Master Forensic Medicine
for FMGE
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Core Concepts
Forensic Medicine (Medical Jurisprudence) applies medical knowledge to legal questions. Key aspects include cause, manner, and time of death determination, injury assessment, identification, toxicology, and medical ethics for legal proceedings. Understanding Indian Penal Code (IPC) sections (e.g., 302, 304A, 307, 320, 326, 375, 498A) relevant to medical practice and medico-legal cases is crucial. Autopsies are performed for unnatural deaths (homicidal, suicidal, accidental) or where cause of death is unknown, for legal and investigative purposes.
Clinical Presentation
- Asphyxial Deaths: Cyanosis, petechiae (eyes/face), ligature marks (hanging, strangulation), frothy discharge (drowning), signs of struggle.
- Thermal Injuries: Burn patterns (scalds vs. flame), soot in airways (ante-mortem burns), CO-Hb levels (fire), frostbite changes (hypothermia).
- Mechanical Injuries:
- Blunt Force: Abrasions, contusions, lacerations, fractures. Pattern injuries may suggest weapon.
- Sharp Force: Incised wounds (longer than deep, clean edges), stab wounds (deeper than long, weapon specific). Defense wounds.
- Firearm: Entry/exit wounds, muzzle imprint, tattooing, scorching, lead bullet fragments. Range of fire assessment.
- Poisoning: Specific signs/symptoms depend on poison (e.g., constricted pupils in opioid, dilated in atropine; specific odors).
- Sexual Offences: Genital/perineal injuries, bite marks, foreign hairs, semen stains. Psychological trauma.
- Identification: Stature, age, sex, race, fingerprints, dental records, DNA, scars, tattoos, occupational markers.
- Post-mortem Changes: Rigor mortis, livor mortis (hypostasis), algor mortis (cooling), decomposition (putrefaction, adipocere, mummification) for Time Since Death (TSD) estimation.
Diagnosis (Gold Standard)
The "gold standard" in forensic medicine is a comprehensive approach integrating: detailed scene investigation, thorough medico-legal autopsy (external & internal examination), toxicology analysis (blood, urine, viscera, gastric contents), histopathology, radiology (X-rays, CT for fractures, foreign bodies), DNA profiling, diatom test for drowning, and ballistic analysis. Correlation of all findings with medical history and circumstances is paramount for establishing cause, manner, and time of death or injury.
Management (First Line)
In forensic medicine, "management" refers to the proper medico-legal handling and investigation of a case. This includes:
- **Scene Preservation:** Ensuring non-contamination and integrity of evidence (often initial police duty, but awareness is key).
- **Medico-Legal Examination:** Systematic documentation of injuries (live cases) or thorough autopsy (dead cases).
- **Documentation:** Detailed, objective, and accurate recording of all findings (diagrams, photographs).
- **Specimen Collection & Preservation:** Proper collection, labeling, and maintenance of chain of custody for all medico-legal samples (blood, urine, hair, semen, viscera, foreign bodies).
- **Medico-Legal Reporting:** Issuance of accurate Medico-Legal Certificates (MLC), Post-Mortem Reports (PMR), injury certificates, and age estimation reports.
- **Court Testimony:** Presenting expert medical opinion in court.
Exam Red Flags
- Misinterpreting post-mortem artifacts as ante-mortem injuries.
- Failure to collect appropriate samples for toxicology or DNA.
- Breaches in the 'Chain of Custody' of evidence.
- Incomplete or subjective medico-legal documentation.
- Failure to differentiate between suicidal, homicidal, and accidental deaths (e.g., differentiating hanging vs. strangulation, or self-inflicted vs. inflicted wounds).
- Lack of knowledge on relevant IPC sections (e.g., professional negligence under 304A).
- Incorrect age estimation methods or interpretation.
- Improper handling or reporting of sexual assault cases.
- Failure to identify signs of child abuse or neglect.
Sample Practice Questions
A 45-year-old factory worker presents to the occupational health clinic with complaints of progressive weakness in his hands and feet, numbness, and difficulty walking over the past few months. He also reports intermittent abdominal pain and constipation. On examination, a bluish discoloration of the gums (Burton's line) is noted. A blood test reveals microcytic hypochromic anemia with basophilic stippling. Which heavy metal poisoning is the most likely diagnosis?
A 30-year-old male is found dead in his apartment. Post-mortem examination reveals cherry-red lividity, fluid blood, and a distinct odor of bitter almonds from the viscera. Which of the following poisons is most likely responsible for his death?
A 28-year-old female presents to a forensic medical examiner with allegations of sexual assault. She reports the incident occurred 48 hours ago. What is the most crucial piece of evidence to collect at this stage for DNA analysis?
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