FMGE Forensic Medicine And Toxicology Flashcards

24 sample cards from the Forensic Medicine And Toxicology deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. Which is the best (most reliable) method of age estimation in a growing child and a young adult?

   In children/adolescents, ossification (appearance and fusion of epiphyses on X-ray) is most reliable. Teeth eruption is reliable up to ~14 years; after ~25 years, age estimation becomes approximate (skull suture closure, etc.).

2. At what ages do the iliac crest, the medial end of clavicle and the head of femur epiphyses fuse?

   Medial end of clavicle fuses last, around 21-25 years (key marker of completed growth). Iliac crest fuses ~21-23 years. Head of femur fuses ~18 years. These mark transition to adulthood.

3. List the essential elements a doctor must prove a charge of medical negligence (the 4 D's).

   Duty (a duty of care owed), Dereliction (breach/deviation from standard of care), Damage (actual harm/injury occurred), and Direct causation (damage was a direct/proximate result of the breach).

4. What is res ipsa loquitur in medical negligence?

   "The thing speaks for itself" — negligence is presumed/self-evident without proof of specific breach (e.g., instrument left in abdomen, wrong limb amputated, blood transfusion to wrong patient). The burden shifts to the doctor to disprove negligence.

5. Define informed consent and the age of valid consent for medical examination/treatment in India.

   Informed consent is voluntary agreement after disclosure of nature, risks, benefits, and alternatives of a procedure. Valid consent in India requires age ≥12 years for examination and ≥18 years for any procedure/operation/general anaesthesia; below 12, parent/guardian consents.

6. What is contributory negligence?

   Negligence by the patient that, combined with the doctor's negligence, contributes to the harm (e.g., not following instructions, not taking prescribed drugs). It serves as a partial defense, reducing the doctor's liability.

7. Differentiate civil from criminal negligence (and the relevant IPC/BNS standard).

   Civil negligence: failure of duty leading to harm, redressed by compensation, standard = balance of probabilities. Criminal negligence: gross/reckless disregard for life (rash/negligent act causing death), punishable, standard = beyond reasonable doubt; e.g., death by negligence under the penal code.

8. Classify witnesses in a court of law.

   Common (ordinary) witness — testifies to facts seen/heard; Expert witness — gives opinion based on special skill/knowledge (e.g., a doctor); and Hostile witness — one who makes statements adverse to the party that called them, with intent to conceal truth.

9. What is a dying declaration and its evidentiary value?

   A statement (oral/written) by a person who is dying, about the cause/circumstances of their death. It is admissible even without oath or cross-examination (in India a magistrate ideally records it, but any person can). It is valid only if the declarant dies; if they survive it becomes a dying deposition.

10. Differentiate a dying declaration from a dying deposition.

    Dying declaration: recorded by a magistrate/doctor/police, no oath, no cross-examination, declarant later dies. Dying deposition: recorded by a magistrate in the presence of the accused/their lawyer, under oath, with cross-examination — carries greater evidentiary value.

11. What is the difference between a summons and a conduct money?

    A summons is a written document compelling a person to appear in court to give evidence; failing to obey is punishable. Conduct money is the fee paid to a witness (usually in civil cases) to cover expenses of attending court.

12. What is rape as legally defined, and what is the medical significance of the hymen?

    Rape is sexual intercourse by a man with a woman against her will/without valid consent (or with a minor). The hymen may be torn during first intercourse, but an intact hymen does not exclude rape (elastic/fimbriated hymens), nor does a torn hymen prove rape — so its evidentiary value is corroborative only.

13. What is the medicolegal importance of seminal stains and the acid phosphatase test in sexual assault?

    Seminal stains are identified by physical/chemical tests; acid phosphatase (high in prostatic secretion) is a presumptive screening test for semen. Confirmation is by demonstrating spermatozoa, and PSA (p30) and DNA profiling establish identity of the assailant.

14. What are the four cardinal principles/steps in the management of acute poisoning?

    (1) Stabilization (ABC — airway, breathing, circulation), (2) Decontamination (removal of unabsorbed poison — gastric lavage, activated charcoal, skin/eye wash), (3) Elimination of absorbed poison (forced diuresis, dialysis, etc.), and (4) Administration of antidotes plus supportive/symptomatic care.

15. List the contraindications to gastric lavage / when it is avoided.

    Contraindicated in corrosive (acid/alkali) poisoning, kerosene/volatile hydrocarbon (aspiration risk) poisoning, convulsions, comatose patient with unprotected airway, and late presentation. Activated charcoal is the preferred decontaminant for most ingestions.

16. Differentiate corrosive (acid/alkali) from irritant poisons.

    Corrosives (strong acids like sulfuric/nitric, alkalis like NaOH/KOH) cause local chemical burns/necrosis on contact (acids → coagulative necrosis; alkalis → liquefactive necrosis). Irritants (e.g., arsenic, mercury, food poisons) cause inflammation/irritation of GIT with vomiting and diarrhoea after absorption.

17. Describe the features and antidote of organophosphate (OP) poisoning.

    OP inhibits acetylcholinesterase → cholinergic crisis: muscarinic (SLUDGE — salivation, lacrimation, urination, defecation, GI cramps, emesis; miosis, bronchorrhoea, bradycardia), nicotinic (fasciculations, weakness), CNS effects. Antidotes: atropine (counters muscarinic effects) and pralidoxime/oxime (reactivates cholinesterase, given early).

18. Name the chelating antidotes for arsenic, lead, mercury, and iron poisoning.

    Arsenic & mercury (and lead) → BAL (dimercaprol) and DMSA/penicillamine; Lead → calcium disodium EDTA (and BAL, DMSA, penicillamine); Iron → desferrioxamine; Copper → penicillamine. (Mercury — BAL is contraindicated in chronic methylmercury.)

19. What are the classic features of arsenic poisoning and the diagnostic finding in chronic exposure?

    Acute: rice-water stools, vomiting, garlicky breath, severe dehydration, burning GIT pain. Chronic: hyperkeratosis/hyperpigmentation (raindrop pigmentation), Mees' lines (transverse white bands on nails), peripheral neuropathy; arsenic deposits in hair and nails (diagnostic on analysis).

20. Describe the clinical staging and antidote of paracetamol (acetaminophen) overdose.

    Stage 1 (0-24h): nausea/vomiting, often asymptomatic. Stage 2 (24-72h): right upper quadrant pain, rising transaminases. Stage 3 (72-96h): hepatic necrosis/fulminant failure. Stage 4: recovery or death. Antidote: N-acetylcysteine (replenishes glutathione), most effective within 8 hours; assessed with Rumack-Matthew nomogram.

21. What is the triad of opioid overdose and its antidote?

    Opioid (morphine/heroin) overdose triad: pinpoint (miotic) pupils, respiratory depression, and CNS depression (coma). Antidote is naloxone, a competitive opioid receptor antagonist given IV (short acting, may need repeat doses).

22. What is the medicolegal classification of poisons by motive/usage?

    Homicidal poisons (e.g., arsenic, aconite, thallium — colourless/tasteless, mimic disease), suicidal poisons (e.g., organophosphates, opium, barbiturates), accidental poisons (e.g., CO, kerosene, aspirin in children), abortifacient, stupefying (e.g., dhatura, cannabis), and arrow/cattle poisons (abrus, aconite).

23. Differentiate the bite and clinical effects of a viper from a cobra/krait (elapid).

    Viper (vasculotoxic/haemotoxic): local swelling, pain, bleeding, coagulopathy, haemolysis, renal failure; fang marks with local necrosis. Cobra/Krait (neurotoxic): minimal local signs, ptosis, ophthalmoplegia, descending paralysis, respiratory failure; krait bites often painless/at night.

24. What is the management of poisonous snake bite?

    Reassure and immobilize the limb (splint), apply a broad pressure-immobilization bandage (avoid tight tourniquets/incision/suction), transport urgently. Hospital: ABC support, polyvalent anti-snake venom (ASV) for systemic envenomation, neostigmine + atropine for neurotoxic bites, manage coagulopathy/renal failure; tetanus prophylaxis.

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