AIIMS MD Entrance Exam November 2009

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.

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

Medical Tourism India (Spanish)

View more presentations from Dr. sumit Seth, i f s.

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.