FMGE Forensic Medicine Syllabus

What are the three modes of death (Bichat's classification)?

Coma (failure of the brain/nervous system, e.g., head injury, poisoning), Syncope (sudden failure of the heart's action, e.g., arrhythmia, hemorrhage), and Asphyxia (failure of respiration/oxygenation, e.g., strangulation, drowning).

What is the difference between the cause, mechanism, and manner of death?

Cause: the disease/injury that initiated the lethal chain (e.g., gunshot wound). Mechanism: the physiological derangement that produced death (e.g., hemorrhage). Manner: how the death arose — natural, accidental, suicidal, homicidal, or undetermined.

List the early post-mortem changes used to estimate time since death.

Cessation of circulation/respiration, pallor and primary flaccidity, cooling of the body (algor mortis), post-mortem lividity (hypostasis/livor mortis), and rigor mortis (muscle stiffening).

What is algor mortis and what factors affect it?

Algor mortis is the cooling of the body after death toward ambient temperature. In temperate climates the body loses roughly 1.5°F per hour initially. It is affected by environmental temperature, clothing, body build/fat, and surface area; it is unreliable in the tropics.

Describe rigor mortis: onset, order, and duration.

Rigor mortis is post-mortem stiffening from ATP depletion and actin–myosin gelling. In temperate climates it begins 1–2 hours after death, takes ~12 hours to develop fully, persists ~12 hours, and passes off over ~12 hours. It follows the descending order (Nysten's rule): face/jaw → neck → trunk → limbs.

What is livor mortis (post-mortem lividity), and why is it forensically useful?

Livor mortis is bluish-purple discoloration from gravitational settling of blood in dependent vessels, appearing ~1–3 hours after death and fixed by ~6–8 hours. It indicates time since death, the position of the body, and whether it was moved; colour can suggest the cause (cherry-red in CO/cyanide poisoning).

What are the late post-mortem changes, and what does each indicate?

Putrefaction (bacterial decomposition with greenish discoloration, gas, marbling — indicates a longer interval); Adipocere (saponification of fat into a soapy substance, in moist environments); and Mummification (drying/desiccation in hot, dry, ventilated conditions).

What is the first external sign of putrefaction and its timing?

A greenish discoloration over the right iliac fossa (caecum), appearing typically 12–24 hours after death in temperate climates (faster in the tropics), due to sulfhemoglobin formation by gut bacteria.

What are the medico-legal objectives (aims) of a forensic (medico-legal) autopsy?

To establish identity of the deceased, determine the cause and manner of death, estimate the time since death, collect and preserve evidence, evaluate injuries (cause, type, weapon), and answer specific questions posed by the investigating authority.

How does a medico-legal autopsy differ from a clinical (pathological) autopsy?

A medico-legal autopsy is ordered by legal authority, requires no relative's consent, focuses on cause/manner of death and evidence, and is complete (all cavities). A clinical autopsy needs relatives' consent, confirms diagnosis and disease extent for medical education/audit, and may be limited.

What is the standard sequence of body-cavity opening incisions in a forensic autopsy?

The primary incision is usually the I-shaped or Y-shaped incision to open the thorax and abdomen; the cranial cavity is opened via a coronal (intermastoid) scalp incision and skull cap removal. All three cavities (cranial, thoracic, abdominal) are routinely examined.

In mass disasters, what are the two broad categories of identification methods?

Primary (scientific, individualizing) methods: DNA profiling, fingerprints, and dental records (odontology). Secondary (supporting) methods: personal effects, clothing, tattoos, scars, medical implants, and visual/photographic recognition.

What does the DVI (Disaster Victim Identification) process involve?

It is an Interpol-standardized process: Phase 1 scene recovery, Phase 2 post-mortem data collection, Phase 3 ante-mortem data collection, Phase 4 reconciliation (matching AM and PM data), and Phase 5 debriefing — to identify human remains after mass disasters.

What is the difference between a mechanical injury and the legal terms simple vs grievous hurt?

A mechanical injury is physical damage from force. Legally, 'simple hurt' is minor/temporary harm, while 'grievous hurt' includes serious injuries such as fractures, loss of a limb/eye/hearing, permanent disfigurement of head/face, or injury endangering life or causing 20+ days of incapacity.

How are mechanical injuries classified by the type of causative force?

By blunt force: abrasions, contusions (bruises), and lacerations. By sharp force: incised wounds, stab/punctured wounds, and chop wounds. By firearm: entry/exit gunshot wounds. (Plus thermal, chemical, and explosive injuries.)

What distinguishes an incised wound from a laceration?

An incised (cut) wound is made by a sharp edge: clean, regular margins, no tissue bridging, length greater than depth, with sharp angles. A laceration is from blunt force tearing: irregular/ragged margins, abrasion/bruising at edges, and tissue (nerve/vessel) bridging in the depth.

What is a patterned injury, and give two examples.

A patterned injury reproduces the shape of the object or surface that caused it, allowing identification of the weapon. Examples: a railway-track/tramline bruise from a rod, a tyre-tread imprint, ligature mark of a rope, or bite marks reproducing dental arches.

What is the difference between an entry and an exit firearm wound?

Entry wound: usually smaller, round/oval, with inverted margins, an abrasion collar and a grease/dirt collar; may show tattooing/blackening if close range. Exit wound: usually larger, irregular/everted margins, no abrasion or grease collar, and bleeds more.

In wound ballistics, how do firing range categories relate to wound appearance?

Contact: muzzle imprint, charring, cherry-red CO-stained tissue. Close (within a few cm): blackening (smoke soot, wipes off) and burning/singeing. Near (up to ~60–90 cm): tattooing/stippling from unburnt powder (does not wipe off). Distant: only the bullet's effect, no powder marks.

What are the medico-legal points to determine when interpreting a pattern of multiple injuries on a body?

Whether injuries are ante-mortem or post-mortem, their age, the type/number of weapons, the direction and force, whether they are defensive or self-inflicted, the manner (homicide/suicide/accident), and whether they are consistent with the alleged account.

What features distinguish self-inflicted/fabricated injuries from genuine assault injuries?

Self-inflicted/fabricated injuries are usually multiple, parallel, of similar depth, superficial, located on accessible body parts, spare vital/sensitive areas, avoid clothing damage over them, and the history is inconsistent with the wounds. Hesitation cuts suggest suicidal intent.

What are defence wounds and where are they typically found?

Defence wounds are injuries sustained while a victim tries to protect themselves from a weapon. They are typically on the ulnar (outer) borders of the forearms, backs of the hands, palms, and fingers — indicating the victim was conscious and resisting.

In examining a victim of sexual assault, what is the medical examiner's role and what consent is required?

The role is to examine, document injuries, collect and preserve evidence, and treat the victim — not to decide whether rape occurred (that is for the court). Informed consent is mandatory; in India, examination is regulated under CrPC and the survivor cannot be denied treatment.

What forensic evidence is collected during a sexual assault examination?

Vaginal/anal/oral swabs (for semen, spermatozoa, acid phosphatase, DNA), pubic hair combings, fingernail clippings/scrapings, clothing, stains (blood/semen/saliva), and swabs from bite marks — all properly labelled, sealed, and handed over maintaining chain of custody.

What chemical/microscopic tests confirm the presence of semen in sexual assault evidence?

Microscopic identification of spermatozoa, acid phosphatase test (presumptive, high in semen), Florence test (choline crystals), Barberio's test (spermine crystals), and PSA (prostate-specific antigen/p30) — with DNA profiling for individualization.

What is the legal significance of the hymen in alleged rape, and why is an intact hymen not conclusive?

Hymenal tears may indicate penetration, but an intact hymen does not exclude rape because the law (in India) requires only slight penetration of the labia, and the hymen may be elastic/fimbriated or only partially torn. Absence of injury does not negate assault.

What are the medico-legal aspects of determining pregnancy and signs of recent delivery?

Pregnancy is relevant to questions of paternity, abortion, concealment of birth, and feigned pregnancy. Signs of recent delivery include a soft enlarged uterus, lochia, lacerations of the perineum/cervix, striae gravidarum, engorged breasts with colostrum, and pigmentation changes.

What are the main classifications of poisons by their site/mode of action?

Corrosives (acids, alkalis — local tissue destruction), Irritants (organic, inorganic, mechanical), Neurotics/systemic poisons acting on the CNS (cerebral like alcohol/opioids, spinal like strychnine, peripheral), Cardiac poisons, and Asphyxiants (CO, cyanide, H2S).

What are the main routes of exposure to poisons, ranked by typical speed of action?

From fastest to slowest: inhalation and intravenous injection (very rapid), intramuscular/subcutaneous injection, ingestion/oral (most common), and dermal/transcutaneous absorption (slowest). Mucous membranes (rectal, vaginal) also absorb poisons.

What is toxicokinetics, and what are its four phases (ADME)?

Toxicokinetics describes how the body handles a toxicant over time through Absorption (entry into blood), Distribution (to tissues, e.g., via blood, fat), Metabolism/biotransformation (mainly hepatic, may activate or detoxify), and Excretion/Elimination (mainly renal, also bile, lungs, sweat).

What is the difference between competency to stand trial and criminal responsibility (the insanity defense)?

Competency to stand trial concerns the accused's present mental ability to understand the proceedings and assist their defence. Criminal responsibility concerns the accused's mental state at the time of the offence — whether mental disorder negated their ability to know the act was wrong (the insanity defense).

What is the McNaughten (M'Naghten) Rule for the insanity defense?

It states that for legal insanity, at the time of the act the accused must, due to a defect of reason from a disease of the mind, either not know the nature and quality of the act, or, if they did know it, not know that it was wrong. It forms the basis of the insanity defense (e.g., Section 84 IPC / BNS in India).