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 Index 09
1. Indian legal system & medical jurisprudence 09

2. Medical Laws & Ethics 15

3. Sexual offences 22
4. Virginity, pregnancy, abortion 34
5. Identification 38
6. Trace evidence 54
7. Torture methods 57
8. Mechanical Injuries 60

9. Forensic ballistics 66

10. Thermal injuries 73

11. Asphyxial death 79

12. Regional injuries 91
13. Taphonomy
97
14. Autopsy 107
15. Forensic psychiatry 112
16. Animal organic irritants 115

17. Agricultural poison 119

18. Deliriant poison 121

19. Irritant organic plants 126

20. Spinal & cardiac poisoning 129
21. Metallic & non metallic poison 132
22. Asphyxiants 136
-

23. Corrosives 137

24. CNS depressants 139
 9

Indian legal system & Medical Jurisprudence

Basic terms

IPC- Indian Penal Code

Crime & punishment

i
CrPC- Criminal Procedure Code
Procedure of punishment

IEA- Indian Evidence act

Evidence & witness Oral evidence more valid than documentary evidence
(Because it can be cross examined)

PLANTIFF(victim) DEFENDANT(Accused)

Files the case Defends the case

:
.

Prosecution Lawyer •
Defence Lawyer

Cases

CIVIL CASE CRIMINAL CASE

Case b/w 2 parties Crime done against state

Plaintiff Vs Defendant State Vs Accused

SUMMONS CASES WARRANT CASES

Cases related to offences in Cases related to offences in
which punishment is < 2yrs which punishment is > 2 yrs
Offences

COGNIZABLE OFFENCE NON-COGNIZABLE OFFENCE

2[C]CRPC 2[I]CRPC
Arrest without warrant Can arrest only with warrant

BAILABLE OFFENCES: Police can give Bail

NON-BAILABLE OFFENCES: Only Magistrate can give Bail
 10
Eg: COGNIZABLE offence
Rape
Murder, attempt to murder
Ragging
Grievous hurt
Robbery
Dowry death
Sexual offence
Inquest

-Investigation of cause of death

Police inquest(m/c used - India)

Magistrate inquest
TYPES
Coroners inquest(Abolished in India)

Medical examiners inquest(Best form)

Procurator Fiscal system(Scotland)

Police inquest Magistrate inquest

174 CRPC 176 CRPC

Done by minimum rank I.Death in police custody

- Subinspector (SI) 2.Death in police firing
3.Death in police interrogation
SI can appoint Head constable 4.Dowry death (within 7 yrs of marriage)
5.Death in mental asylum
All unnatural deaths
6.Exhumation
Inquest report: Panchnama
(5 people witness)
l
1, 2 & 3 will be done by 4, 5 and 6 is done by
Judicial magistrate Executive magistrate

Appointed by High court Appointed by State Govt.

1. District magistrate
2. Sub-divisional magistrate
3. Additional district magistrate
4. District collector
5. Tehsildar
 11
Witness
COMMON WITNESS EXPERT WITNESS
(IEA 45)

Observing & giving witness Person who has got govt training

Eg: Eye witness Eg: Doctor, fingerprint expert

Can give evidence only about Can express opinions/ conclusions

facts perceived by them based on findings

Previous Year Questions AIIMS 2018

First-hand knowledge rule is applicable to
A) Common witness
B) Hand writing expert
C) Doctor
D) Hostile witness

Conduct money
-Diet money

-TA/DA is given
Paid in : 1. Civil cases- party by party
2. Criminal case- Only to expert witness by court (312 IPC)

Dying declaration (32 IEA)

ao

Written/ oral statements of facts by dying person related to death

re

Can be taken by any person- Magistrate

(In presence of 2 witness) Doctor
Police
Public
•

Oath not required

No cross, leading questions
: If patient survives, it act as a corroborative evidence (157 IEA)
Be

Verbatim- “record word by word”

•
Role of Doctor- certify’COMPOS MENTIS’ Person in a composed mind during the
start & throughout the whole recording
 12
COURTS - india

SUPREME COURT Any term imprisonment

HIGH COURT Unlimited fine
DISTRICT/SESSIONS JUDGE/
ADDITIONAL SESSIONS JUDGE

ASSISTANT DISTRICT/ SESSIONS JUDGE Maximum 10 yrs + Any fine

CHIEF JUDICIAL MAGISTRATE

Maximum 7 yrs + Any fine

1ST CLASS JUDICIAL MAGISTRATE Maximum 3 yrs + Rs 10,000 fine

2ND CLASS JUDICIAL MAGISTRATE

Maximum 1 yr + Rs 5,000 fine

Sessions court
- Lowest court which can give Death sentence, but need to be confirmed by High court

Chief Judicial magistrate in metro cities- a/k/a METROPOLITIAN MAGISTRATE

JUVENILE COURT Every death sentence is confirmed by High court

Age < 18 yrs Appeal late at Supreme court

1st class judicial magistrate(Female)
President
Maximum punishment: 3 yrs (Mercy petition)

Forgive death sentence

(Power of Amnesty)
SUMMONS(Subpoena)
•

Legal document to attend court given by Judge

•

Summons from court- 61-69 IPC

•

Disobedience of summons- Punishable offence- 174 IPC(6months/Rs 1000 fine)

When two summons got from 2 courts?

Higher court > Lower court

Criminal court > Civil court
Ad. Testificandum: Common witness
(Attend evidence)
Subpoena
Duces Tecum: Expert witness
(Document take)
 13
Court procedures- order of trial (138 IEA)

OATH (51 IPC)

-In the name of God
-Name of God is not taken by atheist & expert witness
-If doesn’t take oath, punishable- IPC 178
-Age < 12, oath not required

Examination in chief (137IEA)

By same party Lawyer
-No leading questions can be asked- 142 IEA
Leading questions can be asked to hostile witness-154 IEA

Cross examination (145 IEA)

By opposite party Lawyer
-Can ask any questions(Leading questions)- 143 IEA
-No time limit

Re-examination (137-138 IEA)

By same party lawyer
-For clearing doubts in cross examination
-No leading questions

165 IEA- Judge can ask question at any point

Hostile witness (154 IEA) : Conceal truth/ Telling lie

193 IPC: punishment for giving false evidence (Perjury)
(upto 7 year) 118 IEA: No age limit for giving evidence
197 IPC: punishment for producing false documents 119 IEA: Dumb witness by writing/ singing
(upto 7year) 311 CRPC: Recall & reexamination of witness

201 IPC: punishment for disappearing evidence

191 IPC: Definition of perjury
 14

Previous Year Questions NEET PG 2020

The punishment of perjury is dealt under IPC
A) 191
B) 192
C) 193
D) 197

Previous Year Questions NEET PG 2021

While recording evidence in a court of law,the lawyer asked the witness : “ Did you see
that Mr.’A’ Killed Mr.’B’?”.Witness answered : ”Yes”.This type of question is permitted in ?
A. Examination in Chief
B. Direct examination
C. Re-examination
D. Cross examination
 15
Medical laws & ethics
The legal responsibilities of a Doctor
Medical Etiquette: Doctor to each other should have Professional courtesy

Nmc- national medical commision

MCI implemented in 1956- Now called NMC

Schedule 1: Indian medical graduates

3 schedules Schedule 2: Foreign medical graduates

Sub-clause I: Indian medical graduates not included in schedule 1
Schedule 3:
Sub-clause II: Foreign medical graduates not included in schedule 2

FUNCTIONS OF NMC
Medical education
Maintaining medical registers
Appeal in disciplinary action
Examination of foreign medical graduates
Warning of infamous conduct

State medical council (smc)

-Medical education in state
-Medical register
-Appeal in disciplinary action
-Warning for infamous conduct

Infamous conduct
Dishonourable/ Disgraceful conduct of a Doctor
Against medical ethics(Mortality)
Sec 84 Medical Ethics

PUNISHMENTS
Warning notice
: Professional death sentence
 16

Eg: 1. Adultery/ Rape/ Seducing the patient

2. Under influence of alcohol while on Duty
3. Advertisement/ using large sign board
4. Illegal abortions
5. Under influence of heroin/ cannabis & also prescribing these drugs
6. Covering(allowing non-medical person in a medical procedure)
7. Dichotomy(fee splitting)
8. False certificates- 197 IPC
9. Doctor convicted (Eg:PC-PNDT act)

PC-PNDT Act Sex determination

1st offence- 3yrs

Imprisonment
2nd offence- 5 yrs
1st offence- 5yrs
Professional death sentence
2nd offence- Permanent

Medical negligence

Absence of reasonable care & skill or wilful negligence of a medical practioner in the
treatment of patient which causes bodily injury or death of the patient
1. Criminal negligence
2. Civil negligence Tests for medical negligence: BOLAM TEST
TYPES 3. Corporate negligence BOLITHO TEST
4. Contributory negligence
5. Patient negligence
4 ‘D’ ELEMENTS
1. Duty
Doctor should be on duty
2. Dereliction of duty
Absence of reasonable skills/ care
3. Direct causation
Eg: leaving instruments
Facts speaking for themselfs- Res ipsa Loquitor
4. Damage
Death of patient: 34 A IPC- 2 yr + PDS= fine
Hurt of patient
 17
CRIMINAL NEGLIGENCE

Gross negligence
: Leaving swab, instruments, mismatched blood transfusion, tight plaster etc
Violation of laws(specific laws)
: Punishable under 304 A IPC- 2yrs + fine
I

Consent is not a good defence, contributory negligence is not a good defence

-

Handled by criminal court

CIVIL NEGLIGENCE
Types of CONSUMER COURT
1

Non-gross negligence
Handled by civi/ consumer court I. District court- compensation upto 1 crore
: Punishment: Fine II. State- compensation 1-10 crore
III. National- >10 crore

CONTRIBUTORY NEGLIGENCE
Doctor + patient negligence
: Eg: Doctor applies tight plaster cast on patients leg, but instructs him to report
numbness, patient develops numbness in his toes, doesn’t inform doctor- suffers
permits injury

CORPORATE NEGLIGENCE

Entire hospital negligent

: Doctor + nurses + management

PATIENT NEGLIGENCE
From patient side
: Eg: Discharge against medical advice

Previous Year Questions NEET PG 2020

In the civil negligence case against a doctor who bears the onus of proof?
A) Patient
B) Police not under rank of sub inspector
C) Magistrate
D) Doctor
 18
Doctrines related to medical negligence

1. VICARIOUS LIABILITY
\

Respondent superior
A/k/a Doctrine of captain of ship/ Doctrine of deep pockets
: Negligence committed by junior doctor; senior doctor is responsible
Not applicable b/w surgeons & anaesthetist
Not applicable for mistake done by head nurse

2. RES IPSA LOQUITOR

Leaving swab/ instruments
: Civil/ criminal negligence
3. NOVUS ACTUS INTERVENIENS
‘ACT OF GOD”
Eg: when the doctor has been negligent, but a completely unexpected and unforeseen

: act happened which further worsened the pateint condition

The new act intervening should be completely unexpected & unforseen

4. BORROWED SERVANT DOCTRINE

Negligence made by an employee borrowed
: The employer will be responsible

Medical maloccurrence/Inevitable Accident

On certain occasions, despite all proper care given by the doctor during treatment, the
patient fails to respond properly or may suffer some adverse reactions of the drug which
may lead to severe injuries or permanent deformities

MEDICAL JURIS PRUDENCE= using legal knowledge in field of medicine

DOCTRINE OF IMPLIED CONSENT(92 IPC)= SURGERY/ TREATMENT in case of emergency without consent
(Doctrine of anticipation)
 19

PROFESSIONAL MISCONDUCT
If a doctor does not maintain the medical records of his/her indoor patients for a
period of three years as per regulation and refuses to provide the same within 72
hours when the patient or his/her authorised representative makes a request for it
as per the regulation then it is professional misconduct

Previous Year Questions

AIIMS 2018
If a person starts to serve a second employer, the new employer is responsible for his actions by
A) Vicarious liability
B) Doctrine of negligent choice
C) Contributory negligence
D) Borrowed servant doctrine

Previous Year Questions AIIMS 2020

A patient comes to the casualty with life-threatening injuries. There was no time for taking consent. The
doctor started doing life-saving procedures with all precautions, and despite best efforts, the death of the
patient occurred. The doctor is not responsible under which doctrine?
A) Res ipsa loquitor
B) Doctrine of anticipation
C) Doctrine of extended consent
D) Doctrine of conjugated consent

Previous Year Questions AIIMS 2018

In case of professional misconduct, the patient's records on demand should be provided
within:
A) 72 hours
B) 48 hours
C) 24 hours
D) 7 days

Previous Year Questions AIIMS 2020

A surgeon performs a hysterectomy for uterine fibroids after obtaining relevant informed consent
from the patient. Despite the adequate precaution, the ureter was injured intraoperatively. The doctor
is not held responsible under?
A) Novus actus interveniens
B) Medical maloccurrence
C) Res ipsa loquitor
D) Physician error
 20

Grievous hurt

Definition: 320 IPC

Punishment: 325 IPC
Defined as any hurt which endangers life or which causes the victim to be in severe bodily
pain, or unable to follow his ordinary pursuits for a period of 20 days

ACID ATTACK: 326 A IPC

(Vitrialage)
Attempt to do acid attack: 326 B IPC
Hurt: 319 IPC

320 IPC
1. EMASCULATION (CUTTING OF PENIS)- LOSS OF MUSCULINE POWER
2. LOSS OF VISION -Permanent loss of vision- one/ both eye
3. LOSS OF HEARING
4. LOSS OF MEMBER/ JOINT
5. LOSS OF POWER OF A MEMBER/ JOINT
6. DISFIGURATION OF FACE
7. # / DISLOCATION
8. ANY INJURY WHICH CAUSES SEVERE BODY PAIN/ PERSON UNABLE TO DO HIS
ORDINARY ACTIVITIES

299 IPC- Culpable homicide

Includes- murder, non-murder
300 IPC- Definition of murder
Guilt mind + guilt act

302 IPC- Punishment for murder

Death sentence/ life imprisonment
307 IPC- Attempt to murder
201 IPC-disappearance of evidence
 21
MEDICOLEGAL importance of age

1. 7 months of intrauterine life

•
Month of viability
Talus appears at 28 weeks
: Pupillary membrane in eyes disappear
2. One year
Infanticide- 302 IPC
: FELICIDE- Killing of infant or fetus by parents
3. Upto age 5- custody of child is with mother in divorce
Railway act: any difference below 5 yrs - NOT PUNISHABLE

:
4. < 7yrs - CRIMINAL RESPONSIBILITY
<7yrs- Not punishable(82 IPC)

5. 7-12 yrs
Maturity +
:
Punishable(83 IPC)
At 12 yrs: Can give consent for medical examination
6. 14 yrs
: FACTORY ACT(1948)
<14 yrs- punishable for child labour
7. 18yrs
:Can give consent for surgery
MAJOR- can vote
: Driving licence
Organ donation
-

Abortion(MTP)
.

Consent for sexual intercourse

 22

Sexual offences
Classification
Rape
NATURAL SEXUAL OFFENCES Incest
Peno-Vaginal intercourse Adultery 497 IPC: Has been removed(Decriminalised)
Sodomy
Lesbianism
UN-NATURAL
Oral contusion
Bestiality
SEXUAL PERVERSION Sexual paraphyllia
No intercourse
STALKING: Following girl 354 D IPC
SEX LINKED OFFENCES DISROBING FEMALE: Tearing clothes publically 354 B IPC
SEXUAL HARRASMENT in working place 354 A IPC
rape

India, Rape is only with Females(Exception: France)

Definition: 375 IPC

/

Penetration of penis into vagina, anus, oral cavity, urethral route

Insertion of any object
: Manipulation of body for sexual pleasure
Application of mouth into vagina, anus
: Without will, without consent
-

With consent(but in fear/ by fraud/ Intoxicated)

Minimum age for allowing(consent) for sexual intercourse in females: 18yrs

No age limit in males(accused)

STATUTORY RAPE: < 18yrs (married/ unmarked) with/ without consent

PUNISHMENT- 376 IPC

376(1): min 7 yrs to life imprisonment
376(2) Custodial rape: min 10 yrs to life imprisonment
 23
Classification of 376 ipc

376 A: Rape & Murder

Female in coma/ vegetative state after rape
Punishment: life imprisonment/ death penalty

376 AB: Rape on female <12

376 B: Wife without consent or after divorce
Punishment: 2-7 yrs imprisonment
376 C: Custodial rape
Punishment: 5-10 yrs imprisonment
376 D: Gang rape
Punishment: 20yrs to life imprisonment

376 E: Habitual offender

Punishment: Life imprisonment/ Death penalty

Criminal amendment act 2018

Age of women Offence IPC Punishment

Rape 376AB 20 yrs to life imprisonment

<12 yrs
Gang rape 376DB Life imprisonment to death penalty

<16 yrs Rape 376(3) 20yrs to life imprisonment

Gang rape 376DA Life imprisonment to death penalty

16 yr and above Rape 376 10yrs to life imprisonment

354 IPC
354 IPC: Indecent assault of female(COGNIZABLE offence) DOWRY death: 304 B IPC
DOMESTIC VIOLENCE: 498 IPC
354 A: Sexual harassment (1 to 3 yrs)
ABETMENT TO SUICIDE: 306 IPC
354 B: Disrobing or undressing of female(3 to 7 yrs) SEXUAL HARRASMENT AT OFFICE:354A IPC
354 C: Voyeurism- 1st time= upto 3yrs
2nd time= upto 7 yrs (non-bailable offence)
354 D: Stalking- 1st time= upto 3 yrs
2nd time= upto 5 yrs(non-bailable offence)
 24
Vitriolage
326 A IPC: Acid attack (10yrs imprisonment + 10 lakh fine)
326 B IPC: acids attempt (upto 7 yrs)

Examination of victim

Under 164 A CrPC Examined without consent

: Start treatment of the victim 354 IPC- 5yrs imprisonment + fine
Inform police under 39 CrPC
: Consent is required for examination of rape under 53(2) CrPC
Under supervision of registered female practioner
: Refusal of victim for examination is informed refusal which has to be documented
Minimum sub-inspector can handle rape case & must inform doctor within 24hrs
: Check for injuries on the body
Examine clothes for evidence
: Collect hair, semen, blood samples using sexual assault forensic evidence (SAFE) kit
Hymen tear: (m/c hymen- semilunar)

: Hymen rupture is checked using glassier keen rod

M/c site: posterolateral[5 to 7 ‘o’ clock]
Speculum vaginal examination in lithotomy position
Micro injuries checked using Toluidine blue stain
: Four vaginal swabs

Previous Year Questions AIIMS 2018

A registered medical practitioner is requested by a survivor of sexual violence to examine her. What is
the maximum time by which the practitioner can take a vaginal swab to look for the presence of
spermatozoa?
A) Within 72 hours
B) Within 36 hours
C) Within 5 days
D) Within 48 hours
 25
Examination of accused

Under 53(1) CrPC

: Consent not required, reasonable force can be applied
Smegma: If present on penis, indicates no complete sexual intercourse in last 24hrs.
: Examine the penis & glans for vaginal cells using
Papanicolau’s & Lugol’s iodine (positive upto 4days)

166 A IPC: Failure of the police to record FIR

(6 months to 2 yrs imprisonment)
166 B IPC: Any hospital does not provide immediate treatment
(1 yr imprisonment/ fine/ both)

POSCO act-2012

Protection Of Children from Sexual Offence

For child below 18yrs of Age
: Identity should never be disclosed
Special courts to handle cases
: Age of child must be determined by a medical expert under presence of a female doctor
Evidence must be collected within 30 days & trial must be completed within 1 year
: Magistrate: Additional sessions court judge
Definition:
1. Penetrative sexual assault- Penetrate the penis into vagina, urethra, anus or mouth
2. Aggravated penetrative sexual assault- Custodial sexual assault
3. Sexual harassment- Sound & gesture, child phonographs, make child exhibit
or show body parts
4. Sexual assault- Sexually touches, physically forces into sexual
act against their will
 26
OFFENCE PUNISHMENT PUNISHMENT
(POSCO 2012) (POSCO 2019)

Penetrative sexual assault 7 yrs to life term imprisonment + fine If child below 16 yrs:
20 yrs to life term + fine
Aggravated penetrative sexual assault 10 yrs to Life term imprisonment + fine
20 yrs to death in the list of
aggravated sexual assault
1. Assault resulting death of child
2. During natural calamity

Sexual assault without penetration 3 yrs to 5yrs imprisonment + fine Same

Aggravated sexual assault without penetration 5-7 yrs imprisonment + fine Additional offences:
1. During natural calamities
2. Administering any chemical
or harm cervical maturity

Sexual harassment 0-3 yrs imprisonment + fine Minimum 5 yrs imprisonment

Use of child for ponography Additional offences:

0-5 yrs imprisonment + fine
1. Failure to destroy or delete such
Storage of child pornography 0-3 yrs + fine 2. Made for transmitting

Previous Year Questions

AIIMS 2018
According to POCO, aggravated sexual assault includes:
A) Sexual assault done by police officer
B) Threatening
C) Gang penetrative sexual assault
D) All of the above

Previous Year Questions AIIMS 2019

An 11-year-old girl was found to be quiet and shy in her classroom with intermittent crying, since the
past few days. It was discovered that her uncle was touching her genitalia inappropriately. The duty of
the principal is to report this to?
A) Magistrate
B) Police
C) Child Welfare Committe
D) Parents
 27

Previous Year Questions AIIMS 2020

A 14-year-old girl comes to the OPD with her mother. History of penovaginal penetration by the neighbour is
reported to the doctor. The girl admits to giving the neighbor the consent for the same and says she does not want
to be examined. As a medical officer, which of the following should you do?
1. Document informed refusal
2. Do not inform the police A) 1,2,3 are true
3. Counsel the mother and daughter B) 2,3,4 are true
4. Examine with necessary force C) 1,3,5 are true
5. Inform the police D) 3,4,5 are true

Previous Year Questions AIIMS 2020

You are a medical officer at a PHC, a 17-year-old girl presents to you after a sexual assault, the
girl refusesnexamination. How would you proceed in this case?
A. Start treatment for STD and pregnancy
B. Inform the police A) A, B and C are true
C. Record refusal of consent B) B, C and E are true
D. Take vaginal samples C) A, D and E are true
E. Start medical examination D) B and C are true
 28
Unnatural sexual offence

IPC 377: Punishment is maximum 10 yrs

1. HOMOSEXUALITY
A. LESBIANISM
A/k/a Tribadism (b/w female & female)
: Not punishable
Active partner - male character: DYKE/BUTCH
:
Passive agent- female character: FEMME
B. SODOMY/ GREEK LOVE/ BUGGERY
Anal sex
: Sodomy between adult & child: PEDARASTY
Adult: PEDARAST
Child: CATAMITE

Elderly: GERONTOPHILIA
Sodomy b/w adults HIJARA(penis absent)

:
Male prostitutes
(Passive agents) ZENANA
Examine a sodomy patient on KNEE-ELBOW position
Sodomy patient types

:
Normal passive: Multiple anal & peri anal injuries
Constriction of anus

Habitual passive: Anal canal is funnel shaped

(CATAMITE) Anal hair shaved
Lateral buttock traction test
(Paradoxical dilatation of anus during
bimanual traction of anus during bimanual
traction of buttocks)
Prolapse +
Loss of mucosal rugosity
Punishable when without consent- 377 IPC
 29
2. ORAL SEX/ SIN OF GOMORRAH/ BUCCAL COITUS
Not punishable when done in adults with consent
Findings: Erythema
(Oral cavity) Bruise
Spermatozoa

3. BESTIALITY
Intercourse with animals
: Punishable- 377 IPC

Sexual perversion/ paraphilia

SADISM : A/k/a Algolagnia, torturing partner for sexual pleasure

MASOCHISM : Male getting sexual pleasure when female beaters male

BONDAGE : MASOCHISM + SADISM

VOYERISM/ PEEPING TOM :A/k/a SCOTOPHYLIA, watching naked female/ mixoscopia

(2 partners engaged in sex)
TROILISM : Husband getting sexual pleasure when wife having intercourse with another male

FROTTEURISM : Rubbing private parts against female buttocks, thigh, breasts, genital area in crowd
Punishable under IPC 290
GOLDEN SHOWER/ UNDINISM : Sexual satisfaction with smell of urine

COPROPHILIA : Sexual satisfaction with smell of feces

TRANSVERSITIM/ EONISM : Behaving like female, wearing female dress

EXHIBITIONISM : Showing off genitalia/ private parts in public places

294 IPC: punishable upto 3 months
SCATALOGIA : Calling unknown female & sexual conversation

FETICHISM : Sexual pleasure on female inner wears

NECROPHILIA : Sex with dead body 297 IPC

 30
NECROPHAGIA : Sexual satisfaction after eating dead body 297 IPC

URANISM :Licking/ fingering female genital area

BOBBIT SYNDROME : Female partner amputees penis of male partner

SATYRIASIS : Excessive sexual desire in males

NYMPHOMANIA : Excessive sexual desire in females

NARRATOPHILIA : Sexually satisfied by pornography study

BARBERIO TEST

Saturated aqueous/ alcoholic solution of PICRIC ACID added to Spermatic fluid produces
YELLOW- NEEDLE shaped RHOMBIC crystals of SPERMINE PICRATE

Spermin stain
(Prostatic secretions)

FLORENCE TEST

Stain extracted by 10% HCL

Drop placed on glass slide and allowed to dry

Drop of FLORENCE(potassium iodine, iodine, water)

If semen + Choline in stain

(Seminal vesicles)
DARK-BROWN CRYSTALS OF CHOLINE IODINE
(Rhombic or needle crystals)
 31

Previous Year Questions NEET PG 2020

A 5-year-old child with a history of perianal pain is brought to the OPD. On subjecting the specimen from
the perianal region to a test, it produces yellow rhombic crystals of spermine picrate. What is the test
done?
A) Barberio test
B) Florence test
C) Takayama test
D) Teichmann test

Previous Year Questions NEET PG 2021

A person was sitting naked in the balcony facing a crowded park getting sexual
gratification.This paraphilia is known as ?
A. Voyeurism
B. Exhibitionism
C. Masochism
D. Fetichism

Previous Year Questions INICET 2021

An 18-year-old female was sexually assaulted by a 20-year-old male. There was presence of
white stains on the clothes of the victim. Barberio's test was performed on the stains. Which
of the following is detected by this test?
A) Spermine
B) Acid phosphatase
C) Choline
D) Fructose

Previous Year Questions

NEET PG 2019
Frotteurism is
A) Obtaining sexual pleasure by wearing clothes of opposite sex
B) Desire to seek surgery to become member of opposite sex
C) Sexual gratification by rubbing his private parts against another person
D) Exposure of one's genitals to an unsuspecting stranger
 32

SUPERFECUNDATION

-Fertilisation of two ova which have been discharged : from the ovary at the same period,by two
separate acts of coitus committed at short intervals.
-Both ova do not always develop to maturity.
-One foetus may be aborted early or die and retained until the labour that expels the other.
-The dead foetus may be flattened by pressure and may not be recognisable, and is referred to
as FOETUS COMPRESSUS or FOETUS PAPYRACEUS.
-The spermatozoa causing fertilisation may be
from different men.

SUPERFOETATION

-Fertilisation of a second ovum in a woman who is already pregnant.

-Ovulation may occur during first trimester of pregnancy until decidua vera comes into
apposition with decidua reflexa and decidual cavity gets obliterated.
-Fertilisation of newly released ovum may occur following coitus.
-Later, two foetuses are born either at the same time showing different stages of
development, or two fully developed foetuses are born at different periods varying from one to
three months.

SUPPOSITITIOUS CHILDREN

• It means fictitious children.

• A woman may pretend pregnancy and delivery and later produce a living child as her own, or she
may substitute a male child for female child born of her, or for an abortion.
• This is done for obtaining money or for the purpose of claiming property.

POSTHUMOUS CHILD

Posthumous child is a child delivered after the death of the biological father or child
delivered after the death of the biological mother, usually when delivered by a Caesarean
section
 33
Previous Year Questions NEET PG 2018
Which of the following is true about "posthumous child"?
A) The child is born dead
B) The child is delivered after death of biological father
C) The child is illegitimate
D) The child is abandoned by the parents

Previous Year Questions NEET PG 2021

A married woman gives birth to twins.The husband doubts he is the father and gets a paternity
test done.The test shows that he is the father of one infant but not the other.This is :
A. Superfoetation
B. Superfecundation
C. Papyraceous child
D. Suppositious child
 34

Virginity, Pregnancy, Abortion

Virginity

Virginity lost: Defloration

VIRGIN DEFLORATION
Hymen Intact May be torn
Posterior comminuted/ Fourchette Normal Torn
Fossa navicularis Intact Disappered

Hymen

Fold of mucous membrane surrounding vaginal wall

Semilunar/ crescentric type- m/c
: M/c site of hymen rupture: Posterolateral (5-7 ‘o’ clock)
TRUE VIRGIN
A Female who never had sexual intercourse
Hymen: May be intact/ ruptured
FALSE VIRGIN
A female who participated in sexual intercourse
Hymen: Intact(elastic hymen)

Previous Year Questions AIIMS 2018

An 18 year old girl was brought to the OPD. Examination revealed the following findings: labia majora
separated, labia minora- flabby, fourchette tear present, roomy vagina with intact hymen. The findings
are indicative of:
A) True virgin
B) False virgin
C) Premenstrual stage
D) Molestation
 35
Previous Year Questions NEET PG 2020
In the case of rape of a young child, the hymen is usually
A) Ruptured since it is superficially situated
B) Ruptured since it is very thin
C) Unruptured since it is deeply situated
D) Unruptured since it is highly elastic

Mtp act
•

Medical termination of pregnancy act

a

Implemented in 1971 Upto 20 weeks- 1 doctor

MTP- amendment bill ( 2014) Upto 24 weeks- 2 doctor
: Can be done in unmarked females
>24 weeks- Medical board
Age >18, If age is <18 yrs- consent from mother
: Contraceptive failure in unmarked female is an indication
•

Husband consent not required

•

MTP without indication is punishable under MTP act amounts one yr imprisonment & fine

MTP-INDICATION
1. Social indication(contraceptive failure)
2. Eugenic indication(malformed child)
3. Therapeutic indication(high risk mother)
4. Humanitarian(pregnancy as a result of rape)

MTP- QUALIFICATION

Upto 12 weeks: RMP with experience of 25 cases in which 5 were performed

independently(can be MBBS doctor)

>12 weeks: MS/DNB/DGO- OBG/ 6 months in OBG(house job)/ 1 year in OBG

hospital experience
 36
Previous Year Questions AIIMS 2017
Revised A 14-year-old rape victim presents with 22 weeks of pregnancy. What should not be done?
A) Male doctor can examine in the presence of female attendant
B) Vaginal swab examination is not necessary
C) No need to confirm pregnancy by UPT
D) Termination of pregnancy with her consent by a Gynaecologist

Abortion

Premature expulsion of the fetus from the mothers womb at any time of pregnancy, before
the full term of pregnancy is completed

Agents used: Calotropis

Lead
Semicarpus
Papaya
Pineapple

Criminal abortion

Unlawful killing of fetus

312 IPC: with mother’s consent
313 IPC; without mother’s consent
314 IPC: Death of the mother
315 IPC: killing a fetus > 28 weeks(inside uterus/ after birth)
316 IPC: killing fetus in an attempt to kill the mother
Live birth fetus- pm findings
A

>28 weeks
•

Signs of life +
PM FINDINGS
WREDIN TEST :Air in middle ear (Sign of life due to Eustasiab tube air entry)

BRESLAUS SECOND LIFE TEST :Air in bowel (Air entry due to respiration)
FODERE TEST OF LUNG WEIGHT
Before respiration: 30gm
After respiration: 70gm
 37
PLOQUET TEST
Lung wt 1/70= unrespired lung
Body wt 1/35= respired lung(due to increase blood flow)

HYDROSTATIC FLOTATION TEST/ RAYGAT TEST

Fetal lung Specific gravity

Respired : 940 Specific gravity water: 1
Unrespired : 1040
Fetal lung placed in water
Floating: respired
Unfloating: unrespired

Fetal lung cut into pieces, placed in water

Floating: respired
Sinks: unrespired

False +ve: Putrefaction/ artificial respiration

False -ve: Atelectasis/ pneumonia/ infection
Dead born fetus
Died in uterus
PM FINDINGS
1. Maceration
Aseptic autolysis
Skin slippage- in 24hrs
Pink/ red appearence
2. Spalding sign
On 7th day
USG finding- Overlapping of cranial vault
3. Mummification
2weeks
4. Robert sign
<12 hrs
Earliest sign
USG finding: Gas in aorta
5. Rigor mortis
Not seen < 2 months old fetus
 38
Identification
Race identifiaction

Breadth of skull
Cephalic index = X 100
Length of skull

Cephalic index Race

Dolichocephalic 70-75 Negro, Pure aryans

Mesaticephalic 75-80 India, Chinese, European

Brachycephalic 80-85 Mongol

OTHER INDICES FOR RACE DETERMINATION

Length of radius
Brachial Index =
Length of humerus

Length of Tibia
Crural Index =
Length of Femur

Length of Humerus + Length of radius

Intermembral Index =
Length of Tibia + Length of femur

Orbit- Round
Face- Round
Teeth- Shovel shaped incisor
MONGOL Enamel pear seen with premolar
Taurodontism: Bull tooth (wide pulp cavity, tooth itself is big)
Congenital absence of 3rd molar
Hair- Non fragmented, circular

RACE HAIR CROSS SECTION

Negroids Elliptical
Caucasoids Round to ovoid
Mongoloids Circular
 39

NEGRO: Orbit is rectangular

CAUCASIAN: Orbit is triangular, Carmelli cusp in molar teeth

Previous Year Questions

AIIMS 2017

Which of the following is false regarding teeth features and ethnicity?

A) In negroes the cusps of molars are wide and deep and shovel shaped cusps in incisors
B) Caucasians have carabelli cusps
C) Upper third molar is most commonly absent in Mongolians
D) Prominent lingual ridge and labial ridge in mongols

Sex determination

KROGMAN FORMULA - Sex determination using Bone

Complete skeleton : 100% Differentiation

Pelvis + Skull : 98% Differentiation
Pelvis : 95% Differentiation
Skull : 90% Differentiation
Long bones : 80% Differentiation

MANDIBLE MALE FEMALE

Appearance Large, prominent muscle Small, not prominent

markings, U shaped muscle markings

Chin Square shaped Rounded

Angle of body with ramus Less obtuse (<125 degree) More obtuse (>125 degree)
 40

FEATURES MALE FEMALE

Frontal eminence Small Large

Parietal eminence Small Large

Square with Rounded with
Orbits smooth margin sharp margin

Supraorbital ridge Prominent Less prominent

Forehead Steeper Vertical

Glabella More pronounced Less pronounced

Frontonasal junction Distinct & angulated Smooth

Occipital condyle Large Small

Mastoid process Large & blunt Small & pointed

Occipital protuberance Well marked Less marked

Palate Large, broader & U shaped Smaller & parabola

Zygomatic arch More prominent Less prominent

Previous Year Questions AIIMS 2018

Which of the following trait is a feature of the female skull?

A) Larger teeth
B) Frontal and maxillary sinuses are well developed and larger
C) Frontal and parietal eminences are larger
D) Supratympanic crest is present
 41

PELVIS MALE FEMALE

Pelvic inlet Heart shaped Circular

Pelvic cavity Conical & funnel shaped Smooth & rounded

Per auricular sulcus Narrow, shallow, not frequent Broad, Deep, More
frequent(Evidence of pregnancy)

Sub pubic angle V shaped, acute U shaped, obtuse

(< 90 degree) (>90 degree)

Greater sciatic notch Narrow & deeper Wider & shallower

(Best parameter)

Chilotic line Sacral part is more Pelvis part is

(Ileopectineal line) prominent more prominent

Obturator foramen Large & oval Small & triangular

Ischial tuberosity Inverted Everted

Body of pubis Triangular Square

Sacroiliac joint Extends up to 3 Extends up to 2-1/2

vertebra vertebra

PELVIC INDEX MALE FEMALE

Ischia pubic index Length of pubis 91-115

X100 74-94
(Best index) Length of Ischium
A/k/a WASHBURN INDEX

Width
Sciatic notch index 4-5 5-6
Breadth

Transverse diameter of body of S1

Corpobasal index Less More
Maximum anterior breadth or sacral breadth
 42

STERNUM MALE FEMALE

ASHLEY RULE >149mm <149mm

Length of sternum

MALE Length of body > 2X length of manibrium

HYRTL’S RULE
FEMALE Length of body < 2X length of manibrium

Previous Year Questions AIIMS 2017

True regarding corporobasal index of sacrum

A) Breadth of fifth lumbar vertebra X 100 / breadth of all sacral vertebra

B) Breadth of first sacral vertebra X 100 / breadth of fifth lumbar vertebra
C) Breadth of fifth lumbar vertebra X 100 / breadth of base of sacrum
D) Breadth of first sacral vertebra X 100 / breadth of base of sacrum

Previous Year Questions INICET 2021

A skull was recovered from a forest. According to inquest papers, a girl had gone missing 15 days back.
The skull was sent to the forensic research lab. Which of the following would identify it as a female skull?
1. Large frontal and parietal eminence
A) 1 and 4 only
2. Heavy cheek bones
3. Smooth glabella
B) 2, 3 and 4
4. Square orbits C) 1, 3 and 5
5. Narrow mastoid D) 3, 4 and 5

Age calculation
Determination of age of fetus

Up to 5 months of age: RULE OF HAASE

Age(months)= crown heel length(cm)

Next 5 months: MORRISON RULE(modification of HAASE)

Age(months)= Crown heel length(cm)
5
 43
OSSIFICATION CENTRE APPEARANCE

Clavicle 1st month(5-6 weeks)

Calcaneum 5 months
Talus 7 months
Cuboid & capitate
End of 9th month
Lower end of femur
Upper end of tibia 10th month

Previous Year Questions AIIMS 2018

Crown Rump Length is 21 cm, length of lower limb is 10 cm, gestational
age of the fetus will be:
A) 6 to 7 months
B) 4 to 5 months
C) 7 to 8 months
D) Term

STERNUM

APPEARANCE FUSION

5 months MANIBRIUM
Fuses at 60 yrs
5 months 1
Fuses at 25 yrs
7 months 2
Fuses at 20 yrs
7 months 3
Fuses at 15 yrs
10 months 4
Fuses at 40 yrs
3 yrs XIPHOID

Manibrium fuses with body at 60yrs

Xiphisternum fuses with body of sternum at 40 yrs
Body of sternum( development- 4 segments)
 44
Fusion of bone/ joints

FUSION AGE (Yrs)

Patella 14
Xiphoid 40

Iliac crest 20

Inner end of clavicle 21

Ischial tuberosity 22
UPPER LIMB
Basiocciput fuses with basisphenoid
around 18-22 years
Shoulder joint 18
Elbow joint 16
Wrist joint 18
LOWER LIMB
Upper end of femur 16
Lower end of femur & upper end of tibia 18
Lower end of tibia & fibula 16
Hyoid bone: Greater cornu 40-60
All sacral vertebrae form a single bone 21-25

Previous Year Questions AIIMS 2017

A girl was allegedly kidnapped by a man. When taken to the court she said she is a major and is
married to the man. X-ray images of her elbow, wrist and pelvis are given. What is the approximate
age of the girl?

A) 14 to 15 years
B) 16 to 17 years
C) 18 to 19 years
D) 21 to 22 years

Previous Year Questions NEET PG 2018

At what age, basiocciput fuses with basisphenoid?
A) 18-22 years
B) 22-25 years
C) 14-16 years
D) 12-14 years
 45
Previous Year Questions AIIMS 2020
What is the approximate age of a person in whom the medial end of the clavicle is fused and also
the sternum is completely fused
A) <18 years
B) 18-22 years
C) 22-25 years
D) >25 years

Carpal bones
Scaphoid Lunate Triquetrum Pisiform Previous Year Questions
5yrs 4yrs 3yrs 12yrs
First carpal bone to ossify:
A) Lunate
Trapezium Trapezoid Capitate Hamate
B) Capitate
5yrs 5yrs 1yr 1yr
C) Hamate
D) Scaphoid AIIMS 2017
RADIUS(lower end)- 2yrs
FUSION at 18yrs
ULNA(Lower end)- 5-6yrs

Stature - Pearson’s formula

BONE MULTIPLICATION FACTOR

Femur 3.7
Tibia & Fibula 4.5
Humerus 5.3 Stature= Bone length X Multiplication factor
Ulna 6.1
Radius 6.5

Determination age of scar mark

5-6 days: Reddish, firm(angry scar)

2 weeks- 2months: Pale & soft, tenderness+
2-6 months: Brown & tough, tenderness+
>6 months: White & tough, non-tender
Vascularity is present till 2 weeks- 2 months
 46

Previous Year Questions NEET PG 2020

A child who is a victim under POCSO act is brought to the department forensic medicine for age
estimation. The X-ray image of the hand is shown below. What is the likely age of the child?
A) 4 years
B) 7 years
C) 10 years
D) 13 years

Previous Year Questions INICET 2021

Match the following with the respective ages of fusion:
A. Medial end of clavicle A) A-1, B-2, C-3, D-4
1. 22-25 years
B. Sacrum as a single bone 2. 50 years
B) A-4, B-1, C-2, D-3
C. Crista scapulae 3. 45 years C) A-4, B-3, C-1, D-2
D. Lambdoid suture 4,21-25 years D) A-1, B-4, C-3, D-2

Dental numbering
Temporary tooth
UPPER
Total: 20
M PM C I I C PM M
2 0 1 2 2 1 0 2

RIGHT LEFT
M PM C I I C PM M
2 0 1 2 2 1 0 2

LOWER

SEQUENCE OF ERUPTION INCISOR MOLAR CANINE 2nd MOLAR

(12 month) (18 month) (24-30 month)

Lower central: 6 month

Upper central: 7 month
Upper lateral: 8 month
Lower lateral: 9 month
 47
20 temporary teeth remain same till 6 yrs of age
7-11 yrs: Mixed dentition(both temporary & permanent)
No. Of permanent teeth b/w age: (age-5)X4

Permanent tooth
SEQUENCE OF ERUPTION
UPPER
M PM C I I C PM M
TEETH AGE
3 2 12 21 2 3
1st molar 6-7
RIGHT LEFT Central incisor 7-8
M PM C I I C PM M Lateral incisor 8-9
3 2 1 2 21 2 3 1st premolar 9-10

LOWER 2nd premolar 10-11

Canine 11-12
2nd molar 12
Premolar is bicuspid 3rd molar 18-25
(Wisdom tooth)

SUCCESSIONAL TEETH
Permanent tooth which erupts in space of temporary tooth
Total 20- 2 incisor, 1 canine, 2 premolars in each quadrant

SUPRA-ADDED TOOTH
Permanent tooth for which extra space is created
Total 12- 3 molars in each quadrant

Dental formula

PAMAR NOTATION HADERUP FORMULA

8,7,6,5,4,3,2,1 1,2,3,4,5,6,7,8 +8 +7 +6 +5 +4 +3 +2 +1 +1 +2 +3 +4 +5 +6 +7 +8

-8 -7 -6 -5 -4 -3- -2 -1 —1 —2 —3 —4 —5 —6 —7 -8
8,7,6,5,4,3,2,1 1,2,3,4,5,6,7,8
 48

FDI - FEDERATION DENTERE INTERNATIONALE MODIFIED FDI

(Zig zag manner)
1 2 1 2
…..14, 13, 12, 11 21, 22, 23, 24, 25, 26, 27, 28 …..14, 13, 12, 11 21, 22, 23, 24, 25, 26, 27, 28
…..44, 43, 42, 41 31, 32, 33…… ….32, 33, 32, 31 41, 42, 43…..

4 3 3 4

UNIVERSAL FORMULA

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
32 17

Calculation of age using teeth

Weight of tooth
STACK METHOD Used for infant=
Height of tooth

BOYDE’S METHOD Used for dead infant, by counting Incremental lines

LAMENDIN METHOD Gum regression & translucency of tooth is used

MILES METHOD Wear & tear of tooth is used

GUSTAFSON METHOD Modification is called DALIZ METHOD

6 X-ray criteria is used
1. Secondary dentin
2. Cementum opposition
3. Root resorption
4. Attrition
5. Parade to sis
6. Translucency of tooth(most reliable criteria), seen after 30 yrs
Best tooth for this method : INCISOR

NEONATAL LINING
Incremental line found one on the surface of tooth enamel that indicates
that an infant was live born
 49
Preservation of human bite marks

1. Photography
By using two scales perpendicular to each other

:
2. Preparation of cast
By using POP, clay, silicon, rubber
3. Swab especially from fresh bite marks
Likely to contain saliva of assailant, so important to collect swab
: Take a cotton swab & moist it with sterile water and it is used to swab from bite mark

Previous Year Questions AIIMS 2018

All of the following statements are true about the given condition except
A. Swabs should be taken immediately after moistening with sterile water
B. It is most commonly caused by incisors & canines
C. Photograph is taken with 2 scales at right angle to one another in the vertical plane
D. 3D imaging is possible in the given condition
 50

Identification methods

Cheiloscopy - lip print

SUZUKI CLASSIFICATION

TYPE I Clear cut vertical grooves that run across the entire lips

TYPE I’ Vertical, but do not cover the entire lip

TYPE II Branched groove (Y or inverted Y shaped)

TYPE III Intersected groove (X shaped)

TYPE IV Reticular groove(mesh type)

TYPE V Undetermined

Palatography

Study of hard palate

⑨

Discovered by Allen
•

Anterior 1/3rd of hard palate is considered

RUGOSCOPY
Study of Rugae
 51

Tattoo marks
Used to identify decomposed(best), live or dead

DYES used: Carbon particles

India ink(black dye)
Crucial blue
Vermillion
Cinnabar
UV Rays are used if the tattoo marks are faded
Infrared Rays are used for old tattoo marks
Tattoo mark dyes can be detected in the lymph nodes after histopathological section

REMOVAL OF TATTOO
-Burning
-Laser beam
-Corrosive
-Dry ice
-Electrolysis, Excision, Enxymes

Previous Year Questions NEET PG 2020

A deceased male was posted for a post-mortem examination. His relatives reported that he
had a tattoo over his skin, which was not found on examination. Which of the following
structures would you examine?
A) Lymph nodes
B) Liver
C) Arteries
D) Skin

Dactylography
•

A/k/a FINGERPRINT/ HENRY-GALTON SYSTEM

•

Discovered by William Herschel & Galton in KOLKATA(1897)- Writer’s Building

•

Best method for criminal identification

@

Composed of Epidermal ridges

•

DEVELOPMENT Fingerprints begin to develop at 12-16 weeks of Intrauterine life

Completed at 24 weeks
QUETELET Rule: Fingerprints are not same for identical twins
Section for fingerprint: 0.6mm depth
 52
Minimum points which should be similar to criminal fingerprint: 10-12 points
Best finger for finger print: THUMB
Worst finger for finger print: LITTLE FINGER

10 fingerprints are documented for criminal & 1 fingerprint for civil purposes

Live scanning of fingerprint: OPTICAL FRUSTRATED TOTAL INTERNAL REFLECTION(O-FTIR)

Patterns
HENRY CLASSIFICATION
CORE DELTA
TYPES (Point where the ridge recurs) (Central point where the
three ridges converge)

LOOPS 1 1
(M/C)

WHORLS 0 2

ARCH 0 0

COMPOSITE Mixed pattern(L/C)

ARCH LOOP WHORL

1. Leprosy
FINGERPRINTS PERMANENTLY LOST IN 2. Radiation
3. Electrocution
4. Burns
POROSCOPY
Discovered by Edmond Locard Edmond Locard
When partial fingerprints available
Exchange principle
1mm area has 9-18 pores

Shapes & size of pores are Unique

 53
Other identification methods

RETINA SCAN Most precise & reliable method of Biometics

SUPERIMPOSITION TECHNIQUE- SCREENING TEST

Used if the body is decomposed
Skull XRAY is superimposed on the negative of a
photograph of the person
ANTHROPOMETRY
A/k/a BERTILLON SYSTEM/ PORTRAIT PARLE
Person is identified by Body marks, Body measurement & Descriptive data

Previous Year Questions NEET PG 2018

Edmond Locard is most famous for?
A) Finger print study
B) Theory of exchange
C) Stature estimation
D) Forensic ballistics

Previous Year Questions

NEET PG 2019
Identical twins have similarities in all except :
A) Blood group
B) DNA fingerprinting
C) Fingerprint pattern
D) Iris colour
 54

Trace evidences & DNA fingerprinting

Blood stain

Sensitive
B

Low specificity

PRINCIPLE: RBC’s contain Hb Hb have PEROXIDASE ACTIVITY

SCREENING TESTS
1. BENZIDINE TEST
Most sensitive
Not used- Bladder cancer
Colour produced- Blue
False +ve: Salive, Milk, Pus, Rust, Plant juices
2. PHENOPTHALEIN TEST/ KASTLE-MEYER TEST
M/C Used
Colour produced- Pink
3. ORTHO-TOLUIDINE TEST
Colour produced- blue_green
4. LEUCOMALAGITE GREEN TEST
Colour produced- Peacock blue
5. TETRAMETHELENE BENZIDINE TEST
Colour produced- blue
6. LUMINOL TEST
Old/ old washed blood stain
7. GUAIACUM TEST
Colour produced- Deep blue

CONFIRMATORY TESTS
SPECTROSCOPY
(Most specific)
> TAKAYAMA > TEICHMANN
(Glucose + pyridine) (Acetic acid)

PINK FEATHERY CRYSTALS BROWN RHOMBIC CRYSTALS

(HEMOCHROMOGEN) (HEMIN/HEMATIN)
 55
SEMEN ANALYSIS

SEMEN= SPERM(10%) + SEMINAL FLUID(90%)

1. FLORENCE TEST
Rhombic brown crystals (choline combines with KI)
Detects choline- CHOLINE IODINE TEST

2. BARBERIO TEST
FLORENCE TEST
For spermin component
Picric acid is used
Spermin in prostatic secretion combines with Picric acid

Spermin picrate is formed

YELLOW NEEDLE CRYSTALS

BARBERIO TEST
3. UV RAYS/ WOODS LAMP
For dried semen
Semen turns white blue on UV rays
4. CREATINE PHOSPHOKINASE (CPK) TEST
Old semen stain (can detect 6 month old semen)

:
5. ACID PHOSPHATASE TEST: Purple colour on Reagent
Used in aspermia
Quantitative test
Value >100 Bondansky units indicate that ejaculation occurred within 12hrs of examination

6. LACTATE DEHYDROGENASE(LDH) TEST: most specific test

7. P30 GLYCOPROTEIN TEST/ PROSTATIC SPECIFIC ANTIGEN TEST: Quantitative test

8. CHRISTMAS STAINING TEST

9. CHROMATOGRAPHY

SALIVA- PHADEBAS AMYLASE TEST

SPECIES- PRECIPITIN TEST
 56
HAIR
TRICHOLOGY: Study of Hair
HUMAN HAIR ANIMAL HAIR

Cortex bigger Cortex = Medulla

[4-10 times than medulla]

Medulla thin

Pigments at periphery Pigment is in centre

Cuticular scale: small & thin Cuticular scale: large & thick
Width of medulla
Medullary index=
Width of shaft
<0.3 >0.5

Confirmation: PRECIPITIN Test Mongol- Round shaped

SHAPE OF MEDULLA ON CUT SECTION Negro- Kidney shaped
Mongol hair- Non fragmented
Caucasian- Oval shaped

DNA fingerprinting
ALEC JEFFREY- Father of DNA Fingerprinting
1st used in RAPE cases
Same in Identical twins

PRINCIPLE: VNTR= Variable number tandem repeats

A/k/a SATELLITE DNA/ INTRONS
STEPS Technique: RFLP (Restriction Fragment Length Polymorphism)
1. Isolation of DNA
2. Cutting DNA using restriction enzyme(Molecular scissor)
3. Gel electrophorosis(separation)
4. Southern blotting(transferring to nylon membrane)
5. Add radioactive DNA
6. XRAY(bands of DNA seen)

For PATERNITY/ MATERNITY DISPUTE

1. DNA FINGERPRINTING(best)
2. HLA TYPING
3. BLOOD GROUPING(present in all body fluids except CSF
Best test for blood grouping- Acid elution test
 57

Torture methods
Torture was 1st defined in DECLARATION OF TOKYO
TORTURE is punishable under 330 IPC (hurt)- 7yr imprisonment
331 OPC(Grievius hurt)- 10yr imprisonment

1. PARROT PERCH
Suspending from a pole
Causes:
placed under the knees with
Positional asphyxia
wrists bound to the ankles
Congestion
Petechial hemorrhage
Cyanosis

2. BEATING ON PALM & SOLE- ‘FALANGA’/ ‘BESTINADO’

3. LA BANDERA

Person hang at wrist

4. DRY SUBMARINO

Die because of suffocation(plastic covering face)

 58
5. WET SUBMARINO

Person forced to drink dirty water

6. GHOTNA

Wooden log in thighs—squeeze thigh muscle

7. BLACK SLAVE

Heated rod into anus

8. CATTLE PROAD/ PICANA

Electric torture to breast region/ nipples/ vagina/ penis
9. PLANTON
Forced/ long standing
10. TELEFONO
Repeated slapping of the sides of the head of victims(ears)
11. QUIROFANO
Hitting on the abdomen
12. BELLARY
A Stick smeared with red or green chilly paste is inserted into anal canal
13. STRAPPADO
Body suspended from a bar with hands tied behind on it
14. CRUCIFIXION & JACK KNIFE POSITION
Causes positional asphyxia due to Neck compression
15. HOG TIE
Prone position with both his wrists and ankles bound behind his back and secured with a rope
 59
Previous Year Questions AIIMS 2017
Jack knife position causes death due to:
A) Wedging
B) Burking
C) Positional asphyxia
D) Traumatic asphyxia

Previous Year Questions INICET 2021

A 24-year-old man who was accused of murder was taken into police custody. As a part of the
interrogation, the prisoner was kept in a prone position with both his wrists and ankles bound
behind his back and secured with a rope. What is this method known as?
A) Choke/carotid hold
B) Carotid sleeper hold
C) Hog tie
D) Bar arm
 60

Mechanical injuries
Types
ABRASION(m/c mechanical injury)
BLUNT CONTUSION
BASED ON WEAPONS LACERATION
STAB WOUND
SHARP
INCISED WOUND

Abrasion
>

A/k/a GRAVEL RASH

/

Injury of EPIDERMIS
Corneal abrasion- GRIEVOUS HURT(leads to corneal opacity & permanent visual restriction)
: POST-MORTEM ABRASION; Yellow in colour, seen on bony prominence & no intravital reaction

Types of abrasion
GRAZE ABRASION/ BURSH
BURN/ FRICTION BURN/ M/c abrasion in RTA
SLIDING ABRASION Parallel lines are seen

Caused by nail, pin, pointed objects

SCRATCH ABRASION
It has a length but width minimal

PATTERNED ABRASION

I. PRESSURE ABRASION Pressure applied perpendicular to body

Eg: Bite mark, Hanging

II. IMPRINT ABRASION/

Eg: Tyre mark
IMPACT ABRASION
 61

Age of abrasion

AGE FEATURE
Fresh abrasion RED
12-24 hrs REDDISH SCAB
2-3 days REDDISH BROWN SCAB
4-5 days BROWN SCAB
6-7 days BLACK SCAB
7-10 days HEALING WITHOUT SCAR

Previous Year Questions

AIIMS 2018
Identify the injury in the image below.

A) Abrasion
B) Laceration
C) Bruise
D) Imprint

CONTUSION
A/k/a BRUISE

÷
Involvement of dermis +
Confused with artificial bruise, Hypostasis
HEMATOMA in subcutaneous tissue
Margins Irregular/ Diffuse
Heals within 2 weeks

TYPES OF BRUISE

1.MIGRATORY BRUISE Eg: Black eye/ spectacle hematoma

A/w # anterocranial fossa
2. BATTLE BRUISE Due to middle cranial fossa #

3. RAILWAY TRACK BRUISE Two parallel lines +

4. DEEP BRUISE Delayed bruise, occurs after 24 hrs

Common site- Thighs, Abdomen
5. SIX PENNY BRUISE
 62

Age of bruise

AGE FEATURE
Fresh bruise RED
Upto 3 days BLUE D/t DeoxyHB
4th day BROWN d/t Hemosiderine
5-6 days GREEN d/t Hematoidin
7-12 days YELLOW d/t Bilirubin

LACERATION

Caused by Blunt object

: Irregular margin
Bridging of tissues
Ruptured blood vessels
TYPES
1. SPLIT LACERATION
Look like incised looking laceration
Irregular margin
Bridging of tissue(trying to bridge b/w 2 ends)
Common site: Bony prominence

2. STRETCH LACERATION
Due to hyperelasticity

3. AVULSION LACERATION
FLAYING: Detachment

4. TEAR LACERATION
Irregular margin
Due to semi-sharp material
5. CUT LACERATION
CHOP wound
Due to sharp object(heavy)
 63

Previous Year Questions

AIIMS 2020
A 12-year-old boy presents with the following injury that he sustained on being
tackled by an opponent during the course of a football match. As the Casualty
medical officer, you would enter the wound description in the case sheet as
A) Incised wound
B) Abrasion
C) Laceration
D) Bruise

INCISED WOUND

Due to sharp weapon

Can be suicidal: Hesitation cuts
: Length > width > depth
Can be defence wound(active-when person try to grab the
Margins: Clean cut weapon/ passive)
: Tailing of wound +
Can be homicidal

Previous Year Questions

NEET PG 2021

1. Identify the injury :

A. Incised looking laceration
B. Incised wound
C. Lacerated looking incised wound
D. Laceration

STAB WOUND
Caused by sharp-edged which is perpendicular to skin surface
: Depth of wound is the max dimension
0

Length of the wound is slightly less than the width of the weapon, beacause of fibrous contractions
TYPES

1. PENETRATING TRAUMA
Weapon going inside the cavity causes the penetrating trauma
M/c organ injured: Liver
2. PUNCTURE
Weapon going inside the soft tissue of the body causes puncture

3. PERFORATION
Through & through injury
Margins are clean cut & inverted
 64
SHAPES OF STABS
Line of langers: Important lines for deciding the shapes of stab injury

Single edged weapon

O
Tear drop Triangular Fish tailing
Double edged weapon

Spindle shaped

OTHER INJURIES

CONCEALED PUNCTURE WOUND: Seen in nostrils, fontanelles, axilla, vagina, rectum, inner
canthus of eye, nape of neck

Passive defence wound- Injuries on forearm

DEFENCE WOUND:
Active defence wound- Injuries on palm
OVER KILLING: Massive injuries beyond that was needed, to cause death, like multiple stabs
FABRICATED WOUND: Produced by a person himself on his own body/ by another with his consent
SELF INFLICATED WOUND: Produced/ Inflicated by a person on his own body
CHOP WOUND: Laceration + Incised wound

Previous Year Questions AIIMS 2020

Match the following weapons with the possible injuries caused by them:
A. Axe 1. Incised wound
B. RTA A) A-4, B-3, C-1, D-2
2. Tram track bruise
C. Blade B) A-1, B-3, C-4, D-2
3. Grazed abrasion
D. Lathi C) A-1, B-2, C-4, D-3
4. Chop wound
D) A-4, B-1, C-3, D-2
 65

Previous Year Questions AIIMS 2020

A middle-aged man was brought to the ER after an assault
with a sharp axe. Identify the type of wound?
A) Incised wound 23%]
B) Chop wound
C) Lacerated wound [30%]
D) Abrasion
 66

Forensic ballistics
Introduction

FORENSIC BALLISTIC: Study of Firearm

Father of forensic ballistic: CALVIN GODDARD

Classification of weapons

Based on cross section

Rifled weapon Smooth bore weapon

Bullet(one by one)
8

Composed of Lead s

Pellets(multiple at a time)
&

Barrel contains LANDS & GROVE= RIFLING A

Composed of lead
A

Rifling increases velocity(more velocity—more effective) 0

Rifling is absent
Rifling increases RANGE, Penetration 7

Gyroscopic movement, spinning & rotation absent

: Gyroscopic movement,Spinning & rotation of bullet +
Eg: Short gun- range 40m
Eg: Pistol- range 100m
Revolver- range 100m
AK-47- range 600m Range increases by A. Chocking
Military rifle- range 2-3km
Terminal end is constricted

Air rifle
B. Paradox
Mechanism is air compression Terminal end is rifled
Rage- 40m
No blackening, tattooing/ singeing
 67
cartridge

Shortgun catridge

Upper most part - Lead pellets

: Base - Primer
- WAD(plastic/ wood)
- Gun powder Compulsion Gas produced Pellet at high speed

Bullet catridge Primer ignites gun powder

Nose Combustion of gun gun powder

2 parts Gas
Base
Bullet at high speed
Gun powder
Primer PRIMER COMPOSITION
Barium
Lead
Antimony
Sullied
Tetracene

DETONATOR CUP WAD

-Below primer -A lubricant that separates pellets from gun powder
-A/k/a Percussion cap -Present in shortgun catridge
-Composed of Cu/Zn
-Present in both types of catridge
 68

Gun powder

GUN POWDER COMPOSITION

KNO3 (75%)- Oxydising agent

Charcoal(15%)- Fuel
BLACK GUN POWDER Sulphur(10%)- Binding agent
1 gm 4-5 L of Gas

FG, FFG, FFFG = Indicates Fineness of Black powder

1. Single base- Nitrocellulose

SMOKELESS GUN POWDER 2. Double base- Nitrocellulose + Nitroglycerin
(Better) 3. Triple base- Nitrocellulose + Nitroglycerin + Nitroguinadine
1gm 1200-1300 mL of Gas

SEMI-SMOKELESS POWDER Black gun powder(80%) + Smokeless gun powder(20%)

Tests for gun powder residue(GPR)

Harrison-Gilroy test
Atomic absorption spectroscopy
Neutron activation analysis
Dermal nitrate / Paraffin test
SEM-EXDA (scanning electron microscope-Energy dispersive XRAY analysis)
-Most sophisticated
-Detect minute traces
-Qualitative test

Types of bullets
1. RIOOCHET BULLET/ PIGGY BACK BULLET/ BOUNCE BACK BULLET
Deflected bullet -Before reaching target, hits interviewing object & changes pathway
All gun powder effect will be absent in entry wound
Oblique shaped entry wound
Abrasion collar will be absent
2. EXPLODING BULLET/ INCENDIARY BULLET
Causes fire at Target
Contains phosphorous
 69
3. FRANGIABLE BULLET
Bullets fragments on impact
Made of copper, iron
4. TANDEM BULLET
One bullet behind another bullet
2 bullets in barrel Lodged bullet & striking bullet
5. DUM DUM BULLET/ MUSHROOM BULLET/ HOLLOW PIONT BULLET
Causes explosion when strikes
Causes maximum damage
6. TUMBLING BULLET
Rotation(end to end)
7. TRACER BULLET
Has colouring material at base
Visible mark in pathway
8. EXPRESS BULLET
High velocity
Hole in the base
9. PLASTIC BULLET/ BATON ROUND BULLET
Made of PVC
Used in riot control
10. GLANCING BULLET
Caused gutter fracture in skull(touch & go)
11. SOUVENIER BULLET
Deposited in skin & subcutaneous tissue
Can cause lead poisoning
12. YAWNING BULLET

Slow & irregular bullet

Cause key hole shaped entry wound

Features of entry wound

1. GREASE COLLAR
Due to dust/ grease

2. ABRASION COLLAR
Due to spinning of bullet

3. BLACKENING
Due to soot particles
 70
4. SINGEING
Due to burn injury
Eg: singeing of hair
5. TATTOOING
Due to unburnt gun powder at dermis
6. BEVELLING OF SKULL

Entry wound -Inner table bevelling

Exit wound -Outer table bevelling
7. MARGINS & SIZE
Entry wound- Margins inverted & small

Previous Year Questions

AIIMS 2017
In a case of a gun shot injury to skull with entry wound at left temporal region surrounded by abrasion
collar & tattooing and a exit wound at right temporal region along with metal fragments of bullet inside the
bullet track. Which of the following should be preserved to determine the range of firing ?
A) Hair
B) Bullet pieces
C) Blood
D) Clothes

Previous Year Questions

AIIMS 2019
What is bullet wipe?
A) Residual from barrel of gun
B) Blackening
C) Gutter fracture of skull
D) Tattooing

Previous Year Questions AIIMS 2020

Identify the image

A) Shot gun wound
B) Tattooing
C) Arsenic poisoning
D) Graze wound
 71
Previous Year Questions NEET PG 2019
In alleged history of gunshot injury, there is burning, blackening, tattooing around the wound.
The injury is:
A) Close shot entry wound
B) Close shot exit wound
C) Distant shot entry wound
D) Distant shot exit wound

Range of gunshot

REVOLVERS & AUTOMATIC PISTOLS SHORT GUN

1. Contact range 1. Shot gun contact range

Cruciate entry wound(triangular, satellite) Blackening +
Muscle imprint Singeing +
2. Close range 2. Shot gun short range
<9cm 1-2 meters
Blackening + Rat hole entry wound- ‘nibbled margins’
3. Near range 3. Shot gun intermediate range
Tattooing + 2-4 meters
9-60cm Satellite wounds(deeper)
4. Distant range 4. Shot gun long range
>60cm >4 meters
No blackening/ tattooing/ singeing Multiple entry wounds

BULLET FINGERPRINTING
•

Primary & secondary marking

Primary markings - formed when a bullet passes through a barrel & the sides are
: marked by the rifling of the barrel
Secondary markings - irregularities on the inner surface of barrel itself which are
specific for that particular weapon are also seen on the bullet

Previous Year Questions AIIMS 2018

Bullet fingerprinting involves:
A) Primary markings
B) Secondary markings
C) Both
D) None
 72
Blast injuries

1. PRIMARY BLAST INJURIES

Due to Blast waves(shock wave- High pressure)
Common organs: EAR, LUNGS, INTESTINE

Most sensitive Major cause for fatality

Multiple contusions
Multiple hemorrhages
Solid blast- Skeletal injuries(limbs, feet)
Underwater blast- Large intestine(m/c organ involved)
2. SECONDARY BLAST INJURIES
Objects surrounding the person hit the body
1. Laceration
MARSHAL TRIAD 2. Abrasion
3. Bruise
3. TERITIARY BLAST INJURIES
Victim displacement- Person is thrown away to ground
4. QUATERNARY BLAST INJURIES
Due to collapse of building
Burn injuries, collapse of building, electrocution
Leads to asphyxia, suffocation
 73

Thermal injuries
Hypothermia

Dry cold Frost bite(-2.5 °C)

Temperature < 35 °C

Moist cold Trench foot(5-8 °C)

(A/k/a Immersion foot)

Features
-Fat necrosis of pancreas
-WISCHNEWSKI SPOTS in stomach mucosa on postmortem
-Post-mortem staining: PINK RED COLOUR
-Erythema pernio(chilblain)
-Paradoxical undressing due to cutaneous vasodilation

Previous Year Questions AIIMS 2018

Paradoxical undressing is seen in:

A) Heat stress
B) Voyeurism
C) Hypothermia
D) LSD overdose
 74

Hyperthermia

Heat cramps (MINER’S cramps/ FIREMAN’S cramps)

Muscle cramps occurs due to loss of Na+ ion

HEAT STROKE/ SUN STROKE/ HEAT PROSTRATION/ HEAT

THERMIC FEVER/ HEAT HYPERPY EXHAUSTION/ HEAT SYNCOPE

Core body temp >41 °C Death due to vascular collapse

Complete absense of sweating
Patient collapses without
Dry hot skin increase in body temperature
Constricted pupil

Impaired consciousness,
delirium, convulsions

Post-mortem findings: Edema & reduction of

parkinge fibres of cerebellum

Burn

Minimum temperature to produce burn: 44°C

Epidermal burn
WILSON CLASSIFICATION Demo-epidermal burn(most painful)
Deep(relatively painless)

Blackening, singeing present in burns

NECKLASING: Type of homicidal burn practise in south africa

SCALDING

Application of liquid >60 °C

Blackening, singeing are absent
Soddening & bleaching present
Clothes worsen injuries in scalding
 75

FEATURES ANTEMORTEM BURN POST-MORTEM BURN

Line of redness Present Absent

Presence of soot
particles in trachea/ Present Absent
lungs
CO level increase in
Increased Absent
blood

Vital reactions Present Absent

Enzymatic reactions Increased Absent

Blisters containing
Blisters albumin/ protein/ Blister containing air
chloride

FEATURES FOUND IN BOTH ANTEMORTEM & POSTMORTEM

PUGILISTIC ATTITUDE/ BOXING Due to denaturation of

ATTITUDE/ COOKED MEAT APPEARENCE protein(temp >65 °C)

•
Skin/ muscle rupture due
to excessive heat
HEAT RUPTURE/ HEAT LACERATION *
Margins of rupture are irregular
•
Nerves & vessels are intact

•
Resembles EDH
HEAT HEMATOMA B/L, Diffuse
(B/w skull & dura matter) : Honeycomb app in HPE
 76
Estimation of surface area involved
1. Rule of 9
2. Rule of Palm
3. Lund & browder chart

CAUSE OF DEATH
-Immediate(<24 hrs)- Neurogenic shock d/t pain
-Hypovolumic shock(50% of cases)- <48 hrs
-Toxemia & acute renal failure- 3-4 days
-Speticemia- >5days

Electrocution

AC > DC [AC causes Tetany]

Most resistant tissue layer for electrocution: Bones > Skin
CAUSE OF DEATH: Ventricular fibrillation > Respiratory paralysis

Features
1. Entry wound/ JOULE BURN-(most specific)
Firm contact with low voltage
Endogenous burn
Black
Depression in centre- Electric crater - Lined by squamous epithelium
Central area- Necrosis +
Single, 1-1.5cm

2. HPE Findings
Vacuoles
PALLISADE APPEARENCE/
Blisters
SWISS CHEESE APPEARENCE
Nuclei streaming
3. Exit wound
Multiple wounds
Raised margins
Blow-out lesions
 77

4. Crocodile skin burn

High voltage with loose contact
Flame burn
Exogenous burn
5. Spark/ flash burn
Loose contact with air gap
6. Bone pearls/ WAX drippings
When electric current enters bone- melting
of calcium phosphate(Radiological findings)
7. Electrical petechiae
Hemorrhage in surface of Heart(not specific)

MEDICOLEGAL IMPORTANCE
1. Accidental
2. Homicidal
3. Judicial electrocution is done in U.S.A- 2000 volt & 7A for 4 sec
4. Suicide(rare)

Lightening

20 K ampere & 100 million voltage

CAUSE OF DEATH: Ventricular fibrillation > Respiratory failure

Findings
FILIGREE BURN/ ARBORESCENT BURN/ LIGHTEN BURN/ FERN TREE
BURN/ LICHTENBERG BURN/ KERANOGRAPHIC BURN

Occurs due to RBC lyses

Don’tcorresponds to blood vessels
M/c on shoulders, flanks
Disappears in 1-2 days
Sledge hammer sign
TIP TOE SIGN
Black circular mark in thumb/ toe
 78

Previous Year Questions INICET 2021

Identify the cause

A) Lightning strike
B) Electrocution
C) Marbling
D) Trickling down of acid
 79

Asphyxial death
Asphyxia

ASPHYXIA: Lack of Oxygen

Jugular vein 2-3kg
Carotid artery 4-5kg
Wt required for occlusion=
Trachea 10-15kg
Vertebral artery 20-30kg

CLASSICAL TRIAD OF ASPHYXIA: Cyanosis, Petechiae, Congestion

Hanging

*
Form of asphyxia caused by SUSPENSION OF THE BODY by a Ligature encircling the neck, the
constricting force being the weight of the body
•

M/c method of suicide in india

TYPES OF HANGING
BASED ON POINT OF SUSPENSION
COMPLETE HANGING PARTIAL HANGING

No parts of body touching the ground Some parts of body touching the ground

Body wt Constricting force Wt of head

Asphyxia Cause of death Venous congestion

 80
BASED ON KNOT
TYPICAL ATYPICAL

Knot at nape of neck(occipital) Knot at other than nape of neck

BASED ON MANNER OF DEATH

Dribbling of saliva +

:
SUICIDAL HANGING Ligature mark: OBLIQUE

HOMICIDAL HANGING/ Group of people hanging a

LYNCHING person

Partial hanging
ACCIDENTAL HANGING/ :
Person-naked
AUTOEROTIC HANGING/ G

Protective clothing
SEXUAL ASPHYXIA (for sexual pleasure)
Common in males
M

Cause of death: # C2 C3 C4
JUDICIAL HANGING (leading to separation of brain
stem from spinal cord)
 81
Complete circle of ligature material: NOOSE

Cause of death

1. Asphyxia
Wt required: 10-15 kg
2. Venous congestion
Due to occlusion of jugular veins, vertebral veins
Leads to congestion, Petechial hemorrhage, cyanosis

3. Asphyxia + venous congestion M/c/c

4. Dislocation of cervical vertebra- Judicial hanging
Hangman #
5. Reflex vagal inhibition
Fear of death leading to MI
6. Cerebral anemia
Due to occlusion of vertebral artery

Post-mortem findings

LIGATURE MARK
-Incomplete
-Looks oblique
Ligature mark transverse in strangulation
-Absent in knot area
-Normally above thyroid cartilage
-Base is hard & dry - PARCHMENT PAPER APP
-A Type of Pressure abrasion
-On dissection, Pale & glistening area
LIGATURE MATERIAL
-Soft material: ligature mark absent
-to remove ligature material: By cutting opposite to knot & cut ends are tied with thread

LA FACIES SYMPHATHIQUE ‘One eye open’

Mechanism- Knot presses over cervical sympathetic chain

On the same side eye open & pupil more dilated

ANTEMORTEM HANGING
 82
DRIBBLING OF SALIVA
-Opposite to the side of knot due to compression of pterygopalatine ganglion which
stimulate submandibular gland

ANTEMORTEM HANGING

TARDIEU SPOT
-Pin head size hemorrhage over heart, lung, conjunctiva, face
-Non specific finding

AMUSSAT SIGN
-Transverse tear in carotid artery

HYOID BONE #
Inward compression # in throatling
-More common after 40yrs
-Compression # Hyoid bone # is more common in throatling
-Outward #
-Common site: Junction of ant 2/3rd & post 1/3rd

SIMON HEMORRHAGES
-Small hemorrhages in intervertebral disc’s

POST-MORTEM HYPOSTASIS
-Glove & stocking type postmortem lividity
-Protrusion of tongue+/-

Pseudo ligature mark in putrefaction due to selling neck by gases

In postmortem of Hanging, opening of neck is done at last(cranium is opened first)

 83
Strangulation
1. Ligature strangulation
2. Throttling
3. Mugging
TYPES
4. Bansdola
5. Garroting
6. Spanish winglass

LIGATURE STRANGULATION
Form of asphyxia which is caused from constriction of neck by a ligature without
suspending the body

POST-MORTEM FINDINGS
1. Ligature mark & base
-Transverse
-Complete(around neck)
-Marks of struggle
-Soft & reddish base
2. Congested face, multiple bruises, abrasions
3. Subcutaneous tissue- Extensive hemorrhage(Ecchymosis)
4. Thyroid cartilage #
5. Histopathology of neck[Epidermis, Dermis]- Hemosiderin

THROATTLING
-Strangulation by human hand
-Always homicidal
POST-MORTEM FINDINGS
1. No ligature mark
2. Six penny bruise- small crescentric hemorrhage
3. Extensive hemorrhage
4. Bleeding from nose, conjuctiva, ear
5. Neck muscle contusion
6. # of hyoid bone, # of thyroid cartilage
 84

Previous Year Questions AIIMS 2017

A person was brought dead and an autopsy was performed to find the cause of death. The Following
findings were noted on examination. What is the probable cause of death?

A) Throttling
B) Strangulation
C) Hanging
D) Mugging

Previous Year Questions AIIMS 2017

An autopsy was performed to find the cause of death of a person brought dead to the casualty and it
showed a fracture of the thyroid cartilage and bruising around the neck. The cause of death is?
A) Hanging
B) Throttling
C) Strangulation
D) Mugging

MUGGING
-Constriction of neck in elbow bend/ knee bend

BANSDOLA
-Strangulation using bamboo stick(china)

GARROTING MUGGING
-Attack from back

SPANISH WINGLASS
-Ligature placed around neck, tightened in back using screw

SPANISH WINGLASS
 85
Suffocation

Form of asphyxia in which entry of air into lungs is prevented by any means of other than
constriction of neck or drowning
TYPES OF SUFFOCATION
1. ENVIRONMENTAL SUFFOCATION
-Due to High altitude
-Trapping in well
2. SMOTHERING
-Occlusion of mouth/ nostril(external air passages)
-Abrasion over inner lip
-Contusions+
-# of nasal septum
-Bleeding

3. GAGGING
-Closure of airway by forcing a Gag material(rolled up cloth, paper balls) in mouth
4. CHOCKING
-Occlusion of Trachea/ Bronchi/ Larynx
-Congestion+
-Petechial hemorrhage
-Cyanosis
HEIMLISCH Manoeuvre- To remove the occlusion material
5. CAFE CORONARY SYNDROME
-A/k/a Banana syndrome
-Classical signs like congestion, Petechial hemmorrhage, cyanosis are absent
-Cause of death: Vasovagal Inhibition
6. BURKING
-Smooothering + Traumatic asphyxia
7. POSITIONAL ASPHYXIA
-ITALIAN SYNDROME
-Cause of death: Entry of abdominal content into thorax
8. TRAUMATIC ASPHYXIA
-Cause of death: Trauma over chest
Deep cyanosis
-Features: Masque ecchymotique Clear line of demarcation
Petechial hemorrhage
 86
Drowning

Death caused by suffocation when water/ other liquid fills the lungs
: Mostly accidental
Fresh water
Typical
Sea water (Entry of H2O into lungs)
TYPES Dry drowning
Immersion syndrome Atypical
Near drowning

Fresh water drowning

Fresh water(hypotonic)

More water enters lung

Water absorbed into blood

Hemodilution
Pleural effusion absent
RBC Lyse

Release of K+

Hyperkalemia Ventricular fibrillation &

Hyponatremia cardiac arrhythmia
Hypervolumia
Hypocalcemia
More emphysematous lung Death in 5-6 mins

Previous Year Questions AIIMS 2020

Which of the following is seen in freshwater drowning?
A. Haemodilution
A) A,B,C,D
B. Hypokalemia
B) A,B,C
C. Hyponatremia
C) B,C, D
D. Arrhythmia
D) A,C,D
 87
Sea drowning

Sea water(hypertonic)

Water entry into lungs

Water from blood to lung

Hemoconcentration

Pulmonary edema

Crenated RBC, Cardiac failure

Death in 10-12 mins

Dry drowning
D

Water doesn’t enter lung

Water inside larynx & pharynx causes VAGAL INHIBITION
: CAUSE OF DEATH: Laryngeal spasm
(Sign of asphyxia may be present but frothing is absent)

Delayed drowning
-Person dies after 24 hrs after an episode of drowning
-A/k/a Near drowning/Secondary drowning/Post immersion syndrome
Delayed causes: -Encephalopathy
-Pneumonia
-Metabolic acidosis

Immersion syndrome/ hydrocution

A/k/a Submersion syndrome/ Duck diving

Sudden contact of body with cold water in ear, nasal spaces, epigastrium

Vasovagal stimulation

Cardiac arrest
 88
Post-mortem findings in drowning
1. Cadaveric spasm
Most characteristic finding: Clenched hand with
grass suggesting person struggled in water

2. Fresh leathery froth

Mucous, tiny, leathery frothing seen from nasal & oral orifices after death
: Increases on chest compression
Mucus + surfactant + water
3. Paultauf hemorrhage
Subpleural hemorrhage in lower lobe below the visceral pleura
4. Emphysema aquosum
Mucous froth makes lungs heavy
Break in alveoli(HPE)
Feature of living conscious drowning
5. Cutis anserina
Due to Piloerector muscle(cold)
6. Diatoms
-Unicellular algae having coat of silica
-Acid dilation technique to extract diatoms
Antemortem drowning: Diatoms in brain & bone marrow

Tests in drowning
GETTLERS TEST
Quantitative determination of Chloride content in blood in right & left ventricle
25% plasma concentration: antemortem drowning
Left ventricle :Fresh water drowning
Right ventricle :Sea water drowning

Magnesium & Strontium

In left ventricle: suggests Sea water drowning

SEHRT SIGN: Stomach mucosa- Rupture of gastric mucosa

SVESHNIKOV SIGN: Water in Parganas all sinuses
 89

Drowning index & washerwoman hand

Weight of both lungs

Drowning index =
Weight of spleen

>14.1 = Drowning

WASHERWOMAN HAND
Non-specific sign of Antemortem drowning
Changes in skin of palms & soles
Mechanism- Water imbibition
Wrinkling: 2-3 hrs
Bleaching: 12 hrs
Soddening: 2 days
Degloving: 3-4 days

FLOATATION OF BODY
Seen in antemortem as well as postmortem drowning
Decomposition Results in Gas formation
Summer- takes 24hrs
Floatation of body in
Winter- 2-3 days

Previous Year Questions AIIMS 2020

You are posted as an intern in casualty when an MLC case is brought by the police with the
following appearance. She was declared brought dead. What would you mark as the likely
cause of death before sending the patient for postmortem?
A) Drowning
B) Hanging
C) Strangulation
D) Traumatic asphyxia

Previous Year Questions NEET PG 2021

The above phenomenon is due to
A. Case of torture in hot water
B. Case of Post mortem hanging
C. Case of immersion in water for 36 hours
D. Case of colliquative liquefaction
 90
Previous Year Questions INICET 2021
The dead body of a 20-year-old man found in the sea was brought in for postmortem examination. Which
of the following findings would you see in seawater drowning?
1. Hypernatremia
2. Hyponatremia A) 1 and 3
3. Hyperkalemia B) 1 and 4
4. Myocardial anoxia C) 2, 3 and 5
5. Hemodilution D) 2, 4 and 5
 91

Regional injuries
Skull fractures
LINEAR / FISSURED #

M/c # in RTA, Assault

Irregular
Common site: Temporal- ‘pterion’
A/w Extradural HMG

DEPRESSED/ SIGNATURE #

Caused by hammer/ heavy objects with small striking surface

Outer table: Depressed
Inner table: Fractured
Uncommon in children due to elasticity

RING #

Fracture surrounding foramen magnum

Common in fall from height

HINGE #
Common in RTA
3 Types:
Type I (m/c): Passes through sella tursica
Type II : Left side to right side, passes through sella tursica(anterior to posterior)
Type III : Through coronal plane, doesn’t pass through sella tursica
 92
GUTTER #
Due to bullet(oblique bullet wounds)

DIASTATIC #
Any fracture causing sutures separation

POND #/ PING-PONG#

<5 yrs of age

: Inner table is not fractured

SPIDER WEB #

-Comminuted fracture
-Looks like spider web

Previous Year Questions AIIMS 2018

Name the type of fracture

A) Depressed fracture
B) Hinge fracture
C) Pond fracture
D) Comminuted fracture

Previous Year Questions AIIMS 2020

Identify the type of skull fracture in the given image?
A) Ring
B) Depressed
C) Fissured
D) Comminuted
 93

Intracranial hemorrhages

1. EXTRADURAL HEMORRHAGE(EDH)
A/k/a Epidural hemorrhage
-Due to Middle meninges artery rupture
-Exclusively by trauma
-U/L
-Lucid interval: Period of consciousness b/w 2 episodes of unconsciousness
-CT scan: Biconvex -lenticular shaped hemorrhage
-If patient discharge in Lucid interval - MEDICAL NEGLIGENCE
-100cc of Epidural hematoma is fatal
-EDH: Surgery can be done without consent(92 IPC)

Person can make valid will in Lucid interval- TESTAMENTARY CAPACITY

2. SUBDURAL HEMORRHAGE(SDH)
-100-150ml is fatal
-Common in alcoholics, old age, infants
-In boxing: PUNCH DRUNK SYNDROME/ DEMENTIA PUGILISTICA
-Due to BRIDGING VEINS RUPTURE

Acute: up to 7 days
Subacute: 7-21 days
Chronic: >21 days PATCHY MENINGITIS HEMORHAGICA
 94

3. SUB ARACHNOID HEMORRHAGE(SAH)

-M/c intracranial traumatic hemorrhage
-Due to rupture of ANTERIOR COMMUNICATING ARTERY
-CAUSE: Trauma > berry aneurysm
-Thunder clap headache of sudden onset

4. INTRACEREBRAL HEMORRHAGE
-M/c non traumatic hemorrhage
-Due to rupture of CEREBRAL ARTERY RUPTURE
-Most common site: INTERNAL CAPSULE
-M/c spontaneous hemorrhage

Coup & countre coup lesions

COUP CONTUSION COUNTRECOUP CONTUSION

At the site of impact Opposite to the site of impact

Small Usually large

GLIDING CONTUSION
-Produced during angular acceleration
-It is associated with diffused atonal injury(DAI)

CONCUSSION
-Temporary unconsciousness during head injury
-Berlin’s edema is seen
COMMOTIO CEREBRI
-Shearing stresses in the brain leading to small, punctuate hemorrhage throughout the brain

DAI
-Disruption of axolemma of corpus callosum(white matter)
-Axonal bulb/ retraction bulb(Transected axon) visible after 12 hrs
 95
DURET HEMORRHAGE: Hemorrhage of midbrain & pons
KERNOHAN’S NOTCH: Cerebral notch due to raised intracranial pressure

Injury of spinal cord & spleen

Whiplash injury
-Hyper flexion followed by Hyperextension in an RTA
-Front seat occupant of the vehicle

Concussion of the spinal cord

-Seen in railway accident or motor vehicle accident
-Railway spine

M/c organ injured in blunt abdominal trauma: Spleen

M/c organ injured in penetrating injury: Liver
M/c site of aortic injury: Descending thoracic aorta, just distal to the orgin of left subclavian artery

Injuries to pedestrians & Passengers in a vehicle

Injuries to pedestrians

Primary impact injury: Bumper impact (Tibia/ fibula fracture)

Secondary impact injuries: Hood & windscreen impact
Secondary injuries: Ground impacts

SECONDARY IMPACT INJURY TERITIARY IMPACT INJURY

-Roll over the vehicle : Multiple injuries -Thrown away

-Run over by the vehicle: Tyre marks -Most dangerous
-A/k/a Secondary injury

Injuries to passenger sitting in a vehicle

DASHBOARD INJURY STEERING INJURY

-Patella fracture -Sternum, rib fracture

-Distal end of femur fracture -Aortic tear(transverse tear)/ Ladder pattern tear
 96

SEATBELT INJURY
M/c site: Mesentery
M/c organ: Intestine
Injury to abdominal organs
 97

Taphonomy
Post mortem changes
Study of postmortem changes: TAPHONOMY
IMMEDIATE POST-MORTEM CHANGES
Insensibility/ loss of voluntary power
Bishops tripod of life Lack of respiration
Lack of circulation

EARLY POST-MORTEM CHANGES

1. Eye changes
2. Rigor mortis
Cellular death 3. Livor mortis
4. Algor mortis
5. Skin changes

LATE POST-MORTEM CHANGES

Putrefaction(m/c)
Due to decomposition & deccay
Adipocere formation
Mummification

EYE CHANGES
Dilated pupil(pupil can be constricted in rigor mortis)
: Corneal opacity: 6-24hrs
I

IOP: becomes 0 after 2hrs

Trachea noir sclerotica: Triangular patch over sclera due to deposition of epithelial debri
Base towards cornea, tip towards angle of eye
Due to mucus dust accumulation
Occurs within 3-4hrs
Yellow Brown Black

Vitreous humour: Increased k+ ion & Hypoxanthine

Estimation of time since death upto 100hrs MADEA/ STURNER FORMULA

Retinal change: KEVORKIAN SIGN/ RAIL-ROADING PHENOMENON( 1st sign)

-Retinal vessels are fragmented
-Seen within few minutes
 98

Post mortem curves & algor mortis

MUSCLE CHANGES AFTER DEATH

Primary relaxation
(absent in Cadaveric spasm)

Rigor mortis

Secondary relaxation due to Putrefaction

37 C Rigor Decomposition
Algor mortis: Sigmoid curve
Cooling Lividity: ‘L’ shaped, starts early
Temperature(C)

Decomposition: Starts late

Rigor mortis: Follows lividity, inverted ‘U’ shaped
Lividity

Algar mortis

-Post-mortem cooling due to heat loss from body

-Starts immediately after death, reaches enviornmental temp at 12-16 hrs
-Ideal site to record temperature: Rectum(core body temperature)
-THANATOMETER is used
-Inverted ‘S’ shaped curve

Rate of fall: 0.4- 0.6 C/ hour

Normal body temperature(NBT) - Rectal temperature(RT) after death

Time since birth=
(Temp as in Fahrenheit) Rate of fall

TSD = NBT -(RT +3)

(When temp in centigrade)
 99
Post mortem caloricity
Temperature remains raised for the 1st 2 hrs
CAUSE: 1. Sunstroke
2. Tetanus
3. Strychnine poisoning(spinal)
4. Septicaemia
5. Pontine hemorrhage

Post mortem staining/ post mortem lividity/ hypostasis/ vibices/ suggilation

-Collection of blood in dependent area(not pressure areas) due to capilovenous distension

-Starts within 1-2hrs, fixed in 6-12hrs
-Persists till decomposition
-Absent in severe HMG/ severe anemia/ drowning in floating water
-Margins are regular( irregular margins seen in Bruise)
-Contact flattening +

POISONING POST MORTEM LIVIDITY

CO Cherry red
Cyanide Pink/ bright red

Phosphorous Yellow/ brown

H2S Blue-green
Opium Black

Nitrate Chocolate brown

Hypothermia Pink red
Aniline Red brown
Hanging Glove & stocking pattern

Body moving(running) Absent

Septicaemia

Clostridium welchii Blue-green

Clostridium perfringens Bronze

 100
Previous Year Questions
AIIMS 2018
Identify the following post-mortem change:

A) Tattooing
B) Suggilation
C) Putrefaction
D) Decomposition

Muscle stiffening & rigor mortis

MUSCLE STIFFENING

HEAT STIFFENING
Coagulation of muscle proteins when the surrounding temperature is >65 C

COLD STIFFENING
Freezing of body fluid then the surrounding body temperature is < -5 C

GAS STIFFENING

Seen 2 to 3 days after decomposition(due to the gas produced)

Rigor mortis/ Cadaveric rigidty

Shortening & stiffening of muscle/ Joints
: Mechanism- ATP depletion
•

All muscles involved 1st muscle: Myocardium(involuntary)[0.5 - 1 hr after death]

1st external muscle: Upper eye lid [1-2 hrs]
pH = Acidic
: A/k/a SOMMERS MOVEMENT
Death
Primary flaccidity
Rigor mortis

Stiffening of actin & myosin filaments

Decomposition starts

Secondary relaxation
 101
RULES OF RIGOR MORTIS
1. Rule of 12
1st 12 hrs: Appears in all body muscles

2nd 12 hrs: Remains the same in all body muscles

3rd 12 hrs: Disappears from all body muscles

2. Shapiro’s rule
Proximal-distal progression Rigor mortis 1st occurs in proximal muscles

3. Nysten’s law
Sequential order of rigor mortis in various muscles groups

Heart(left side of heart)- 1hr

Eyelids- 3-4hrs
Previous Year Questions
Neck, lower jaw NEET PG 2019
Rigor mortis occurs first in:
Face- 4-5hrs A) Eyelids
B) Intestines
Chest
C) Myocardium
Upper limb- 7-9hrs D) Neck

Abdomen

Lower limbs- 9-11hrs

Fingers & toes- 11-12hrs

Previous Year Questions AIIMS 2017

Order of appearance of rigor mortis:
A) Orbicularis oculi, facial muscles, thorax, upper limb
B) Orbicularis oculi, neck, facial muscles, upper limb, thorax
C) Neck, muscles of eyelid, upper limb, thorax
D) Neck, muscles of eyelid, facial muscles, thorax, upper limb
 102
Cadaveric spasm
Seen just after death
: ATP depletion Hard stiffening, not broken easily
ANTEMORTEM change
: Affects voluntary muscles & also short group of muscles
pH= Alkaline
: Responds to electric stimuli, so a/k/a instantaneous rigor
Gives an idea about the mode of death

:
Decomposition
Refers to external changes
Surest sign of death
: Internal decomposition is PUTREFACTION
M/c bacteria: Clostridium welchii AUTOLYSIS: If the body enzymes helps in destruction
: M/c enzyme: Lecithinase Eg: Cloudy appearence of cornea after death

CHANGES IN DECOMPOSITION
1. Greenish discolouration at right iliac fossa: 1st External change
-Due to sulhemoglobin
-Caecum is located below right iliac fossa(max bacteria)
-Starts in 12-18hrs in summer

2. Reddish-brown discolouration of intima of large blood vessels like aorta: 1st Internal change

3. Greenish discolouration under the surface of liver

4. Abdominal distension: 12-18 hrs(summer) & 1-2 days(winter)
5. Post-mortem Blister formation: 18-24hrs
6. Emphysematous subcutaneous tissue: 24-48hrs
7. Facial distension: Almost 24 hrs
8. Foamy liver/ Honeycomb liver: 24-36hrs
 103
9. Marbling
Visible veins due to sulfhemoglobin
Purple-Red staining of superficial veins
Chest Thigh Shoulder
Starts in 24hrs, becomes prominent in 36-48hrs
10. Maggot formation
Flies lay eggs Larva(maggots)
Normal conditions: 2-3 days
Rainy seasons: 1-2 days
11. Gas stiffening & post mortem purge: 2-3 days
12. Loosing of hair & teeth: 2-3days
13. Glove & stocking pattern(skin peeled of): 3-5 days

Previous Year Questions

AIIMS 2019
The postmortem change seen in the image below corresponds to
which ofthe following:
A) Marbling
B) Algor mortis
C) Rigor mortis
D) Post mortem lividity

Putrefaction

Internal decomposition
1st organ to decompose: Larynx/ trachea

Stomach, intestine, spleen

Liver, lung

Brain, heart, uterus

In females: non-Gravid uterus

Last organ to undergo putrefaction In male: Prostate
Overall last: Bone
 104

Best organ for DNA sampling in a decomposed body: Brain

1st amino acid to disappear from bone: Proline, Hydroxyproline
Last amino acid to disappear from bone: Glycine
Colliquative necrosis of the body: 5-10 days

POST-MORTEM LUMINESCENCE
Light coming from the dead body
Due to photobacteria & fungus

CASPERR DICTUM
Rate of decomposition of the dead body is different in different media
Air > Water > Soil

POISONS INHIBITING PUTREFACTION

Cyanide, Carbonmonoxide, Carbolic acid
Metallic poison: Arsenic, Antimony, Thalium
Strychine

Modification of decomposition

Adipocere
A/k/a Saponification/ Grave wax
Seen when body is in warm & humid climate or in water
Ammonia smell
Bacteria: Clostridium welchii
Enzyme: Lipase

Fatty acids of face, breast, buttock & abdomen undergo hydrogenation & hydrolysis

Absent in fetus < 7 months (no subcutaneous fat)3weeks to 3 months

Facial features are preserved
Gives idea about climate, identification and time since death
Pseudo smell in clothing of doctor
 105
Mummification
Occurs in high temperature, dry area, proper air movement
: Occurs due to dehydration/ desiccation of the body
Odourless
: Bones & body are preserved for a longer duration
Loss of body wt upto 70%
: Colour : Black (due to drying)
Facial features are well preserved

:
Embalming
Done to preserve the dead body
Should be done within 6 hrs of natural death
: Embalming fluid: formalin, methanol, glycerin, sodium borate, sodium citrate
Embalming is done after postmortem

: If done before autopsy: 201 IPC(disappearance of evidence)

Methods: 1. Arterial embalming- Femoral artery is preffered
2. Cavity embalming

Previous Year Questions NEET PG 2018 Previous Year Questions NEET PG 2018
Which is the first organ to putrefy? What is the odour of the mummified body?
A) Brain A) Odourless
B) Heart B) Pungent
C) Kidney C) Putrid
D) Offensive
D) Prostate
 106

Previous Year Questions AIIMS 2018

Identify the correct pair

i- Mummification
ii- Adipocere
iii- Marbling
iv- Lividity of death
A) i-4, i-3, iii-2, iv-1
B) i-3, ii-4, iii-2, iv-1
C) i-3, ii-1, iii-4, iv-2
D) i-3, ii-4, iii-1, iv-2

Previous Year Questions

AIIMS 2020
Identify the condition shown in the image.

A) Postmortem lividity
B) Marbling
C) Filigree burns
D) Subcutaneous emphysema

Previous Year Questions INICET 2021

Match the following postmortem findings and their time of appearance:

A. Adipocere formation 1. 24 hrs
A) A-4, B-1, C-2, D-3
B. Relaxation of urethral sphincter 2.2-3 days
B) A-3, B-1, C-2, D-4
C. Marbling of veins 3. 4-5 days
C) A-4, B-2, C-1, D-3
D. Liquefaction of tissues 4.8-10 days
D) A-1, B-2, C-3, D-4

Previous Year Questions NEET PG 2021

Which of the following is true regarding the changes
given in the image below ?
A. Seen in 24 hours
B. Due to sulphhaemoglobin
C. Due to non bacterial cause
D. Due to Drowning
 107

Autopsy
THANATOLOGY: Study of Death
: Death is defined under 46 IPC (brain stem death)- Declaration of sydney
Bichat’s mode of Death- 3 types

:
A. Asphyxia(cessation of respiration)
B. Coma(cessation of brain function)
C. Syncope(cessation of circulation)
Death critera
1. HARVARD CRITERA- Cortical brain death
A. Unreceptivity & unresponsibity_ due to damage to cortex
B. No movements
C. Apnea(due to brain stem)- Respiration tested for 3min
D. Absence of superficial, deep, spinal reflex
E. Irreversible COMA
F. Isoelectric EEG

Repeat all these after 24hrs

2. MINNESOTA CRITERIA- For Brain stem death
A. No spontaneous movements
B. Apnea( due to damage to PONS & MEDULLA)- Testing period is 4 mins
C. Brain stem reflex- Absent
Corneal reflex
Pupillary reflex
Gag reflex
Vestibular reflex
D. EEG is not mandatory
Repeat all these after 12hrs
Suspended animation
Apparent death(death like state)
Pulse rate, Respiratory rate: Very weak due to BMR
: CAUSES: 1. After anaesthesia- Eg: Ketamine
2. Barbiturates/ New born infants
3. Cholera/ Cerebral concussion/ COMA
4. Drowning- Near drowning
5. Electrocution
6. Frozen state
7. Heat stroke
8. Yoga
 108
TYPES OF DEATH

SOMATIC DEATH
A/k/a Atria Mortis
: Respiration stops
Circulation stops
: Brain function stops

MOLECULAR DEATH/ CELLULAR DEATH

Death of cells & tissues individually
: Takes place usually one to two hours after stoppage of vital functions

SUPRA-VITAL INTERVAL
Interval between somatic death & molecular death
: Time for organ harvesting

AUTOPSY
1st Post-mortem : 1693 (by Buckley)

In unnatural cases(rape, fire-arm)

Consent is not required
By request of police/ magistrate
MEDICOLEGAL AUTOPSY
Police inquest- 174 Crpc
Magistrate inquest- 176 CrPC
All cavities opened
Cause of death & time since death are decided

By pathologist for PATHOGENESIS

PATHOLOGICAL AUTOPSY Consent of relatives is required
For academic purposes

A/k/a Virtopsy
VIRTUAL AUTOPSY
Cause of death is detected by CT/MRI scan

In suicide cases
PSYCHOLOGICAL AUTOPSY Questions regarding mental status is asked to family
members & friends
 109
Vagal inhibition
Gross finding: Negative Laryngospasm
NEGATIVE AUTOPSY Lab findings: Negative Cause: Thyrotoxicosis
Toxicology analysis: Negative Status asthmaticus
Histopathology: Negative Common krait bite

Bruise
OBSCURE AUTOPSY Minimal findings Eg:
H/O fall with no intracranial hemorrhage

Types of skin incisions in autopsy

Chin
‘I’ shaped Most common incision
Pubic symphysis without umbilicus

Behind mastoid

Acromion process

‘Y’ shaped Used in females Undersurface of breast

Xiphoid process

Pubis symphysis

Mastoid process

Used in hanging, strangulation Midpoint of clavicle

Modified ‘Y’ shaped
Bloodless desection of neck in hanging Sternal notch

Pubic symphysis

Acromion

‘X’ shaped Done in custodial death, spine injury Midline

Gluteal region

Inverted ‘Y’ incision Infant autopsy

‘T’ shaped To explore vertebral arteries

 110
Techniques of autopsy
1. VIRCHOW TECHNIQUE
Organs are removed one by one and examined
Most common

2. ORGAN BLOCK- GHON TECHNIQUE

Enblock dissection
Cervical block, thoracic block, abdominal block are take separately
3. IN-SITU DISSECTION- ROKINTANSKY

Organs are not taken outside the body

Prevent occupational hazard(HIV, HBV, COVID 19)
4. EN MASS DISSECTION- LETTULE
Best techniques
All organs connected to each other taken out
(To preserve the blood supply)

Dissection technique
STOMACH: Opened from Greater curvature
: SPINAL CORD: Opened posteriorly
5
LIVER: Dissected along long axis
BRAIN: Dissected in coronal plane
: HEART: Dissected along with blood flow
(RA RV Pulmonary artery Lungs LA LV Aorta)

MODE OF DEATH 1st CAVITY TO BE OPENED LAST CAVITY TO BE OPENED

Asphyxial death Cranium Neck(bloodless field)

Head injury Thorax Head

Poison Brain

Infant Abdomen
(To see position of diaphragm)

Air embolism Head

Thorax(filled with water)

Water test- Bubbles coming from
Pulmonary embolism pulmonary alveoli
Pyrogallol test- Pyrogallol gives colour
when comes in contact
with air
 111
Exhumation

Digging out an already buried body legally from grave

: Done in early morning
No time limit for exhumation
: 176 CrPC: Magistrate inquest
 112

Forensic Psychiatry
For committing crime : Criminal intention (mens Rea)
Criminal intention absent in insane
Criminal act (Actus Rea)

Insane in India : not responsible for crime (section 84 IPC)

Laws for insanity

McNaughten's rule : Implemented in 1843 84 IPC

84 IPC -Unsound mind due to mental disease

-Defect of reasoning due to mental disease

McNaughten's rule A/k/A legal test, right or wrong test

When mentally ill person commits crime in view of revenge Not comes under 84 IPC

82 IPC- minimum age for criminal responsibility: 7yrs

83 IPC- 7 to 12 yrs = criminality depends on maturity, Age of full maturity= 18yrs
84 IPC- Protection of Insane
85 IPC- Involuntary intoxicated(not responsible for crime)
86 IPC- Voluntary intoxicated(responsible for crime)

CIVIL RESPONSIBILITIES OF INSANE PERSON

CRIMINAL RESPONSIBILITIES OF INSANE PERSON
Marriage under insanity INVALID
Avoid enquiry 328 CrPC
Witness in court of Law INVALID
Avoid trial 329 CrPC
Consent INVALID
Avoid conviction 84 IPC
INVALID DURING INSANITY
Testamentary capacity
VALID IN LUCID INTERVAL

TESTAMENTARY CAPACITY- MENTAL CAPACITY TO MAKE VALID WILL

(31 IPC)

LUCID INTERVAL
-Phase of sanity b/w 2 period of insanity
-During this period accused will be responsible for crime
-Can act as witness & testify
 113

DIAGNOSIS OF INSANITY
-Minimum 3 examinations
-After magistrate order: Person can be declared insane in 10 days( min time)
-On magistrate order: Insane can be detained for 30 days(maximum)

OTHER RULES - CRIMINAL RESPONSIBILITY OF INSANE PERSON

1. American law institute test : If Adequate capacity to appreciate the criminality of conduct lost

2. Brawner's rule : Substantial capacity to appreciate the wrongfulness of conduct is lost

3. Currens rule : Capacity to conduct is lost

4. Durnams rule

5. Irresistible impulse test : Free agency of will lost due to mental disease
(HAMSPSHIRE DOCTRINE)

Previous Year Questions AIIMS 2017

Criminal responsibility of Insane is defined in:
A) McNaughten's Rule
B) Currens Rule
C) Durham's Rule
D) American Law Institute Test

Previous Year Questions NEET PG 2018

McNaughten's rule falls under which Section?
A) Section 84 of CrPC
B) Section 84 of IPC
C) Section 184 of IPC
D) Section 184 of CrPC
 114

Phobias
•

AGORAPHOBIA: Fear of open spaces

@

CLAUSTROPHOBIA: Fear of closed space

ACROPHOBIA: Fear of height
: NYCTOPHOBIA: Fear of darkness
MYSOPHOBIA: Fear of dirt
: HYDROPHOBIA: Fear of water
AIEROPHOBIA: Fear of cats

Kleptomania
Impulse disorder: Steals articles
: Knowledge/ Insight: +
Doesn’t get advantage of 84 IPC

:
Mental health care act

Mental health act- MHA, 1987

Mental healthcare act, 2017

MHA, 1987

10 chapter, 98 sections Anything against the act: 2 yr punishment

•

Definition of mental illness- Schizophrenia, Mania, Bipolar disorder…..(Except Mental Retardation)

•

Attempt to suicide was punishable- 309 IPC ( now decriminalised)

•
Indications for immediate restrain When person looks DANGEROUS(for himself/other)
•

Voluntary admission duration by hospital: 90 days

•
Maximum duration of period of observation of mental illness: 30 days

ADVANCE DIRECTIVE: An individual with known psychiatric disorder/ on treatment & is not a minor
can choose to decide the caretaker and the the course of treatment

CONDITIONS where person is not responsible for crime 1. Twilight state

2. Oneiroid state
3. Post traumatic automatism
4. Somnambulism
5. Involuntary drug intoxication
6. Delirium tremens(alcohol withdrawal)
 115

Animal organic irritants

Snake bite

Ophiotoxemia: Study of Snake poisoning

Classification of poisonous snakes

COBRA
COMMON KRAIT
I. NEUROTOXICITY- ELAPIDAE
MAMBA
CORAL

RUSSEL VIPER
II. HEMOTOXIC- VIPERIDAE
SAW SCALDED VIPER
•

Paralysis of skeletal muscles

III. MYOTOXIC- SEA SNAKES •

All sea snakes are poisonous

NEUROTOXIC SNAKES HEMOTOXIC snakes

Acts on Neuromuscular junction causing Paralysis Causes Lyses of RBC & Endothelial cells

CLINICAL FEATURES CLINICAL FEATURES

-Ptosis -Bleeding manifestations
-Facial weakness -Blisters
-Abdominal pain -Increased Bleeding time, clotting time
-Excessive sleepiness -DIC
-Respiratory paralysis(cause of Death) -Renal failure
-Death(6-8 hrs) -Parotid enlargement(Viper)
-Hematuria(Russell’s Viper)
-Death(1-2days)

Features of poisonous snakes

Head scales Small

Belly scale Broad

Distal scales Single row

Fangs Long, Hypodermic needles

Tail Pointed

Habits Nocturnal

Bite marks Two

 116
COBRA

“NAJA NAJA”
More dangerous- amount of venom is more
: Fatal dose: 12mg
Oviparous

: Hood +
Spectacle mark + (Spectacle mark absent in king cobra)
•

Head scale: 3rd supra orbital scale is large

Common krait
“BUNGARUS CAERULEUS”
•
More poisonous
•
Fatal dose: 6mg
Steel black in colour

: White transverse line +

Fang mark invisible
•

Can bite without stimulus

C/F resembles like stroke
: Only snake where no swelling & no burning is seen at the site of bite
•

Head scale: 4th infra-labial scale is large

Russel viper
“DOBOIA RUSELLI”
Fatal dose: 15mg
Triangular/ V shaped head
Constricted neck
Broad body
Black/Brown- 3 rows spots
Pointed tail
Viviparous
Cause of death: SHOCK
 117
Saw scaled viper
•

Diamond shaped areas

•

White waxy line

•

Bird foot mark

•

Viviparous

Management of snake bite

1. Reassure the patient
2. Immobilization using sling
3. Go to hospital as soon as possible
4. Polyvalent anti-snake venom[PSAV]- horse orgin
(Given within 4 hrs)
Protects from: Common krait
Test dose not given
Cobra
Russel viper Mild symptoms: 5 vials
Saw scaled viper Moderate symptoms: 10 vials
Severe symptoms: 15 vials
Not taken for king cobra bite

2nd dose required in NEUROTOXIC snakes

S/E: Hypersensitivity

5. Neostigmine: only in NEUROTOXIC snakes

Atropine is not useful in the management of krait bite. The toxin in common krait's venom acts
presynaptically, hence atropine is not used in the treatment of envenomation by krait
As the cobra venom acts postsynaptically, atropine can be used in the management

Previous Year Questions

AIIMS 2020
Which of the following is false regarding the management of snakebite in India?
A) Atropine and neostigmine are very useful in the management of krait bite
B) Neostigmine and ventilatory support are used in treatment along with AV
C) ASV is the mainstay of treatment
D) Current ASV in India is not effective against humped pit viper
 118

Scorpion poisoning

It may be HEMOTOXIC/ NEUROTOXIC

: Treated by anti-scorpion venoms, barbiturates, calcium, atropine & prazosin

Previous Year Questions NEET PG 2019

Which of the following acts as a physiological antidote to scorpion venom?
A) Physostigmine
B) Norepinephrine
C) Prazosin
D) Atropine

Spiders poisoning
Most poisonous spider: Black window
: Treatment: Anti-spider venom & dapsone
 119
Agricultural poison
Organophosphorous poisoning
•

Organophosphorus smells like kerosene, as it is kept in a solvent called aromax.

HETP- F.D:350mg
TEPP- F.D:100mg
Alkyl phosphate
OMPA- F.D:175mg
Malathion(kill bug)- F.D: 1gm
Types
Parathion(folidol)
Aryl phosphate
Diazinon(TIK 20)

Mechanism of action

Irreversibly inhibits acetylcholinesterase Ach

(Parasympathetic overactivity)
Bradycardia
Increased secretions
Constriction of pupil

Diagnostic method
Best : RBC cholinesterase (significant when <50%)
-M/c used : Plasma cholinesterase

Treatment
-Gastric lavage
-Antidotes : DOC-Atropine (inhibits central& muscarinic effects) + oximes (inhibits nicotinic effect)
Activated charcoal: 1-2g/kg body wt

CAUSE OF DEATH: RESPIRATORY PARALYSIS, VENTRICULAR ARRHYTHMIA

Postmortem findings
1. Kerosene like smell
2. Pulmonary edema
3. Frothing
4. Signs of asphyxia
5. Congested organs
 120
Carbamates
Eg : Aldicarb, Decarb, Baygon, Propoxur

mechanism of action
Reversible inhibition of acetylcholinesterase(but doesn't penetrates CNS)
Treatment

Antidote : atropine (oximes are not given)

organochlorines

Examples : Endrin (also Known as plant penicillin), DDT

Endrin is a CNS stimulant & acts through sodium gated channel

Organochlorines are deposited in subcutaneous fat

•

Organochlorines causes mydriasis

Chronic poisoning of organochlorine leads to head tremors known as Kepone shake
: There is no specitic antidote

POISON SMELL
Arsenic
Phosphorous Garlic
Cyanide Bitter almond
H2S Rotten egg
Zinc phosphade Fishy smell
Nitrobenzene Shoe polish
 121

Deliriant poisons
Datura

Also called 9 D poisoning

Active principle: Atropine, Hyoscine and Scopolamine (Truth serum)
Anti-cholinergic Plant

Fatal dose: 0.6 gm to 1 gm (100 - 125 Seeds)

Fatal period: 24 hrs

Datura fruit- THORN APPLE

Clinical features
Dysphagia
•
Dysarthria
Dilation of blood vessels
: Diplopia
•
Dry hot skin Carphologia - Picking of imaginary threads.
•
Drunken gait Characteristic pupil: Corn-Picker pupil with unilateral mydriasis
•
Drowsiness
•

Delirium in datura: Muttering delirium

•
Dryness of mouth
•
Mydriatic test Positive

Datura Alba- White Datura. Datura Niger- Purple Datura. Datura Stramonium - Thor Apple.

Treatment
Gastric lavage Hemodialysis not used
Activated charcoal
Datura-Lipid soluble
Antidote : Physostigmine > Pilocarpine.
 122
Cocaine

A/k/a White lady/ crack/ coke/ cadillac

: Coca plant: Leaves of ERYTHROXYLON COCCA

Local anaesthetic/ CNS depressant/ CNS stimulant/ vasoconstrictor
•
Fatal dose: 1g
Skin cocaine: drug injection in skin
Main lining: I.V
ROUTES
Nasal inhalation: Snorting
Chasing the Dragon: Smoking

Nor-epinephrine
Epinephrine MOOD
Serotonin

Nasal septal perforation

CLASSICAL TRIAD OF COCAINE POISONING Black tongue & teeth
Gangrene of nose & ear

COCAINE BUGS: Tactile hallucination

A/k/a MAGNAN SYNDROME

SPEED BALL: COCAINE + HEROIN SHOOTING THE GALLERY: Place where Heroin is smoked

Treatment
•
Antidote: Amyl Nitrite
•
Nasal swab sample is taken in cocaine poisoning

Previous Year Questions AIIMS 2019

Identify the plant which produces a deliriant toxin.
A) Erythroxylum cocca
B) Datura
C) Hyoscine
D) Digitalis purpura/cannabis
 123
Previous Year Questions NEET PG 2021
Child consumed some unknown fruit.After some time,he started symptoms of irritability,
restlessness,confusion,inability to pass urine,hot skin and photophobia.Select the poison and
antidote ?
A. Datura and Physostigmine
B. Yellow oleander and Physostigmine
C. Datura and Digibond
D. Yellow Oleander and Digibond

Previous Year Questions NEET PG 2021

A 25year old female came to the ER and was given the history of Cocaine overdose. What is
the least likely symptom seen in this person :
A. Agitation
B. Hyperthermia
C. Bradycardia
D. Myocardial Infarction

Cannabis sativa

CNS stimulant
: Active ingredient: 9-Tetrahydrocannabinol

TYPES

BANG GANGA HASHHISH/CHARAS MARIJUANA

15% 9-THC 25% 9-THC 40% 9-THC

A/k/a SIDDHI A/k/a WEED/REEFER Most potent Dried flower

Dry leaves Female flower top CHARAS- resign of plant Flash back phenomenon
A motivational syndrome
Burnt rope smell Run-Amok: Homicidal tendencies
Fatal dose: 10g Fatal dose: 8g Fatal dose: 2g KORO - Patient thinks that size of
penis/ breast is decreasing

Clinical features
•
Euphoria
•
Increased appetite
•
Constipation
•
Paranoid dellusions
 124
Previous Year Questions AIIMS 2017
Match the following 1. Cocaine A. Hunan hand
2. LSD B. White lady
3. Arbus precatorius C. Purple wedge
4. Capsaicin D. Gunchi
A. 1=A, 2=B, 3=C, 4=D
B. 1=B, 2=C, 3=D, 4=A
C. 1=D, 2=A, 3= B, 4=C
D. 1=C, 2=D, 3=A, 4=B

Previous Year Questions NEET PG 2020

The most common drug which causes physical dependence is?
A) Ketamine
B) Heroin
C) LSD
D) Phencyclidine

hallucinogen

LSD Bad trip

MDMA A/k/a ECSTASY, Molly, Love drug, Hug drug

Urine/ Slang of Amphetamine addicts

AMPHETAMINE
Sold as LIQUID GOLD
(Contains 60-70% Amphetamine)

Previous Year Questions AIIMS 2018

Match the following:
A) i-2, ii-1, iii-4, iv-3
i- Heroin 1-Ganja
B) i-3, ii-2, iii-1, iv-4
ii- Eve 2-Acid
iii-Joint C) i-4, ii-2 iii-1, iv-3
3-Brown sugar
iv-LSD 4-Amphetamine D) i-3, 1-4, iii-1, iv-2
 125
POISON EFFECT IN CVS EFFECT ON OCCULAR SYSTEM

COCAINE Tachycardia Mydriasis

Systemic arterial HTN Loss of eyebrows/ eyelashes
MI Corneal abrasion/
Tachyarrhythmias ulcerations
Dilated cardiomyopathy CRAO
Aortic dissection & rupture B/L blindness

Irregularities of heart with Amblyopia

NICOTINE occasional extrasystole Narrowing of field of vision
Episode of chest pain suggestive of Blindness
angina

CANNABIS Tachycardia Blood shot eyes(conjunctival

Palpitation congestions)
HTN Occasional mydriasis &
nystagmus

ATROPINE Tachycardia Dilated pup[il(mydriasis)

Arrhythmias Diplopia

Previous Year Questions AIIMS 2017

A 35 year old male came to casualty with complaints of rapid heart rate. On examination
everything was normal except for episodic tachycardia and occasional extra systole. Ocular
examination shows visual field defects. Which of the following is the likely cause?
A) Cocaine
B) Nicotine
C) Cannabis
D) Atropine
 126
Irritant organic plants
Castor seeds

“RICINUS COMMUNIS”
•

A/k/a ARANDI
•

Ricin is 6000 times powerful than cyanide

Fatal Dose: 10 seeds

Fatal period: 3-4 days Shiny, grey & black markings,
mottled
Mechanism of action

Ricin Inhibits RNA polymerase Inhibition of Protein synthesis

Eg: Umbrella murder case

Treatment
Symptomatic only

Croton tiglium
A/k/a Napala, Jamalghota
Toxalbumin: CROTIN

Fatal dose: 10 seeds

Fatal period: 3-4 days
Non-shiny, non-mottled

Rati seeds
“ARBUS PRECAUTORIUS”
A/k/a Gunja, Jequirity, Rosary beads, Indian liquorice
Toxalbumin: ABRINE-ABRALINE
Fatal dose: 1-2 seeds/ 90-120mg

Signs & symptoms- Like Viper Red_black appearence

USES: Animal poison(needle/Sui measuring 15mm)
Arrow poison
Criminal abortions
 127
•
All parts of the plant are poisonous
Treatment
Gastric lavage
: Anti-baring
Dissection of needle
•

Semicarpus anacardium

A/k/a Marking nut/washer and seeds/laundry men seed

Toxalbumin: BHILAWANOL & SEMICARPOL

USES: Vitriolage & artificial bruise

Criminal Abortion

Black, heart shaped,

projection at one end
Ergot
Formed by fungus- Claviceps purpura(found commonly on rye plant)
Ergot poisoning leads to Burning sensation at limbs- St. Anthony fire
CHRONIC ERGOT POISONING: Ergostism

Tingling
Numbness of skin
formication(tactile hallucination)

Calotropis
A/k/a Akar & Madar, Rubber bush
Active principle: USCHARIN & CALOTOXIN
Symptoms: Salivation
Dilated pupils
USES:Cattle poison
Criminal abortion
 128

Previous Year Questions AIIMS 2020

Identity the seeds shown in the image below.

A) Tropicana canna
B) Nigella sativa
C) Datura seeds
D) Opium seeds

Previous Year Questions NEET PG 2021

The active principle of this poison is :

A. Abrin
B. Ricin
C. Crotin
D. Bhilawanol
 129

Spinal & cardiac poisoning

Spinal posioning
Nux vomica/ kuchila

Active principles: BRUCINE, STRYCHNINE, KARABIN, LOGANIN

: Bitter in taste
Fatal dose: 1 crushed seed Fatal period: 2-6 hrs
Mechanism of action

Anterior horn cells Inhibits Glycine in Contraction

Strychnine (Renshow cell) Glutamate
post synapse of muscles

USES: Arrow poison

Aphrodisiac
Rodenticide
Killing street dogs
Respiratory stimulator

Clinical features
•

Excitatory, mimics like Tetanus

•

Convulsions in all muscles

@

Positions: Opisthotonus(m/c): Hyperextension of back

Pleurosthotonus: Lateral bending
Emprosthotonus: Forward bending
Trismus & Risus sardonicus

CAUSE OF DEATH: RESPIRATORY MUSCLE PARALYSIS

Tests : WENZEL TEST & SONNENSCHEIN TEST

TREATMENT
Diazepam
Acidification of urine

Post-mortem calories is seen

 130
Conium maculatum
•
Nerve poison
•
A/k/a HEMLOCK
•
Progressive motor paralysis
•
Active principle: CONIINE
•
Smells like Carrot
CAUSE OF DEATH: RESPIRATORY MUSCLE PARALYSIS

Curare
•
Active principle: CURARINE

CAUSE OF DEATH: RESPIRATORY MUSCLE PARALYSIS

Cardiac poisoning
Aconite
QUEEN OF ALL POISONS
ARSENIC- KING OF ALL POISONS
A/k/a MEETHA ZAHAR/ MONKHOOD/ BLUE ROCKET
Confused with HORSE RADISH ROOT
All parts are poisonous
ROOT- most poisonous part
Sweet in taste

Fatal dose: 1-2gm

Fatal period: 2-6 hrs
Mechanism of action

Acts on Sodium channels on Myocardium DELAYS DEPOLARISATION

ARRYTHMIA
 131

CLINICAL FEATURES
HIPPUS Sign: Alternate Dilatation & constriction of pupil
: XANTHOPSIA: Yellow Halo surrounding object
00

Numbness/ Tingling over tongue(m/c), mouth, skin

Increased salivation
: Bradycardia
Hypotension
: Ventricular arrhythmia

CAUSE OF DEATH: HYPERKALEMIA

Previous Year Questions AIIMS 2018

Which of the following is incorrect regarding the image shown?
A) Only the roots of this plant are poisonous
B) Causes AV block
C) Drug of choice for poisoning is Atropine
D) Mitha zaher is one of the variety of this plant

Oleander

Yellow oleander White oleander

CEREBRA THEVETIA NERIUM ODORUM

Active principle: NERIN, NERIFOLON Active principle: THEVETIN, THEVETOXIN
 132

Metallic & non metallic poison

Arsenic

M/c source: water

M/c compound: Arsenic trioxide

: Others: Paris green, scheele’s green

Ideal homicidal
Tasteless
: F.D: 100-200 mg

CLINICAL FEATURE
1. Aldrich mee’s line- white transverse line in nails
2. Rain drop pigmentation
3. Diarrhoea-rice water type stool- resemble cholera)
4. Black foot disease
5. Carcinoma
6. Erythomelagia
7. Red-velvety stomach
DIAGNOSIS
1. Marsh test Arsenic can be found in nails, bone,
2. Reinsch test hairs even after many years
4. Gutzeit test
TREATMENT
DOC- BAL(chelating agent)
British anti-lewisite, dimercaprol, dimercaptopropanolol

Previous Year Questions AIIMS 2017

Black foot is seen in which poisoning
A) Arsenic
B) Lead
C) Mercury
D) Phosphorus
 133
Previous Year Questions NEET PG 2020
Which of the following poison can be found even in skeletonised remains of the
body?
A) Arsenic
B) Carbon monoxide
C) Hydrogen sulphide
D) Phosphorus

Previous Year Questions NEET PG 2018

Which metallic poisoning causes proximal convoluted tubule damage with proteinuria
and muscle pain ?
A) Arsenic
B) Chromium
C) Mercury
D) Lead

Mercury

Pink disease/ Quick seller

Commonly used in glass industry
Looks like Kawasaki disease of children, also mimics Diphtheric colitis
Toxicity: organic mercury > mercuric salt > mercurous salt
Most poisonous salt: Mercuric chloride(corrosive sublimate)

CONDITIONS a/w MERCURY POISONING

Hatter’s shake, Glass blower’s shake
: Mercuria lentils: mercury deposition in anterior lens capsule
Minamata disease of japan
: Hydragyrism(chronic Hg poisoning)
to

Mercurial erethism
CLINICAL FEATURES
Tremor: Danbury tremor(m/c in hand)
: Acrodynia: limbs become painful, puffy & pink
Blue black line on gums
: Physiological disturbances

TREATMENT
Antidote: BAL(chelating agent)
: Sodium formaldehyde sulfoxylate is used in gastric lavage
 134
Lead poisoning/ saturnism

M/c salt: lead acetate (F.D- 20 gm)

: Chronic lead poisoning- Plumbism/ saturanism

CLINICAL FEATURES
Anemia(micro cystic hypo chromic)
: Abortions
Basophilic stippling(d/t nucleotides)
: Burtonian line(on gums)- d/t lead sulphide
Constipation & abdominal pain
: Wrist drops, foot drops d/t neuropathy at 60-80 microgram per dl
Encephalopathy when > 80-120 microgram per dl

: Facial pallor(earliest sign)

Gout
HTN
: Impotence, intestinal nephritis

TREATMENT Previous Year Questions

NEET PG 2018
Pencillamine
: BAL
DMSA
Saturnine gout is seen in:
A) Lead poisoning
B) Cadmium poisoning
C) Beryllium poisoning
D) Mercury poisoning

PHOSPHOROUS

Yellow phosphorous: white + red phosphorous

: Asterixis: Flapping tremors in hand ( in chronic poisoning)
WHITE PHOSPHOROUS RED PHOSPHOROUS
M

Garlicky smell lo

No smell
t

F.D: 60-120mg Non toxic

F.P: 2-8 days
: No morphology
: Crystalline, Luminous
Non luminous
A

A/k/a Diwali poisons 9

Present on the sides of match boxes

 135
PHOSSY JAW: a/k/a GLASS JAW-Osteomyelitis of jaw bone
SMOKING STOOL SYNDROME: due to luminescence of phosphorus

Previous Year Questions NEET PG 2018

Luminescent stools are associated with which of the following?
A) Mercury
B) Cadmium
C) Phosphorus
D) Oxalic acid
 136

Asphyxiants
1. Cyanide
2. CO2
3. CO- Cause of death: Anemic anoxia
4. H2S
5. Nerve gases- sarin, Sabin, VX, GA, GB = death in seconds
Cyanide
Ideal suicidal
: Homicidal(cyanide Mallika)/ accidental(Bhopal gas tragedy)
MECHANISM: Hystotoxic Hypoxia due to inhibition of cytochrome oxidase
SIGN: BRICK-RED postmortem hypostasis
Bitter almond smell
F.D: Pure acid: 50-60mg(2-10 mins)
Mixed with NaCN & KCN: 200-300mg(30 mins)
Inhalation all: 270 ppm(immediate)
F.P: 2-8 mins

TREATMENT
Sodium nitrate(IV)
Sodiu thiosulphate(IV)
Amyl nitrate(inhalationally)

Previous Year Questions AIIMS 2018

What is the cause of death in smoke inhalation?
A) Histotoxic hypoxia
B) Ischemic hypoxia
C) Anemic hypoxia
D) All the above
 137

Corrosives
ACIDS COAGULATIVE NECROSIS except Hydrofluric acid
ALKALIS LIQUIFACTIVE NECROSIS

ACIDS-stomach perforation
ALKALIS-esophageal perforations

Sulphuric acid

Only local action

-Non-fuming, transparent
-Severe damage with 5-10ml[F.D]
-F.P: 12-24hrs Previous Year Questions

1 sec of contact = Partial thickness burn NEET PG 2019

Gastric lavage can be performed in case of
30 sec of contact = Full thickness burn
poisoning by
CLINICAL FEATURES A) Sulphuric acid
B) Strychnine
p

Chalky white teeth

C) Carbolic acid
Black tongue
: Stomach perforation D) Kerosene oil

CAUSE OF DEATH: CIRCULATORY COLLAPSE

CArbolic acid [phenol/ Lysol/ dettol]

Disinfectant
F.D: 10-20 ml
F.P: 3-4 hrs
CLINICAL FEATURES
Carbolic urine green colour(d/t pyrocatechol, hydroquinolone)
:
Coma
Constriction of pupil/ oochronosis
: Leathery stomach(harden’s stomach)
TREATMENT
Gastric lavage
 138
NITRIC ACID
Yellow colour
: PM findings: yellow colour discolouration(d/t xanthoprotein reaction)
F.D: 10-15ml
F.P: 12-24hrs

Oxalic acid
Prismatic crystals, white colour
: Weak acid, vegetable acid
Used in FORGERY

:
CLINICAL FEATURES
Tetany(d/t Hypocalcemia)-chrostek’s sign
Nephrotoxicity

F.D: 15-20gm
F.P: 1-2hrs

TREATMENT
Calcium gluconate

Contraindications of Gastric lavage

• Corrosives poisoning (except carbolic acid)
• Convulsants/CNS stimulants
• Comatose patients
• Volatile poison
• Upper Gl pathology (eg. esophageal varices)
• Hypothermic patient
• Severe heart disease
• Advanced pregnancy
 139

CNS Depressants

Alcohol-ethanol

If males & females consume same amount of alcohol

Females have 20-30% more blood alcohol concentration than males

(Reason: Alcohol dehydrogenase(metabolising enzyme) is less in females)

TYPES % ETHANOL

Absolute alcohol 99.95%

a: amount of alcohol
WIDMARK FORMULA
Rectified spirit 90% P: Body weight
a = PCR C: Blood alcohol concentration
Denatured spirit 95% R: Constant(0.68 in male & 0.55 in female)

Methylated spirit 95%

100% proof spirit/ Alcohol 50%

SMALL INTESTINE: Site for maximum absorption of Alcohol

Legal aspects
•

510 IPC- Misconduct after alcohol [1 day Jail]

•
Drink & Drive TESTS [Mechanism: Level of Aldehydrogenase]
@

185 MVA (motor vehicle act) @

Kozelka-Hine test
•
Legal limit: 30mg% •

Breath analyser -Henry’s Law

(A/k/a Drunkometer, contains Infrared rays)
@
>30 mg% : Punishable @

Cavett test
•

Gas chromatography(best & most specific)

Treatment
Antidote: NO SPECIFIC ANTIDOTE
 140
Previous Year Questions AIIMS 2017
A 30-year-old drowsy male was brought to the casualty. His pulse was 130/min, respiratory rate -30/min, blood
gas analysis revealed metabolic acidosis, Hypocalcemia, Blood Urea - 100 mg/dI, Creatinine - 3.4 mg/dl. Urine
analysis showed Calcium oxalate crystals. He showed improvement on nasogastric aspiration and
administration of Sodium bicarbonate, Calcium gluconate, and 4-methyl pyrazole. What substance did he most
likely consume?
A) Formaldehyde
B) Ethylene glycol
C) Paraldehyde
D) Methyl alcohol

Alcohol-methanol

“Wood alcohol”
⑧

Produces Formaldehyde, Formic acid

Fatal dose: 100ml

Complications
Optic neuritis
: Retinal damage
@
Snowfield vision
•

Coma
Hemorrhages

:
Treatment
TOC: Haemodialysis
Antidote: ETHANOL(1st preffered & better)

: Gastric lavage
Activated charcoal
•
Fomepizole- Inhibits alcohol dehydrogenase
•

Folinic acid

POST MORTEM FINDINGS

Post mortem clot is absent
:
Putamen necrosis is present
 141
NDPS ACT-1985

NARCOTIC DRUGS & PSYCHOTROPHIC SUBSATNCES

1. OPIUM
2. CANABIS
3. COCAINE
4. MDMA
5. LSD
+ 70 DRUGS
-Cultivation, consumption, transport(body packer syndrome), storage, selling are punishable

PUNISHMENT
1. Small offence 1 yr jail +/- 10k fine
Under 1kg Ganga
100gm CHARAS
2g cocaine
5g heroine

2. Medium offence 10yrs +/- 1 lakh fine

1kg-20kg Ganga
100g-1kg CHARAS
2g-100g cocaine
5g-250g heroin
3. Serious/ commercial offence 10-20yrs + 1-2 lakh fine
>20kg Ganga
> 1kg CHARAS
>100g cocaine
>250 g heroine
OPIUM
-Papaver somniferum
-Content: morphine, heroin

CLINICAL FEATURES
Respiratory depression TEST FOR DETECTION: MARQUIS TEST
Pin-point pupil
Coma

TREATMENT: NALOXONE, METHADONE