. More than 5% v. Less
of CO Hb

AIIMS MD Entrance Exam May 2009

1.Digitalis Toxicity seen in a/e:-
a) Hyperkalemia
b)Hypomagnesemia
c)Hypercalcemia
d) Renal Failure

EXPLANATION: All Hypo like hypomagnesemia,hypokalemia,hypo-renal function(renal insufficiency),hypoxemia,hypothyroidism,hypo-coronary supply(myocardial ischemia or infarction).. increases digitalis toxicity. Only calcium is hyper in the list of digitalis toxicity inducing agents.

2. Diff b/w Ante mortem and Postmortem bruise all except
1) Sharp edge
2) coagulation in Blood vessels
3) raised
4) Color Change

EXPLANATION:

Difference between ante mortem (produced during life) and post mortem (produced after death) bruise

A bruise produced during life shows
1. Swelling
2. Colour changes (If the person survives for sometime)
3. Coagulation (Clotting) of the extravasated blood in the subcutaneous tissues and muscle fibres. These signs are absent if the bruise is produced after death.

3. Formication and delusion of persecution occurs in
1.Cocaine
2.Amphetamine
3.Cannabis
4.Morphine

ANSWER IS A COCAINE
Tactile hallucination is common in cocaine psychosis. This may take the form of small ants crawling over the body so called formication. In cocaine psychosis this type of hallucination occurs together with delusion of persecution and is known as cocaine bug.

4. A farm worker presented with abdominal pain with garlic odour and linear line in nails?
a. Lead poisoning
b. Arsenic

c. Mercury

d. Copper

Arsenic Poisoning :

Garlicky odor on breath; Hyperkeratosis, Raindrop Hyperpigmentation, Exfoliative dermatitis, and Mees' lines (transverse white striae of the fingernails); sensory and motor polyneuritis, distal weakness. Radiopaque sign on abdominal x-ray; ECG–QRS broadening, QT prolongation, ST depression, T-wave flattening;

5. Cuts on genitalia?
a) Homicidal
b) Suicidal
c) Accidental
d) Self Inflicted

Incised wounds on ears, nose, genitalia are invariably homicidal in nature. Cuts on genitalia may be result of sexual jealousy, caused by angry paramour, husband or wife

6. Bruise are most prominent with minimum force is seen in :-
a) Scalp
b) Soles
c) Palm
d) Face

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All India Pre PG Exam 11 January, 2009

Topics asked in this exam are as follows

1.Privileged Communication

2. Fire Arm Injury Stellate wound

3. Traumatic Asphyxia

4. Road Traffic Accident

5. Finger Prints

6. Abrasions

All the Question could be answered from the 3rd Edition of "Review of Forensic Medicine" so one more time its a 100% Strike Rate!

Lets see these topics in more detail:

Privileged Communication:( Page No 257 from 3rd Edn of R o F M )

• It is a statement communicated by a doctor to the concerned authority to protect the interest of the community of state.

• Examples of privileged communication

1. A syphilitic bath in a public pool

2. Engine or bus driver found to be colour blind

3. A person with infectious disease working as a cook.

4. A doctor’s duty is to notify birth, death, and infectious disease to public health authority.

• Exceptions to the General rule of Professional Secrecy is—“CIVIC SIN”:

1. C — Crime

I — Infections Disease

V — Veneral Disease

I — Interest (Self)

C — Courts of Law

S — Servant and Employee

I — Interest (Patients)

N — Negligence suits/Notifiable diseases

2.Wounds from shot-gun (Suggesting Range) Page No.66

Shape of wound Distance

1. Cruciate or Stellate shape

Contact over bone

2. Oval shape Upto 30 cm

3. Rat hole wound 30-100 cm

4. Satellite wound More than 2 metres

5. Individual pellets Over 4 metres

3. Traumatic Asphyxia ( Page no. 88 )

• Traumatic asphyxia results from respiratory arrest due to mechanical fixation of the chest*, so that the normal movement of the chest wall are prevented.

• Common cause is crushing by falls of earth in a coal mine or during tunnelling or in a building collapse

• An intense cyanosis of deep purple or purple red colour of the head, neck and upper chest, above the level of compression is the prominent feature

4. Pedestrians Injury ( Page 273 )
1)Primaryimpact: These are caused when first part of the strikes the vehicle

In the typical case, the victim is struck by the front of the vehicle and sustains so called bumper injury on legs

2)Secondary impact injuries: These are injuries cause by further impact by the the vehicle

3) Tertiary impact injuries (Secondary injuries) These are injuries caused when the victim striking objects such as the ground)

5.Dactylography(Page 18 )

Fingerprint system, Galton system, Dermatoglyphycs)

• Most reliable* method of identification of a person.

· First Finger Print Bureau* was established at Writer’s Building, Calcutta* ,India

• Fingerprints are impressions of pattern formed by the papillary ridges of the fingertips.

• Fingerprints are classified primarily as

1. Loops 67%(most common*)

2. Arches

3. Whorls

4. Composite forms–1-2% (least common*)

• Minimum no. of points to estd proof of identity is 8* (Supreme Court ruling*)

• The patterns are not inherited.

• The pattern is different even in identical twins. (Adolphe Quetelet’s Rule* of biological variation*)

Categories of Finger Prints

§ Latent Finger PrintsàBarely visible

§ Plastic Finger PrintsàPrints made on soft surface(Soap, cheese etc)

§ Visible Finger Printsà Stained with blood, greese etc

• In leprosy and Charring fingerprints may be lost*

Abrasions (Gravel Rash)

• An abrasion is destruction of the skin, which involves superficial layers of epidermis only.

• It has only length and breadth.

• The exposed raw surface is covered by exudation of lymph and blood, which produces a protective covering known as scab or crust.

Types

1. Scratches: These are caused by a sharp object passing across the skin, such as fingernails, pin or thorn.

2. Grazes: They are most common type* of abrasions. An abrasion caused by violent lateral rubbing by friction force* is called brush burn.

3. Impact Abrasion: They are caused by impact of a rough object such as a person is knocked down by a motor car.

4. Pressure Abrasion: They are caused by crushing of the superficial layers of the epidermis e.g. ligature mark of hanging.

Impact Abrasion and Pressure abrasions are also known as Patterned Abrasions*

Age of Abrasions*

1. Fresh —Bright red.

2. 12 to 24 hours—Lymph and blood dries up leaving a bright scab.

3. 2 to 3 days—Reddish-brown scab.*

4. 4 to 7 days—Epithelium grows and covers defect under the scab.

5. After 7 days—Scab dries, shrinks and falls out.

• In antemortem abrasions, intravital reaction and congestion is seen.

• Erosion of the skin produced by Ants, exco­riations of the skin by excreta and pressure sores resemble abrasions.

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?..Interesting, Unbelievable True Forensic Case.

At the 1994 annual awards dinner given for Forensic Science, AAFS President Dr. Don Harper Mills astounded his audience with the legal complications of a bizarre death.

Here is the story:
On March 23, 1994....... the medical examiner viewed the body of Ronald Opus, and concluded that he died from a shotgun wound to the head. Mr. Opus had jumped from the top of a ten-story building intending to commit suicide....
------------------------------------------------
He left a note to the effect indicating his despondency. As he fell past the ninth floor, his life was interrupted by a shotgun blast passing through a window, which killed him instantly. Neither the shooter nor the deceased was aware that a safety net had been installed just below the eighth floor level to protect some building workers and that Ronald Opus would not have been able to complete his suicide the way he had planned.
------------------------------------------------
"Ordinarily, " Dr Mills continued, "Someone who sets out to commit suicide and ultimately succeeds, even though the mechanism might not be what he intended, is still defined as committing suicide." That Mr. Opus was shot on the way to certain death, but probably would not have been successful because of the safety net, caused the medical examiner to feel that he had a homicide on his hands.
------------------------------------------------
The room on the ninth floor, where the shotgun blast emanated, was occupied by an elderly man and his wife. They were arguing vigorously, and he was threatening her with a shotgun! The man was so upset that when he pulled the trigger, he completely missed his wife, and the pellets went through the window, striking Mr.Opus. When one intends to kill subject "A" but
kills subject "B" in the attempt, one is guilty of the murder of subject B."
-------------------------------------------------
When confronted with the murder charge, the old man and his wife were both adamant, and both said that they thought the shotgun was not loaded.
The old man said it was a long-standing habit to threaten his wife with the unloaded shotgun. He had no intention to murder her. Therefore the killing of Mr.Opus appeared to be an accident; that is, assuming the gun had been accidentally loaded.
-------------------------------------------------
The continuing investigation turned up a witness who saw the old couple's son loading the shotgun about six weeks prior to the fatal accident..
-------------------------------------------------
It transpired that the old lady had cut off her son's financial support and the son, knowing the propensity of his father to use the shotgun threateningly, loaded the gun with the expectation that his father would shoot his mother.
--------------------------------------------------
Since the loader of the gun was aware of this, he was guilty of the murder even though he didn't actually pull the trigger. The case now becomes one of murder on the part of the son for the death of Ronald Opus.
--------------------------------------------------
Now comes the exquisite twist... Further investigation revealed that the son was, in fact, Ronald Opus. He had become increasingly despondent over the failure of his attempt to engineer his mother's murder. This led him to jump off the ten-story building on March 23rd, only to be killed by a shotgun blast passing through the ninth story window.
--------------------------------------------------
The son, Ronald Opus, had actually murdered himself. So the medical examiner closed the case as a suicide.

A true story from Associated Press, (Reported by Kurt Westerville)

AIIMS PG NOVEMBER 2008

75. WHAT IS FALLANGA?

A. BEATING ON SOLES WITH BLUNT OBJECT
B. Plucking hairs
C. Persistent pushing of head into vomit
D. Beating on soles



76.HYDROCUTION REFERS TO?

A. DROWNING IN COLD WATER
B. ELECTROCUTION IN WATER
C. POST MORTEM IMMERSION
D. IMMERSION IN BOILING WATER

77.NOT A CONSTITUENT OF EMBALMING FLUID?

A. PHENOL
B. ETHANAOL
C.FORMALIN
D. GLYCERINE

Explanation: Typically embalming fluid contains a mixture of formaldehyde, methanol, ethanol and other solvents. The formaldehyde content generally ranges from 5 to 29 percent and the ethanol content may range from 9 to 56 percent.

Embalming fluid is injected into the arteries of the deceased during embalming. Many other bodily fluids may be drained or aspirated and replaced with the fluid as well. The process of embalming is designed to slow the decomposition of the body.

Chemicals and additives

Potential ingredients include:

a. Preservative. 18%-35% mixture of formaldehyde, glutaraldehyde or in some cases phenol which are then diluted to gain the final index of the arterial solution. Methanol is used to hold the formaldehyde in solution. Formalin refers specifically to 37% aqueous formaldehyde and is not commonly used in funeral embalming but rather in the preservation of anatomical specimens.

b. Water Conditioner. These are designed to balance the "hardness" of water (the presence of other trace chemicals that changes the water's pH or neutrality) and to help reduce the deceased's acidity, a by-product of decomposition, as formaldehyde works best in an alkaline environment. Additionally, water conditioners may be used to help "inactivate" chemotherapy drugs and antibiotics which may bind to and render ineffectual the preservative chemical.

c. Cell Conditioner. These chemicals act to prepare cells for absorption of arterial fluid and help break up clots in the bloodstream.

d. Dyes. Active dyes are use to restore someone's natural colouration and counterstain against conditions such as jaundice as well as to indicate distribution of arterial fluid. Inactive dyes are used by the manufacturer of the arterial fluid to give a pleasant color to the fluid in the bottle, but does nothing for the appearance of the embalmed body.

e. Humectants. These are added to dehydrated and emaciated bodies to help restore tissue to a more natural and hydrated appearance.

f. Anti-Edemic Chemicals. The opposite of humectants these are designed to draw excessive fluid (edema) from a body.

g. Additional Disinfectants. For certain cases, such as tissue gas, specialist chemicals normally used topically such as Dis-Spray are added to an arterial solution.

h. Water. Most arterial solutions are a mix of some of the preceding chemicals with tepid water. Cases done without the addition of water are referred to specifically as "waterless". Waterless embalming is very effective but not economically viable for everyday cases

i. Cavity Fluid. This is a generally a very high index formaldehyde or glutaraldehyde solution injected undiluted directly via the trocar incision into the body cavities to treat the viscera. In cases of tissue gas phenol based products are often used instead.


Now what is meant by HUMECTANT??


A humectant is a hygroscopic substance. Examples of humectants include glycerine, propylene glycol and glyceryl triacetate. Others can be polyols like sorbitol, xylitol and maltitol, or polymeric polyols like polydextrose or natural extracts like quillaia, or lactic acid or urea. Lithium chloride is an excellent humectant but is toxic.

Although glycerine is itself not a germicide and has no preservative quality, it does increase the germ killing power of other chemicals, probably because it is an excellent solvent for disinfecting chemicals; its good solvent ability makes it an efficient carrier for the chemicals. Glycerine is also a good lubricator and is hygroscopic. If retained in tissues, it helps to prevent dehydration.

AND REGARDING PHENOL, REFERENCE FROM "Page number 124 & 125 of Embalming By Robert G. Mayer, Jacquelyn Taylor"

Phenol, also known as carbolic acid, phenol was one of the most commonly found components of both arterial and cavity fluids manufactured in the early days of the fluid industry. Today, it is used chiefly in cavity fluid formulations. Phenol is a coal-tar derivative that is a colorless crstalline solid. Upon exposure to strong light or metallic contamination, it darkens and assumes an amber or reddish brown appearance when in solution. The potency of phenol is not impaired to any great extent when such change occurs.

Phenol penetrates the skin very readily and is very rapidly absorbed by protein structures. Phenol and phenolic derivatives are good germicides. In addition, they assist formaldehyde in forming insoluble resins with albumins. Generally, their use in embalming fluids is confined to cavity fluids because they tend to produce a "putty gray” tissue. Formulations containing these compounds are often used as bleaching agents to lighten discolorations on the skin surface. The solution either is applied as an external pack or is injected subcutaneously with a hypodermic syringe.

78. THANATOLOGY IS STUDY OF?

A. DEATH
B. POLLEN GRAINS
C. DEAD NEW BORN
D. POST MORTEM INTERVAL

79.A MAN WORKING AS A PEST KILLER COMES TO OPD WITH PAIN ABDOMEN AND GARLIC ODOUR IN BREATH WITH TRANSVERSE LINES ON NAILS.POSONING IS DUE TO?

A. LEAD
B,ARSENIC
C.MERCURY
D. CADMIUM