PGIMER Entrance Forensic Medicine and Toxicology Syllabus

Forensic Medicine and Toxicology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Forensic Medicine and Toxicology in PGIMER Entrance, not a summary of it.

1. 1

   Forensic Pathology and Identification

   4 topics

   • Death, postmortem changes and time since death
   • Identification of living and dead
   • Mechanical injuries and wound interpretation
   • Asphyxial and thermal deaths
2. 2

   Medical Jurisprudence

   4 topics

   • Medical ethics and professional misconduct
   • Consent, negligence and consumer protection
   • Court procedures and medical evidence
   • Sexual offences and forensic examination
3. 3

   Toxicology

   4 topics

   • General management of poisoning
   • Corrosive, agrochemical and metallic poisons
   • Drug overdose and substance abuse
   • Snake bite and biological toxins

Forensic Medicine and Toxicology flashcards for PGIMER Entrance

23 of 54 cards from the Forensic Medicine and Toxicology deck — real questions with worked answers.

1. Define forensic medicine (legal/state medicine).

   The branch of medicine that applies medical knowledge to the administration of justice, dealing with the medical aspects of law and assisting courts in legal matters.

2. What is the difference between somatic (clinical) death and molecular (cellular) death?

   Somatic death is the irreversible stoppage of the brain, heart and lungs (loss of personality). Molecular death is the death of individual cells/tissues, occurring 3-4 hours later as cells lose function.

3. List the postmortem changes in chronological order used to estimate time since death.

   Immediate (cessation of heartbeat/respiration), early (algor mortis/cooling, rigor mortis, postmortem lividity), and late (decomposition/putrefaction, adipocere, mummification).

4. What is algor mortis and approximately how fast does body temperature fall?

   Algor mortis is postmortem cooling of the body. In temperate climates it falls about 1.5°F (approximately 0.8-1°C) per hour for the first few hours, slower thereafter.

5. Describe rigor mortis: order of onset, timing, and mechanism.

   Stiffening of muscles due to ATP depletion and accumulation of lactic acid causing actin-myosin gel. Onset 1-2 hrs after death, completed in ~12 hrs, persists ~12 hrs, passes off ~12 hrs. Follows Nysten's rule (proceeds downward, face/jaw first).

6. What is cadaveric spasm and how does it differ from rigor mortis?

   Cadaveric spasm is instantaneous stiffening of a muscle group at the moment of death (no preceding primary flaccidity), seen in violent/emotional deaths. Unlike rigor, it appears immediately, affects only one group, has medicolegal value (e.g., weapon grasped), and cannot be reproduced artificially.

7. What is postmortem lividity (hypostasis/livor mortis) and when does it become fixed?

   Bluish-purple discoloration of dependent parts of the body due to settling of blood after circulation stops. Begins within 1-3 hrs, well developed by 4 hrs, and becomes fixed (does not shift on changing position) by about 6-8 hrs.

8. What is the color of postmortem lividity in carbon monoxide and cyanide poisoning?

   Cherry-red in carbon monoxide poisoning (carboxyhaemoglobin); bright cherry-red/pink in cyanide poisoning; chocolate-brown in methaemoglobinaemia (e.g., nitrites, potassium chlorate).

9. Differentiate adipocere from mummification.

   Adipocere is the conversion of body fat into a greasy, waxy substance (saponification) occurring in moist environments. Mummification is dehydration/drying of tissues with preservation of features, occurring in hot, dry, ventilated conditions.

10. What features are used to estimate time since death from stomach contents and entomology?

    Stomach emptying time (roughly 4-6 hrs after a meal it is empty) helps estimate time since last meal; insect (maggot) succession and larval stages on the body (forensic entomology) help estimate the postmortem interval, especially in later stages.

11. How is age estimated from teeth (eruption milestones)?

    Temporary teeth: 20 erupt by ~2-2.5 years. Permanent teeth: first molars ~6 yrs, central incisors ~7 yrs, all (except third molars) by ~12-14 yrs, third molars (wisdom) erupt 17-25 yrs.

12. What is the medicolegal importance of fingerprints (dactylography)?

    Fingerprints are absolutely individual (no two persons, even identical twins, have identical prints) and remain unchanged for life, so they are a definitive means of identification of the living and dead. Main patterns: loops, whorls, arches, composite.

13. How are sex and stature estimated from a skeleton?

    Sex: pelvis is the most reliable (female pelvis broader, greater sciatic notch wide, subpubic angle obtuse); skull next. Stature is estimated from long bone lengths using regression formulae (e.g., Karl Pearson's formula multiplying femur/tibia/humerus length by a factor).

14. What is the difference between identification of the living and a complete vs incomplete identification?

    Complete (absolute) identification = positive, full establishment of individuality. Incomplete (partial) identification = only some facts ascertained (e.g., age, sex, race) helping narrow down the person. Living identification uses fingerprints, scars, tattoos, deformities, occupation marks.

15. Define a bruise (contusion) and what its color changes indicate.

    A bruise is extravasation of blood into tissues from ruptured vessels due to blunt force. Color changes: red (fresh) → blue/purple (few hrs) → bluish-black (1-3 days) → greenish (4-6 days) → yellow (7-12 days) → normal (~2 weeks), due to haemoglobin breakdown.

16. Differentiate an abrasion, a laceration and an incised wound.

    Abrasion: superficial injury to epidermis by friction. Laceration: tearing/splitting of skin by blunt force with irregular margins, tissue bridges, and abraded edges. Incised wound: clean-cut wound by a sharp-edged weapon, length > depth, clean margins, no tissue bridges.

17. Differentiate an incised wound from a stab (punctured) wound.

    Incised wound: caused by sharp edge, length greater than depth, gaping clean margins. Stab/punctured wound: caused by pointed weapon, depth greater than width/length, may damage deep organs, external wound may be small.

18. What are the features of an entry vs exit firearm wound?

    Entry wound: smaller, inverted margins, has abrasion collar and (in close range) blackening/tattooing/burning. Exit wound: larger, irregular, everted margins, no abrasion collar or scorching.

19. How is the range of fire estimated from a gunshot wound?

    Contact: muzzle imprint, cruciate/stellate tearing, charring, carboxyhaemoglobin in tissues. Close (a few cm to ~30 cm): burning, blackening (soot), tattooing/stippling. Distant (beyond ~1 m): only the bullet hole with abrasion collar, no powder marks.

20. Differentiate antemortem from postmortem wounds.

    Antemortem wounds show signs of vital reaction: bleeding (with spurting/clotting), gaping, retraction of edges, inflammation, and healing/repair. Postmortem wounds show little or no bleeding, no vital reaction, yellow margins, and no signs of repair.

21. Define mechanical asphyxia and list its general signs.

    Asphyxia is interference with respiration (oxygenation) producing hypoxia. General signs: cyanosis, petechial (Tardieu) haemorrhages, congestion of organs, dark fluid blood, and engorgement of right side of heart.

22. Differentiate hanging from strangulation by ligature mark.

    Hanging: ligature mark is oblique, high up on neck (above thyroid), incomplete, non-continuous, runs upward toward the knot, pale/parchment-like. Ligature strangulation: mark is horizontal, low on neck (below thyroid), continuous and completely encircling, with more local bruising.

23. What is the cause of death in typical hanging?

    Most commonly asphyxia, but death can also result from venous congestion, cerebral anoxia from carotid/vertebral artery occlusion, vagal inhibition (reflex cardiac arrest), or fracture-dislocation of cervical vertebrae (judicial hanging - 'hangman's fracture' at C2).

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