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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.

Saturday, May 14, 2011

AIIMS Pre-PG MAY 2011( Forensic Medicine)

Q1. Condition promoting adipocere formation

1. Dry and hot
2. Hot and humid `
3. Dry & optimum
4. humid and optimum(temperature) 
Favourable for adipocere:
1. Fat
2. Female
3. Newborn
4. Open wounds
5. No drugs/sudden death
6. Room temperature (36hrs)
7. Autumn or winter
8. Fog, misty & humid
9. corpses buried one over the other
10. More deep graves
11. Oak, lead n Zn coffins
12. clothing made of nylon
13. Moist, clayey, loamy soils
14. pH >7
15. Low redox potential
16. High anaerobic
17. high salt content

Unfavourable for adipocere:

1. Thin
2. Male
3. Older
4. No wounds
5. Antibiotics, drugs, poisons
6. Cold temp(4-7d): Hot temp(decompose) [Clincher*]
7. Spring and summer
8. Dry
9. Individually buried corpses
10. Shallow or surface graves
11. Pine n sprue coffins
12. Straw bedding
13. Hot, Sandy, limey soils

2. What does the word "cardiac polyp" mean?

1. Acute infarct
2. Cardiac aneurysm
3. Benign tumour
4. Fibrinous clot
Cardiac Polyp : Mural thrombus in the right/left atrium at the time at the time of post-mortem examination appears as pedunculated mass with a stalk attached to wall of the heart and main mass in the lumen in cavity of the hear. 
Q3. In civil negligence, onus of proof is with

1. Judicial first degree magistrate
2. Police not below the level of sub inspector
3. Doctor
4. Patient
Doctorine of Burden of proof : 
In criminal litigation, the burden of proof is always on the state. The state must prove that the defendant is guilty. The defendant is assumed to be innocent; the defendant needs to prove nothing. (There are exceptions. If the defendant wishes to claim that he/she is insane, and therefore not guilty, the defendant bears the burden of proving his/her insanity. Other exceptions include defendants who claim self-defense or duress.)
In civil litigation, the burden of proof is initially on the plaintiff ( patient in case of Medical Negligence suit) . However, there are a number of technical situations in which the burden shifts to the defendant. For example, when the plaintiff has made a prima facie case, the burden shifts to the defendant to refute or rebut the plaintiff's evidence. 

Q. 4 A man working as a pest killer comes to opd with pain abdomen, garlic odor in breath & transverse meis lines on nails. What is diagnosis

1. Arsenic poisoning

2. Lead poisoning
3. Mercury poisoning
4. Cadmium poisoning

Arsenic  Poisoning  :  

Metallic arsenic is not poisonous, as it is not absorbed from the alimentary canal.
     Poisonous compounds:
     1.  Arsenious oxide or Aresenic trioxide (Sankhya or Somalkar): it is known as white arsenic. It has been found to be useful in treatment of Acute Promylocytic Leukemia (APL)*
     2.  Copper acetoarsenate (paris green): It combines with sulphydryl enzymes and inter­feres with cell metabolism.
     3.  Copper Arsenate (Schcele’s green).
–   Signs and Symptoms:
     1.  The Fulminant type: Large doses of arsenic can cause death in one to 3 hrs from shock.
     2.  The Gastro enteric type: This is acute poison­ing, resembling bacterial food poisoning or cholera.
          –   This is the most common form.
          –   The stools are expelled frequently and involuntarily, are dark coloured, stinking and bloody, but later becomes colorless, odourless and water resembling rice water stools of cholera.**
          –   Sequence of symptoms:
               • Throat pain
               • Vomitting (Bile, Blood and Mucous)
               • Purging (Tenesmus present)
     3.  Narcotic form: Tenderness of the muscle, delirium, coma and death.
     •    Arsenic poisoning resembles
          –   Pre malignant condition
          –   Cholera
          –   Fading measles
          –   Addison’s disease.

–   Treatment
     1.  Freshly prepared precipitated hydrated ferric oxide (arsenic antidote)* is given. Dialysed Iron is substitute.
     2.  In arsenic poisoning BAL is an antidote. (BAL is contraindicated in cadmium and iron poisoning).
     3.  Calcium disodium versenate
     4.  Alkali is contra indicated.
–   Postmortem appearance
     •    Red Velvety* appearance of the stomach mucosa.
     •    Subendocardial haemorrhage of heart.*
–   Chronic poisoning:
     1.  CNS—Polyneuritic, optic neuritis
     2.  Skin—finely mottled brown change mostly on the temples, eyelids and neck (RAIN Drop pigmentation)
          •    There may be a rash resembling fading measles rash*
          •    Hyperkeratosis and Hyperpigmentation of the palms and soles with irregular thicken­ing of the nails is seen.
          •    Nails show ALDRICH MEE’s line (Leuko­paronychia).{Confuser* Beau’s Lines
® Chronic Systemic Disease, also Muehrcke’s Line® hypo proteinemia}
          •    Nails show ALDRICH MEE’s line (Leukoparonychia).
–   Arsenophagists are people who take arsenic daily as tonic or as an aphrodisiac and they acquire a tolerance of up to 0.3gm or more in one dose.
Medicolegal Importance
    Arsenic is the most popular homicidal poison.
•    Napolean was killed using Arsenic poison (c.f. Socrates was killed using Hemlock poisoning).
•    It delays putrefaction.
•    It can be detected in completely decomposed body.
•    It can be found in bones, hair and nails for a long time.
•    It can be detected in charred bone and ashes.
•    It is sometimes used in abortion sticks.
•    Arsenic causes Black foot disease.*
•    Marsh test and Reinsch test are important Chemical tests*.
     Early stages greatest quantity in liver  Later keratin tissues: BONE, HAIR & NAILS.
     Test for Arsenic®
    I.  Reinsch Test
  II.  Marsh Test (mARSenich)
III.  Gutzeit Test.


Q 5 Formication & delusion of persecution occurs together in ( Repeat from AIIMS May 2009 )

1. LSD
2. Cocaine psychosis
3. Canabis
4. Amphetamine
Magnan’s symptoms or cocaine bug is char­acteristic, in which there is feeling as if grains of sand are lying under the skin or some small insects are creeping on the skin (tactile hallucinations). This phenomenon is also known as formication. Some subjects report hallucinations of weak flashes of light, termed "snowlights." 

Q.6 During autopsy, if spinal cord is to be examined what is the most commonly used approach

1. Anterior `

2. Posterior
3. Lateral
4. Antero-lateral
 Explanation :                                                               
Most commonly used approach : Anterior
BEST approach to examine Spinal Cord: Posterior
 Which approach used to open : Anterior, Posterior & Antero- lateral 

Q. 7 Degrees awarded by Indian universities are mentioned in

1. Schedule I of MCI act

2. Schedule II of McI act
3. Part 1 of schedule III
4. Part 2 of schedule III
1. The medical qualifications granted by any university or medical Institution in India which are included in the first Schedule shall be recognised medical qualifications for the purposes of this Act.

2. The medical qualifications granted by medical institutions outside India which are included in the Second Schedule shall be recognised medical qualifications for the purposes of this Act.

3. The medical qualifications granted by medical institutions in India which are not included in the First Schedule and which are included in Part I of the Third Schedule shall also be recognised medical qualifications for the purposes of this Act.

4. The medical qualifications granted by medical institutions outside India, before such date as the Central Government may, by notification in the Official Gazette, specify which are included in Part IInd of the Third Schedule shall also be recognised medical qualifications for the purposes of this Act

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