Forensic Medicine

Types of injuries
Abrasion
Bruise
Contusion
Laceration
Incision
Stab
Chop

ARTIFICAL BRUISE:
Injuries
Age of abrasion Age of contusion Livor mortis vs contusion:
RRRBBB
Dependent:
Well defined:
Direction: Blanch:
Vital reaction Extravasation:
Negative and positive zone Colour change:

Multiple bruises different age:

No colour change:

Antemortem vs Postmortem clot:

Firm, dark red-
Striae of Zahn -
Coralline platelet thrombus-
Chicken fat clot-

Harakiri = Seppuku
Jigai
Injuries

Electrical injury
More dangerous:
Most important factor for death:
MCC of death:
Rigor mortis-
Thermal injuries
EDH with honeycomb
appearance
Bilateral, diffuse

No bleeding
Intact nerves and
vessels
Wishnewsky ulcer:
Curling ulcer:
Cushing ulcer:
Cameron ulcer:

Heat cramps
Heat exhaustion Charring Blisters+ Ulcers+
Heat stroke Singeing Splashing+ Distinct
Classical: Blackening Line of colouration +
Exertional: redness+
RTA and Blast Injuries

Aortic tears:

Days within which death attributed to RTA

 Skull fractures

Lucid interval:
Valid evidence, will and criminally liable
 Ballistics
Calvin Goddard:

Rifling Choking

PELLET
BULLET

Primary marking: Secondary marking:

Bullet fingerprinting:
Dermal nitrate test GSR collected using paraffin wax
Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy
Kennedy phenomenon
Rayalasima phenomenon
 BLACK

Barium nitrate SMOKELESS

Lead peroxide
Lead styphnate single-base powder-nitrocellulose
Antimony Sulfide double base powder-NC + nitro-glycerine
Tetracene triple-base powder- NC + NG +
nitroguanidine

SEMI-SMOKELESS
Types of Bullets:

Keyhole:
Gutter fracture:
Kronlein shot:
Asphyxial deaths
Fresh Water vs Salt Water Drowning Dry Drowning:

Near Drowning:

Immersion syndrome:
Suffocation:
Café coronary
Strangulation:

ASPHYXIAL
DEATH
 Features Hanging Strangulation
Direction Oblique Transverse
Continuity Non- continuous Continuous
Level in the neck Above thyroid At or below thyroid

Base Pale, hard, parchment-like Soft and reddish

Hyoid fracture Abduction # Adduction #

Surest Sign of Antemortem Hanging:

 Human identification
Teeth: Temporary teeth Permanent teeth Mixed dentition:
Best method: I M1 C M2 M1- CI- LI-PM1-PM2-C-M2- M3 Total:
Carabelli’s cusp-
Gustafson criteria
Most reliable-

Dactylography-Galton system
Development in fetus by 24 weeks
Quelet rule:
Rugoscopy:
Superimposition:
Change Disease
Complete loss Burns, Celiac disease
DNA samples-Blood, muscle, teeth
Permanent impairment RT, Electrical injury,
Ashley rule: Leprosy,
Change in distance Acromegaly, Rickets
Durhan (Product test), Curren, Brawner rule:
Ridge alteration Scleroderma, Eczema,
Krogman’s accuracy max- Acanthosis nigricans
 Female Pelvis Male Pelvis
Shape of the Wider Narrower
pelvis
Pelvic inlet, outlet Larger Smaller
Coccyx Moveable and more curved Immovable and less curved
anteriorly anteriorly
Public arch Wider V shaped
Subpubic Angle Greater than 90o Less than 90o
Pelvic brim Large and round Small and heart-shaped
Sciatic notch Wider Narrower
Obturator foramen Small and triangular-shaped Large and oval-shaped

Sacroiliac joint Short, wider and curved Long, narrow and straight
surface
Pelvic acetabulum Small and faced anteriorly Large and faced laterally

All large and wide in

females except: Corpobasal index:
O Breadth of S1/ Breadth of base of sacrum *100
S
A
Feature Male Female
Architecture Rugged Smooth
Plate Large, broader and U shaped Smaller and parabola
Occipital condyle Large Small
Supra orbital ridges Prominent Less prominent
Digastric groove More deep Less deep
Mastoid process Large and blunt Small and pointed
Zygomatic arch More prominent Less prominent
Occipital protuberance Well marked Less marked
Frontal eminence Small Large
Parietal eminence Small Large
Orbits Square with smooth margin Rounded with sharp margin

All large and wide in males except:

-F/P eminence
-Nasal aperture
-Female forehead, orbit, chin round
BONE AGE ESTIMATION

2 mon: Lambdoid suture: 45yrs

3 mon:
3yr:
4yr:
5-6yr:
9-12yr:
Thanatology
Eye changes:
Minutes:
3-6hrs:
6hrs:
Best indicator TSD-

PM caloricity: Rigor mortis PM lividity:

Heat stroke First- Cherry red-
Pontine hemorrhage First external- Brick red-
Sepsis Nysten’s rule Chocolate-
Tetanus/strychnine Rule of 12
Cholera Not in fetus <7mon
NOT BURNS Late rigor mortis: Asphyxia, Hemorrhage, Pneumonia
Putrefaction delay: Putrefaction: Casper’s dictum
Strychnine, metallic Larynx/trachea-> Prostate,
poison, Carbolic acid nongravid uterus, bone, teeth
Autopsy
Order in autopsy: Organs preserved in Poisoning cases:
1) Poisoning Blood
2) Newborn Urine
3) Asphyxia Entire stomach
4)Pneumothorax Proximal 30cm SI
500g liver
Virchow- Half of each kidney
Letulle-
Ghon-
Rokitansky-

Incisions:
I–
Y- Embalming fluid:
Modified Y- Preservative:
Inverted Y- Germicide:
X- Buffer:
Anticoagulant:
NOT ETHANOL
Sexual perversions
Exhibitionism Exposing ones’s genitals to an unsuspecting person or
performing sexual acts that can be watched by others

Frotteurism Touch or rubbing against a non-consenting person

Voyeuristic disorder Observe an unsuspecting person who is naked,

354C undressing or engaging in sexual activates
354D- Stalking
Sexual masochism Wanting to be humiliated, beaten, bound or otherwise
disorder made to suffer for sexual pleasure
Sexual sadism disorder In which pain or humiliation of a person is sexually
pleasing
Transvestic fetishism Arousal from clothing associated with members of the
Eonism opposite sex

Oedipus complex

Electra complex
TORTURE

Declarations
Tokyo,Istanbul,Hamburg
Hongkong
Venice
Oslo
Helsinki and Nuremberg code
Ottawa
Sydney
Geneva
Malta
Stains for fluids
BLOOD SEMEN
Luminol stain-UV light 1) Florence stain
CONFIRMATORY TEST 2) Barberio test
1) MICROCRYSTAL TEST 3) Brentamine / Walker test
TEICHMANN: 4) MUP test
Brown rhombic 5) ICT-Semenogenelin, LDH
TAKAYAMA: CONFIRMATORY TEST: MICROSCOPY
Pink feathery
Crystal violet:
2) MICROSCOPY
3) ABSORPTION SPECTROSCOPY
Edelman’s agent:
Medical law-Court proceedings
Evidence: Direct- HIERARCHY OF COURTS Max punishment/fine
Indirect-
Circumstantial:
Hearsay:

Sexual Assault case: Duties of doctor Min age for consent: General Physical exam-
1) Inform police PV/PR/ Surgery/ transplant-
2) Consent for examination-Age: Implied-
3) Psychological counselling Expressed- Verbal/ written
4) Written refusal Open/ blanket-
5) Provide diagnosis and treatment BEST:
Time limit: Therapeutic privilege:
Vaginal swab- Extended consent:
Semen sample- Therapeutic waiver:
Criminal negligence:
Duty-Dereliction-Direct causation-Damage
Res ipsa loquitor:
Medical maloccurence:
Dichotomy:
Professional misconduct:
Novus actus intervenes :
Double jeopardy=Res judicata
Contributory negligence:
Res indicate
Leading questions:
OPD/ IPD records maintained for: MLC records:
Time to provide records:
Post humous child

POCSO 2012 PCPNDT 2002: Prohibit sex selection

Penetrative sexual assault, Sexual assault, Sexual harassment, and prenatal diagnostic tests
Pornography Medical board:
Aggravated:
Loco parentis Form F
 Hymenal tear:
Posterolateral (4-7)
Anterior:
Intact despite intercourse:

During the first five months of pregnancy:

Square root of the length = age of the fetus in months

After first five months of pregnancy:

Length divided by 5 = age of the fetus in months

Superfetation VS Superfecundation:
Live born vs Still born
Foder’s test: Lochia
Plocquet’s test:
Wredin test: Vagitus uterinus/vaginalis
Breslau’s second life test:
Intrauterine death signs:
Hydrostatic test Earliest-
Robert sign-
False positive:
Spalding sign
False negative: Ball sign
TOXICOLOGY: CORROSIVES
Corrosive Poisoning: Stomach mucosa
Black/ Blotting paper-
-Acid: Yellow-
-Alkali: Leather /Grey-
Red velvet-
Hypocalcemia: Yellowish brown
UGIE: Slate gray

Miosis

Universal antidote: Gastric lavage:

Time:
Position:
CI: Convulsants
Corrosives
Comatose
Kerosene
 ASPHYXIANTS AND CARDIAC POISONS
ASPHYXIANTS
Carbon monoxide:
Anoxia-
Pulse oximetry:
Cutaneous blisters
CYANIDE: Bitter almond smell
Anoxia-
Lee Jones test

Canthardin, Priapism

Indian red scorpion –

Mesobuthus
Autonomic storm

DOC-
 SNAKES

Specific antidote: Polyvalent ASV: effective against

Cobra, Krait, Russel’s viper & Saw scaled viper
CARRY NO RIGHT Given within 4 hrs
No torniquet/incision/cautery/sucking/coffee/alcohol
R-Reassure
I-Immobilize
G-Go to H-Hospital T-Tell symptoms Neostigmine + Atropine:
OTHER POISONS

Protoplasmic poison
Luminiscent vomit, feces
Smoking stool syndrome
Yellow fatty liver
Diwali poison
Organophosphates (Dyflos/Malathion) = Early mushroom poisoning
Kerosene odour Itai itai disease:
Carbamates: Carbaryl/ Propxur

Garlic Odour:

Late mushroom:
Monday morning :
1) fever + chills: Wenzell test,
2) Chest tightness Sonnenchein test
3) sickness (headache):
Japanese detergent suicide / Sewer gas / Bluish green lividity:
 METALLIC / NON-METALLIC POISONS

Plumbism=Saturnism
A Minamata disease
B -Mad Hatter’s = Glass
C blower shakes =
D Danbury tremors
Urine E -Erethism
Bone F -Gingivostomatitis
Marsh, Reinsch, Gutziet G
Tactile Hallucination CEA
ANTIDOTES:
PCM CHELATORS: Hemodialysis:
BAL/ Dimercaprol- Barbiturate
BZD DMSA/Succimer- Lithium
B blocker D-penicillamine- Alcohol
EDTA- Salicylates
Cyanide Desferioxamine- Theophylline
Meth Hb Level >500ug/dl in children
Prussian blue-

Fe toxicity:
GI bleed-> asymptomatic -> Liver failure-> pyloric stenosis

Forced alkaline diuresis Forced acidic diuresis

ALCOHOL
ALCOHOL WITHDRAWAL:
Earliest:
Alcoholic hallucinosis:
Delirium tremens:
TOC:
BZD safe in liver failure:
Anti-craving: LEGAL LIMIT:
CRITICAL LEVEL:

McEwen sign
Morbid jealousy
Munich-Beer heart
Mellanby effect
Marchiafava Bignami
Wernicke’s encephalopathy HEROIN
Korsakoff psychosis Toxicity DOC:
Withdrawal DOC:
Carbohydrate deficit transferrin > GGT
 Acute Drug Intoxication
Class Clinical features
Hallucinogen • Dissociation
• Nystagmus (horizontal or vatical)
Hallucinogen • Euphoria
• Tachycardia/hypertension
• Bad trip, flashback
Stimulant • Seizures
• Tachycardia/hypertension
• Mydriasis
• Magnan bugs
• Black teeth
Stimulant • Violent behavior
• Paranoid hallucinatory syndrome
• Choreiform movements

Psychoactive • Increased appetite

Bhang / Majoon • Amotivational syndrome
Ganja • RUN AMOK
Charas/Hashish • Smell of burnt rope
• Conjunctival injection
Opioid • Depressed mental status
• Miosis
• Respiratory depression
• Constipation
Speedball= cocaine + heroin • Marquis test
Hot Shot= Heroin + Strychnine • COLD TURKEY
Micky Finn= Chloral hydrate
TOXICOLOGY MASTER-CHART
MIOSIS MYDRIASIS

CHOLINERGIC DEPRESSANT PONTINE ANTI- STIMULANT OPIOD

HEMORRHAGE CHOLINERGIC WITHDRAWAL
CARBOLIC ACID

PUPIL:
Cholinergic:
Anticholinergic:
Sympathetic:
Anti-sympathetic:
BNS
82-
83-
84-
85-
86-

87-
89-
90-
92-
191-
193-
228A-

299-
300-
302-
304-
 i. Emasculation.
304A- ii. Permanent privation of the sight of either eye.
iii. Permanent privation of the sight of either ear.
304B- iv. Privation of any member or joint.
v. Destruction or permanent impairing of any
312: member or joint
vi. Permanent disfiguration of the head or face
313: vii. Fracture or dislocation of a bone or tooth
viii. Any hurt which endangers life or which causes
314: the sufferer to be during the space of twenty
days in severe bodily pain or unable to follow
his ordinary pursuits
319-
320-
375-
376 -
 CrPC- IEA

Bharatiya Nagarik Suraksha Sanhita Police inquest:

Minimum rank
CrPC: Citation: Act No 46 of 2023 Sub-inspector-Sexual offences
174- Head constable-Others
Magistrate inquest:
176- Custodial death/ rape/ disappearance:

Dowry death:
Bharatiya. Sakshya Adhiniyam
Exhumation:
IEA-Bill No. 123 of 2023
32-
45-
154-
FMT PYQ
1.Calculate the percentage of burns in a patient that
presented to the emergency with flame burn injury
covering the entire anterior chest and abdomen, the entire
right upper limb and full circumference of the right thigh.

A. 27

B. 36

C. 45

D. 53
2. In 18th century British East India company used to
transport which substance of abuse to China:

A. Opium

B. Marijuana

C. Cocaine

D. Magic mushroom
3. Cadaveric spasm is seen in all except:

A. Suicidal firearm wounds

B. Traumatic asphyxia

C. Drowning

D. Electrocution
4. An Autopsy was conducted on a male with history of
drowning. However, no water was found in his lungs, and he
was determined to have experienced ‘dry drowning’. What
is the cause of death:

A. Asphyxia

B. Vagal inhibition

C. Laryngospasm

D. Ventricular fibrillation
5. A 13-year-old girl is brought to the hospital by her
mother. She complaints of pain in the abdomen. On
examination her UPT is positive. What will be first step
done by you as a medical officer :

A. Inform police

B. Start examining

C. Preserve clothing

D. Take consent from mother

6. What is the cause of tattooing around the entry wound of
a bullet?

A. Unburnt gunpowder

B. Smoke

C. Impact

D. Muzzle impression
7. What is the postmortem sign in which a gas shadow is
present in the great vessels of a fetus in the case of
intrauterine demise?

A. Robert’s sign

B. Spalding sign

C. Ball sign

D. Halo sign
8. Identify the postmortem change given in the image
below?

A. Marbling

B. Tattooing

C. Lividity

D. Filigree burns
9. A patient presents with urinary crystals as shown in the
image below. What can be the cause?

A. Ethylene Glycol

B. Methyl Alcohol

C. Aconite

D. Organophosphate Poisoning
10. During fetal autopsy, what is the order of examination
to differentiate between live and stillbirth?

A. Thorax > Abdomen > Thorax

B. Thorax > Head > Abdomen

C. Head > Abdomen > Thorax

D. Head > Thorax > Abdomen

11. A 40-year-old female consumed a white colored
rodenticide powder and presents with a potassium level of
2.5 mEq/L. She has irregular pulse and muscle paralysis.
ECG shows multiple ventricular ectopic beats. What is the
suspected poison?

A. Aluminum Phosphide

B. Zinc Phosphide

C. Barium Carbonate

D. Warfarin
12. An autopsy was performed on a woman who was
reportedly discovered near a village lake. Among the listed
factors, which one does not indicate drowning prior to
death:
A. Water in stomach

B. Washerwoman's hands and feet

C. White leathery foam around mouth and nostrils

D. Positive diatom test

13. Which of the following statements is false about
postmortem changes?

A. Greenish discoloration in right iliac fossa is the earliest sign of

decomposition.

B. In cases of drowning, postmortem hypostasis is seen only in lower limbs.

C. Adipocere is seen in bodies recovered from water source.

D. Cadaveric spasm is seen only in specific group of muscles.

14. Who conducts inquest in police custodial death?

A. Higher police official

B. Judicial magistrate

C. Medical examiner

D. Coroner
15. Which of the following eye sign is given in the
image? (FMGE JULY 2024)

A. Tache noire

B. Kevorkian sign

C. Corneal changes

D. Vitreous humour changes

16. In a case of alcohol abuse, blood during autopsy is
preserved in: (FMGE JULY 2024)

A. Sodium fluoride

B. Rectified spirit

C. Sodium chloride

D. Formalin
17. A person is having intense fear of heights. Correct
name of this phobia is:

A. Ailurophobia

B. Acrophobia

C. Claustrophobia

D. Agoraphobia
18. During a police investigation, bones are uncovered at
the crime scene. What key characteristic feature would be
crucial in differentiating between human and animal bones,
aiding forensic analysis?

A. Precipitin test

B. Acid phosphatase

C. LDH

D. Phenolphthalein test
19. A 10-year-old boy will have ____ permanent and ____
temporary teeth?

A. 4, 20

B. 8, 16

C. 8, 12

D. 20, 4
20. Identify the plant:

A. Nerium Odorum

B. Cerebra Thevetia

C. Aconite

D. Cerbera odollam
21. A man is working in an industry without wearing a
helmet. A heavy hammer falls on his head due to slipping
from the head of his colleague working on the top floor. The
X-ray is shown below. What is the diagnosis?

A. Depressed Fracture

B. Linear Fracture

C. Fracture of the base of the skull

D. Sutural Fracture
22. Graph of cooling of the body?

A. Sigmoid shaped

B. Inverted sigmoid shaped

C. Parabola

D. S shaped
23. A child before playing consumed fruit from the garden.
After some time, he developed a high fever, confusion,
photophobia, and unable to urinate. What are the likely
causative agent and the appropriate antidote used in this
case? (NEET PG 2023)

A. Datura, Pralidoxime

B. Datura, Physostigmine

C. Yellow oleander, Pralidoxime

D. Yellow oleander, Physostigmine

24. The method of autopsy carried out en masse to remove
from tongue to prostate is? (NEET PG 2023)

A. Virchow technique

B. Rokitansky technique

C. Ghon technique

D. Letulle technique
25. A 10-year-old male child came to the casualty with
difficulty in walking and pain in the perianal region. On
subjecting the specimen from the perianal region to a test,
yellow needle-shaped crystals are seen under the
microscope. What is the test done? (NEET PG 2023)

A. Barberio’s test

B. Florence test

C. Teichmann test

D. Acid phosphatase test

26. IPC Section 314 deals with? (NEET PG 2023)

A. Abortion with consent of mother

B. Abortion without consent of mother

C. Abortion leading to death of mother

D. Preventing the child from being born alive

27. The temperature of a body of a deceased person is
found to be 39 degrees Celsius. Which of the following is
the most probable reason? (NEET PG 2023)

A. Cyanide poisoning

B. Septicaemia

C. Corrosive poisoning

D. Intra-abdominal hemorrhage
28. A farmer was sleeping in the field, and he felt a sting on
his leg. He saw something moving away quickly. He then got
drowsy and was taken to the hospital. He developed pain
around the site and continued to bleed profusely from the
wound site. The wound became red with blisters. Which of
the following is the most likely cause? (NEET PG 2023)

A. Viper

B. Cobra

C. Wasp bite

D. Scorpion
Thank You