INI CET Forensic Medicine Syllabus

Differentiate post-mortem lividity (livor mortis) from a bruise.

Lividity: appears in dependent areas, vessels intact, no clotting/coagulum, spares pressure points, fades on incision and washes away. Bruise: anywhere, extravasated clotted blood in tissue, swelling, does not wash off on washing.

Define cadaveric spasm and state its medico-legal importance.

Cadaveric spasm is instantaneous stiffening of a group of voluntary muscles at the moment of death without preceding primary flaccidity, occurring in violent/emotional deaths. Importance: it cannot be produced artificially, so a weapon/object gripped in the hand indicates suicide or that the act occurred at death.

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

Cause = the disease/injury that initiated the lethal sequence (e.g., gunshot wound). Mechanism = the physiological derangement producing death (e.g., exsanguination). Manner = how it arose: natural, accident, suicide, homicide, or undetermined.

State the primary objectives of a medico-legal (forensic) autopsy.

To determine the cause, mode, manner, and time of death; identify the deceased; recover/preserve evidence; and document injuries to assist the criminal justice system. It is ordered by a magistrate/police and does not require relatives' consent.

Contrast a clinical (pathological) autopsy with a medico-legal autopsy regarding consent and scope.

Clinical autopsy: requires consent of relatives, done to determine disease/confirm diagnosis, may be partial. Medico-legal autopsy: by legal authority (no relative consent needed), always complete (all three cavities opened), for legal purposes.

In mass disaster victim identification, what four phases does the DVI (Disaster Victim Identification) process follow?

Phase 1 – Scene (recovery/documentation); Phase 2 – Post-mortem (autopsy/data collection); Phase 3 – Ante-mortem (collecting records from families); Phase 4 – Reconciliation (matching PM and AM data) — followed by Debriefing.

Name the three 'primary' (most reliable) identifiers used in disaster victim identification.

Fingerprints, dental records (forensic odontology), and DNA profiling. These are scientifically robust and can establish identity on their own; visual recognition/personal effects are secondary identifiers.

Classify mechanical injuries based on causative force.

Blunt force injuries (abrasion, contusion/bruise, laceration, fracture), sharp force injuries (incised wound, stab/punctured wound, chop wound), and firearm injuries (gunshot, shotgun).

Differentiate an incised wound from a laceration.

Incised wound: caused by a sharp edge, clean/regular margins, length > depth, no tissue bridging, edges everted. Laceration: caused by blunt force tearing tissue, irregular/abraded margins, tissue bridging present, often more bleeding controlled by crushed vessels.

What is a 'patterned injury' and why is it medico-legally important?

A patterned injury reproduces the shape of the object that caused it (e.g., tyre marks, belt-buckle, bite marks, 'railway-track' tramline bruise from a rod). It is important because it can identify the weapon or mechanism of injury.

Describe the characteristic 'tramline' (railway-track) bruise.

Two parallel linear bruises with a central pale (spared) zone, produced by a cylindrical/rod-like object; blood is forced to the margins where vessels rupture while the directly compressed central skin is blanched.

What features distinguish an entry from an exit gunshot wound?

Entry: usually smaller, round/oval, inverted margins, abrasion collar, may show grease collar/tattooing/blackening (close range). Exit: usually larger, irregular/everted margins, no abrasion collar, no soot/tattooing.

In wound ballistics, define tattooing, blackening, and the abrasion collar.

Tattooing (stippling) = punctate abrasions from unburnt/burning powder grains (intermediate range). Blackening (smudging/soot) = deposit of smoke, wipeable, close range. Abrasion collar = ring of grazed skin around an entry wound from the spinning bullet.

How do you estimate firearm range from a rifled weapon entry wound?

Contact: muzzle imprint, blackened/charred margins, cherry-red wound (CO), cruciform if over bone. Close (within a few cm): blackening + tattooing. Near (up to ~60–90 cm): tattooing without blackening. Distant: only the wound with abrasion collar, no soot/tattooing.

What is the legal definition category of injuries under IPC: simple vs grievous?

Simple injury = neither serious nor extensive, heals without permanent damage. Grievous injury = falls in the IPC list: e.g., emasculation, permanent loss of sight/hearing, loss of a limb/joint, fracture/dislocation, disfiguration of face/head, or any hurt endangering life or causing ≥20 days of disability.

In interpreting injury patterns, how can you determine if an injury is ante-mortem or post-mortem?

Ante-mortem injuries show vital reactions: bleeding/hemorrhage into tissues, swelling, retraction of wound edges, inflammation, and (with time) healing/infection. Post-mortem injuries lack significant bleeding and inflammatory/vital reaction.

What are 'defence wounds' and where are they typically located?

Defence (self-defence) wounds are sustained while warding off an assault, found on the ulnar borders of forearms, palms, and backs of hands (e.g., incised cuts gripping a blade). Their presence indicates the victim was conscious and resisting.

Define rape under Indian law (post-2013 amendment), in essence.

Sexual assault by a man on a woman without her consent, or with consent obtained by fraud/fear/incapacity, or with a girl below 18 years (statutory rape) regardless of consent. It now includes penetration with any object/body part, not only penile-vaginal.

What is the medical examiner's role/limitation in alleged sexual assault?

The doctor examines and documents findings (injuries, signs of recent intercourse, samples) and gives an opinion on whether intercourse/assault is consistent with findings — but cannot certify 'rape' (a legal term) nor whether it was consensual.

List the key specimens collected during the forensic examination of a sexual assault victim.

Vaginal/anal/oral swabs and smears (for spermatozoa/semen), pubic hair combings, nail clippings/scrapings, blood for DNA/alcohol/drugs, clothing, and swabs of any bite marks/stains — all sealed, labelled, and chain-of-custody maintained.

Why is the 'two-finger test' (per-vaginal examination of laxity) no longer permitted in assessing sexual assault?

It is scientifically invalid, unethical, and held unconstitutional by the Supreme Court of India — vaginal laxity/hymenal status does not prove consent or prior sexual activity and re-traumatizes the victim.

What is the medico-legal significance of estimating the duration of pregnancy from uterine/fundal height?

It helps in matters of legitimacy, MTP eligibility, concealment of birth, and infanticide. Rough guide: fundus reaches the umbilicus at ~24 weeks and the xiphisternum at ~36 weeks; symphysis-fundal height in cm ≈ gestational age in weeks (16–36 wks).

Define 'live birth' and 'viability' as used in medico-legal practice.

Live birth = the child showed any sign of life (breathing, heartbeat, cord pulsation, voluntary movement) after complete expulsion. Viability = capacity for extra-uterine life, generally from 28 weeks (≈210 days) gestation in classic medico-legal teaching (now ~24 weeks medically).

Classify poisons according to their predominant mode of action.

Corrosives (strong acids/alkalis), Irritants (inorganic, organic, mechanical), Neurotics/systemic (CNS — somniferous, inebriant, deliriant, spinal, peripheral), Cardiac poisons, Asphyxiants (CO, CO2, H2S), and Miscellaneous.

List the major routes of exposure to poisons in order of typical speed of action.

Inhalation (fastest) and intravenous injection ≈ very rapid; then intramuscular/subcutaneous injection; oral/ingestion; and dermal/transcutaneous (slowest). Speed depends on absorption surface and vascularity.

Define the four toxicokinetic (ADME) processes.

Absorption (entry into bloodstream), Distribution (transport to tissues, governed by volume of distribution and protein binding), Metabolism/biotransformation (mainly hepatic, Phase I & II reactions), and Excretion/Elimination (renal, biliary, pulmonary).

In clinical toxicology, what does the term 'toxidrome' mean? Give the cholinergic example.

A toxidrome is a constellation of signs/symptoms suggesting a class of poison. Cholinergic (e.g., organophosphates) — mnemonic SLUDGE/DUMBELS: Salivation, Lacrimation, Urination, Defecation, GI cramps, Emesis (plus miosis, bradycardia, bronchorrhoea); antidote atropine + pralidoxime.

What is the medico-legal importance of 'chain of custody' when collecting forensic evidence?

It is the documented, unbroken record of who collected, handled, transferred, and stored each sample. It ensures the evidence presented in court is the same as that collected and untampered; a break can render evidence inadmissible.

State the M'Naghten Rules — the legal test for the insanity defence (criminal responsibility).

At the time of the act, due to a defect of reason from disease of the mind, the accused either (a) did not know the nature and quality of the act, or (b) did not know that it was wrong. If proven, the accused is not criminally responsible (this underlies IPC Section 84).

Distinguish 'fitness/competency to stand trial' from 'criminal responsibility (insanity at the time of the act)'.

Competency to stand trial concerns the accused's present mental state — ability to understand proceedings and instruct counsel. Criminal responsibility (insanity defence) concerns the mental state at the time the offence was committed. A person may be fit to stand trial yet not criminally responsible, and vice versa.

What essential elements must a forensic doctor record when documenting an injury?

Type of injury; precise anatomical site (with reference points); size/dimensions (length × breadth × depth); shape; margins/edges; surrounding skin/colour (age of injury); direction; and any foreign material — ideally with diagrams, scale, and photographs.