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Dr. Sumit Seth,is a career diplomat,member of prestigious Indian Foreign Service.He happens to be the youngest post-graduate of Forensic Medicine in India.

Friday, November 26, 2010

AIIMS MD Entrance Exam November 2010

1) Auto-Rikshaw ran over a child’s thigh, there is a mark of the tyre tracks, it is an

A) Contact bruise
B) Patterned bruise
C) Imprint abrasion
D) Ectopic bruise


Imprint or patterned abrasions may result from forceful impact, as in a pedestrian struck by a Vehicle. The importance of patterned abrasions lies in the fact that their shape can be matched to the causative object, and for this reason they should be documented by photography with a scale, or by an accurate tracing. Common examples of imprint abrasions are the sole patterns of footwear in kicking assaults, and motor vehicle tyre tread marks in run-over pedestrian deaths.

2) Aluminum phosphide poisoning - all true except
a. Sub-endocardial infarcts
b. Produces phosphine gas
c. Oesophageal stricture
d. Cyt. A oxidase inhibitor

Explanation: Aluminum phosphide ( Celphos) toxicity appears to be due to release of PHOSPHINE on contact with moisture . This phosphine gas due to non competitive inhibition of cytochrome oxidase system of mitochondria or damage by free radicals causes global hypoxia.Significant inhibition of cytochrome-c oxidase activity can be found in ALP-poisoned patients
Organs with the greatest oxygen requirements appear to be especially sensitive to phosphine, including the brain, kidneys, heart, and liver. Phosphine has a characteristic odor described as "decaying fish. Cardiac dysrhythmias probably secondary to electrolyte imbalances have been described in sub-lethal acute exposures. Transient atrial fibrillation and sub-endocardial infarction, adrenocortical injury with elevated serum cortisol levels have been reported.

3) True about subendocardial hemorrhage are all except
a.) May be seen after head injury
b.) Involves RV WALL
c.) Continuous pattern
d.) Flame shaped hemorrhages

Explanation: Subendocardial hemorrhage are found after intracranial hemorrhage following injury due to trauma, suddenly hypotension following any bleeding problems, obstetric complication, toxic poisoning particularly with iron, arsenic, cocaine and cerebral hemorrhage strokes. SEH involves left ventricular walls, flame shaped confluent, non-petechial and continuous. SEH are signs of agonal vital events. (Page 295 Forensic Pathology Reviews: Michael Tsokos)

4) Spanish WINDLASS technique is a form of which type of execution?
a) Garroting
b) Mugging
c) Bansdola
d) Hanging

Garroting was practiced in Spain 

5).Pale infarct not seen in?

a. Kidney
b. Spleen
c. Heart
d. Lung

Hemorrhagic Infarct of Lung 
Explanation: Anemic infarcts (also called white infarcts) are white or pale infarcts caused by arterial occlusions, and are usually seen in the heart, kidney and spleen. These are referred to as "white" because of the lack of hemorrhaging and limited red blood cells accumulation, (compare to Hemorrhagic infarct). The tissues most likely to be affected are solid organs which limit the amount of hemorrhage that can seep into the area of ischemic necrosis from adjoining capillary beds. The organs typically include single blood supply (no dual arterial blood supply or anastomoses)

6) Wid marks formula

a) Alcohol
b) Time since death
c) Times since injury
d) Identification

New i-Phone application 
Explanation: In order to calculate the Blood Alcohol Concentration, we must divide the weight of the alcohol by the weight of only the portion of the body that holds the alcohol, rather than the weight of the whole body. Widmark's original research, still valid today( check out the new i-Phone app), found that the average man's body can hold alcohol in even distribution in 68% of its weight. Widmark called this "0.68" factor his Widmark `r' factor. The lower-case "r" stands for "reduced body mass", or "reduzierte körpermasse".

7) 20 yr boy is having diarrhea, rhino rhea, sweating, what is the most probable diagnosis?

a) Cocaine withdrawal
b) Heroin withdrawal
c) Marijuana withdrawal
d) LSD withdrawal

Explanation: Heroin Withdrawal symptoms: Restlessness, Insomnia, Diarrhea, Vomiting, Cold flashes with goose bumps, Kicking movements, Muscle and bone pain. Cocaine withdrawal symptoms (cocaine crash) : Fatigue, depression, restless behavior and a feeling of anxiety or paranoia.
Marijuana withdrawal: Irritability, anxiety, physical tension, increased aggression / anger, strange dreams.
LSD withdrawal: For LSD, the term withdrawal does not have the same meaning as for drugs that are habit-forming or addictive. While LSD use can rapidly lead to tolerance, it is not addictive.

8) About cranial trauma false is:
a) Racoon eyes seen in subgaleal hemorrhage
b) Depressed skull # is always over the immediate area of impact of brain
c) corticocavernous fistual occur in base skull #
d) post traumatic epilepsy seen in 15%

  Rule of Thumb* "Always" in choices is most of the time correct answer!
*apply at your own risk!

o BATTLE SIGN- Bruising behind ear at mastoid region, due to petrous temporal bone# (middle fossa #)
o LIGHT HOUSE SIGN--- seeping out of secretions in acute OTITIS media
o RACOON SIGN-Indicate subgaleal hemorrhage,and not necessarly base of skull #
o STANKIEWICK'S SIGN - indicate orbital injury during FESS. fat protrude in to nasl cavity on compression of eye ball from ouside
o TEA POT SIGN is seen in CSF rhinorrhoea.


piyush said...

superb sir.!!! thnx a lot sir.!!!

Manamita N said...

thnx a lot sir!!!!!!!!! :)

doxo said...

Bruises tend not to reflect accurately the shape of the object which produced them, and they change shape with time. Exceptionally the surface detail of the striking object may be imprinted as a #patterned bruise# on the skin, often #associated with a patterned abrasion#. Such patterned or imprint bruises typically occur following #a heavy impact,# such as from a shod foot or #"motor vehicle"#, or from the muzzle or foresight of a gun in a contact gunshot wound, with death occurring soon after injury, and so limiting the diffusion of blood and the obscuring of the imprinted pattern. Patterned bruises commonly have a bright red intra-dermal component whose diffusion is limited also by the dense collagenous dermal tissue. Occasionally clothing or jewellery may leave a patterned bruise on a body when it is crushed into the skin surface by an impacting object, e.g. a motor vehicle striking a pedestrian, or a kick through

##Patterned bruises## often result from abusive injuries. The bruise pattern commonly mimics the injuring object.1 With high-velocity injuries, like whippings or slaps, an unbruised negative image of the cord or hand may be outlined by a fine rim of petechae. At the margin of an injuring object, high-velocity impact stretches capillaries sufficiently to tear them. This may occur even when the force does not crush directly impacted vessels. Greater forces rupture directly impacted vessels creating in addition a positive image bruise of the object. If severe forces are applied more slowly, the elastic limit of the capillaries at the margins will not be exceeded.

sir confused with regard to above lines

doctorsumitseth said...

Dear Doxo!

Let me help remove this confusion by reading the lines again...

1. tend not to reflect accurately: Majority of cases do not reflect shape of object(Tyre)

2. Exceptionally: its exceptional rather than rule to see bruise

3. With death occurring soon: In the Q its a run over thigh o death won't take place.(hence there will be diffusion of blood which prevents patterned bruise to appear)

4. Run over injury has resultant of two vectors, perpendicular force plus tangential force as the tyre is moving in circle to cause run over hence the imprint of tyre will get printed on skin...

Above all, I've seen many cases where there are imprint abrasions in such run over cases...

So the answer is Imprint Abrasion.

In case you have counter-coup confusion! please feel free to discuss back.. that is what scientific temperament is all about.. and in final analysis only this will count not Qs/As...

Best wishes even if you have marked bruise as choice... I'm open for discussion...

mashu said...

dear sir,if patterned abrasion would be in option,could it be good answer than imprint abrasion.
dr.vij has classified abrasion as a.pressure( crushing,imprint) b.patterned seprately

which is THE STANDARD BOOK FOR FMT which most PG follows?

doctorsumitseth said...

@Mashu: Patterned and imprint abrasion are used interchangeably..

Pressure abrn can also leave an imprint..

For PG there are plethora of books.. I read Spitz and fisher & Bernard Knight in my PG

yashwin said...

thank you..sir...

Ashutosh said...

for Q20 as regards oesophageal stricture, there's no mention of it in the explanation provided by you. please enlighten.. thanks

pandey.shubh said...

hello sir...regarding Q8) racoon eyes r seen in # of anterior cranial fossa.. n acc to harrison 17/e pg 2597 depressed skull #are often asymptomatic bcoz the impact energy is dissipated in breaking the bone.......so i think the ans should b option (a)..thanks