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

Explanation:

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%

Explanation:
  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.