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Forensic medicine certificates proforma, Cheat Sheet of Forensics

Very usefuk fir proff practical exams

Typology: Cheat Sheet

2019/2020

Uploaded on 05/04/2023

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FMT CERTIFICATE FAQs
-Rajas Mudgerikar
-Ankit Patil
(GSMC Mumbai)
INDEX
Common questions
02
MCCD
06
Age certificate
13
Potency certificate/Examination of
accused
18
Examination of victim
26
Drunkenness certificate
30
Injury and weapon report
36
Sickness and fitness certificate
43
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FMT CERTIFICATE FAQs

- Rajas Mudgerikar

- Ankit Patil

(GSMC Mumbai)

INDEX

Common questions 02

MCCD 06

Age certificate 13

Potency certificate/Examination of

accused

Examination of victim 26

Drunkenness certificate 30

Injury and weapon report 36

Sickness and fitness certificate 43

COMMON QUESTIONS

1. What is consent?

Ans: According to Sec 14 of Indian Contract Act, it is agreement between two parties.or

voluntary agreement, compliance or permission.

2. Importance of consent?

Ans: Examination or any procedure done without consent is considered as assault

according to Sec 351 IPC and is punishable with fine & 1mth-2yrs fine.

3. Who can give consent? Ans: Sec 87 IPC – Any person above 18 yrs can give consent for major procedures Sec 89 IPC – Child > 12 yrs can give consent for routine physical examination - For child < 12 yrs parent/legal guardian can give consent Sec 90 IPC – Consent obtained under influence, intoxication, insanity is invalid. Sec 92 IPC – In emergency conditions, not required to take consent. *The person can be examined without consent, if requested by the subinspector of police *loco parentis- in emergency involving children,if their parents or guardian not available,consent is taken from the person in-charge of the child. Eg school principle 4. Importance of identification marks? Ans: To know if it is the same individual for whom the certificate has been issued when someone is viewing the certificate afterwards. 5. How to take consent if person does not have limbs? Ans: Audio-visual

12. If operating or examining under intoxication but patient is not harmed, it is professional negligence or misconduct? Ans: Misconduct & not negligence. To label it as civil negligence, 4 conditions should be satisfiesd ➢ Duty ➢ Dereliction ➢ Damage ➢ Direct causation 13.If operating or examining under intoxication & patient is harmed, it is professional negligence or misconduct? Ans: Both misconduct & negligence. 14. Difference between medical ethics & ettiquetes? Ans: Ethics are moral values practised by a doctor towards patients & the State. Violation is punishable. Eg. Towards patient- maintaining professional secrecy Towards state- reporting cases of homicide, infectious diseases, responding during emergency Etiquettes are practised by a doctor towards his colleagues. Violation not punishable. Eg. Not taking fees from another doctor. 15. Types of professional negligence Ans: ➢ Civil ➢ Criminal ➢ Contributory ➢ Corporate ➢ Ethical ➢ Comparative to be mentioned only if asked

16. Define professional negligence & misconduct. Ans: Negligence – Lack of reasonable care, skill & knowledge or wilful negligence on part of the doctor which leads to some damage to the patient. Damage may be physical, mental or financial. Misconduct – If a medical man during the practice of his profession does something which is regarded as highly disgraceful, dishonourable or infamous by his other colleagues of good repute & competency, then the state medical council holds him guilty of misconduct. 6A BCDEFG - Adultery - Association with unqualified doctor - Abortion criminal - Advertisement - Addiction (t/t under influence of) - Alcohol (t/t under influence of) - - Advertisement - Bribery - Covering, commission - Dichotomy (fee splitting) - False medical certificates - Gifts from pharma companies Imp- take signature of person after taking him/her consent, as consent is invalid without signature. Also take signature of medical attendant, if present It is advisable to go through all theory imps for theory viva with special importance to Chapter Medical Jurisprudence.

6.What are the two types of death? Ans: Somatic death (stoppage of function of the body) & molecular death (death of the cells). The period between somatic & molecular death is important for organ harvesting.

7. What are changes after death? Ans: Immediate changes Stoppage of function of Bishop’s triad of life i.e. - Stoppage of respiration (function of lungs) - Stoppage of circulation (function of heart) - Stoppage of sensibility (function of brain) Immediate signs correspond with somatic death. Early changes - Skin changes - Eye changes Imp- ➢ Railroad trucking sign/Kevorkian sign on retina- 2 - 3 min. ➢ Tache noires sclerotic (triangular deposition of dust on conjunctiva) 3-6 hrs ➢ Intraocular pressure becomes zero in 2 hrs. - Livor mortis Imp- Onset by 30 min, visible by 2 hrs & becomes fixed 6-12 hrs (avg 8hrs) - Rigor mortis - Algor mortis Late changes - Decomposition Imp- Marbling (veins on shoulders, axilla, breast become prominent due to deposition of blood pigments in the walls) 36 to 72 hrs. - Mummification - Adipocere formation Early & late changes correspond with molecular death.

Read in detail from textbook.

8. Importance of MCCD? Ans: Legal- - Insurance claims - Inheritance of property - Hospital reimbursement - Releasing gratuity & provident fund claims and - Cremation Administrative - Surveillance of diseases & immediate control measures - Deleting the name of the deceased from ration card, voter’s card. Statistical - Mortality statistics - Developmental plans - Public health & medical research 9. Who can issue MCCD? Ans: Any RMP (Registered medical practitioner) i.e. MBBS, Ayurvedic, Homeopathic, Unani doctor. Dentist can issue it if the death has occurred during some dental procedure. 3 conditions should be fulfilled for an RMP to issue MCCD ➢ He should have been medical attendant of the deceased during life ➢ Has attended the patient within past 14 days before death ➢ He is satisfied with the cause of death 10. When not to issue MCCD immediately? Ans: ➢ Injured is brought dead ➢ Crime has already been registered with police ➢ Cause of death is unknown eg. Poisoning cases

  • Rokitansky’s – in situ (cases of HIV, Hepatitis, Radiation) 16. Types of autopsy incisions Ans:
  • I shaped – done routinely; chin to pubic symphysis
  • Y shaped – shoulder tip (acromian) to xiphisternum to pubic symphysis
  • Modified Y shaped – Angle of mandible to Sternoclavicular notch to pubic symphysis; done in case of hanging & strangulation.
  • X shaped – in case of custodial deaths to see deep contusions on the back. In strychnin posoing
  • T shaped – Acromian to Sternoclavicular notch to pubic symphysis 17. Preservation of viscera Ans: 3 bottles ➢ Bottle 1- Entire stomach & its contents, initial 1/3 of small intestine with its contents ➢ Bottle 2- Liver 1/3 in adults, ½ in children
  • Spleen ½ in adults & full in children
  • Kidney ½ of each in adults & full in children ➢ Bottle 3- Blood 10mL Preservative used is saturated salt solution, in acid poisoning it is rectified spirit except carbolic acid. Overall most commonly used is saturated salt solution preservative is rectified spirit. 18. Why ID marks are not written in death certificate? Ans: As body has already been identified by the relatives and is cremated, buried afterwards. 19. Punishment for not preserving viscera or not preserving gastric lavage fluid? Ans: According to Sec 201 IPC it amounts to causing disappearance of evidence. 20. What is suspended animation?

Ans: Due to decreased metabolic rate, the vital signs of life i.e. pulse, BP, respiration cannot be detected clinically but person is alive. eg. Suspended animation in new HD TV. ➢ I = Iatrogenic, Insane ➢ N = Neonates ➢ E = Electrocution ➢ W = Wasting diseases like cholera, TB ➢ H = Heat stroke, Hypothermia ➢ D = Drowning ➢ T = Typhoid ➢ V = Voluntary in yoga practitioners

21. What is exhumation? Ans: Digging out of dead body- procedure given in Sec 176(3) CrPC. In India, there is no time limit for exhumation. Presence of doctor, Magistrate & police necessary. Done early morning to prevent public attention. 500g soil sample taken to see if there is imbibition of any poison in soil. Eg. Arsenic. 22. What are the types of autopsies? Ans: 6 types ➢ Medicolegal ➢ Pathological ➢ Virtual ➢ Psychological ➢ Negative ➢ Educational 23. What is the purpose of doing autopsy? Ans: To find out ➢ Cause of death ➢ Time since death

AGE CERTIFICATE

  1. What are the parameters of age estimation? Ans: 4 parameters Bones Teeth Hair Secondary Sexual characters
  • Apperance & fusion - Gustafson’s method of ossification centres - Boyde’s method Dental charting Fusion of ossification centres Upper limb: 18 – 16 – 18 yrs for shoulder – elbow – wrist Lower limb: 16 - 18 - 17 yrs for hip – knee – ankle Carpal bones: Capitate – 1 yr Hamate – 2 yrs (Remember 2 vertical lines of H) Triquetral – 3 yrs (Remember TRIquetral, so 3) Lunate – 4 yrs (Remember L resembles of ) Scaphoid – 5 yrs (5 resembles S) Trapezium & Trapezoid – 6 yrs Pisiform – 10 - 12 yrs From 2-6 yrs no. of carpal bones = age Other ossification centres to be read from textbook. Above ones are most important. Teeth Order of appearance: Scalp Pubic Facial Axillary Tanner staging

a) Gustafson’s method Based on SCRIPT S = Secondary dentine apposition C = Cementum deposition I = attrItion by mastication P = Peridontosis T = loss of root Translucency b) Boyde’s method: based on incremental lines on teeth. c) Temporary & permanent teeth Temporary teeth follow rule of 12 Permanent teeth: Mama Is In Pain Papa Can Make Medicine Molar 1 – 6 yrs Incisor central – 7 to 8 yrs Incisor lateral – 8 to 9 yrs Premolar 1 – 9 to 10 yrs Premolar 2 – 10 to 11 yrs Canine – 11 to 12 yrs Molar 2 – 12 to 14 yrs Molar 3 – 17 to 25 yrs Dental charting methods: a. Palmar’s/Zigmondy’s b. Cunningham’s/Universal c. Hardrup’s d. FDI (Federation Dentaire Internationale) – currently used 17 16 15 14 13 12 11 21 22 23 24 25 26 27 47 46 45 44 43 42 41 31 32 33 34 35 36 37 Stands for unerupted teeth. Secondary sexual characters

½ fare in railways 7 yrs No criminal responsibility under 7 yrs age as per Sec 82 IPC 7 - 12 yrs Sec 83 IPC if criminally responsible if mature enough to understand the nature & consequences of the act. Maturity decided by the court. 10 yrs Kidnapping 12 yrs Person <12 yrs cannot give consent for routine physical examination. Oath not necessary for <12 yrs age. 14 yrs <14 yrs cannot be employed in factory acc to Factories Act (except helping family in non-hazardous task). 15 yrs 14 - 15 yrs can be employed in non-hazardous job in daytime.

15 yrs can be employed in any job. 16 yrs Sexual intercourse with any female <16 yrs even if with consent or wife is punishable. Kidnapping 18 yrs Attainment of majority, person called as adult Can give consent for major procedures. Age 16-18 yrs will be tried as adults if involved in heinous crime. Girl >18 yrs can marry. Right to vote. Can make a will. 21 yrs Boy can marry. Minimum age for holding senior govt posts 25 yrs Minimum age for contesting elections as MP or MLA 35 yrs Minimum age for appointment as President, vice President or Governor

3. What are the routinely advised Xrays for age estimation? Ans: Pelvis, knee, wrist, elbow. 4. Importance of eye colour? Ans: In old age there maybe white opacities due to cataract. 5. Importance of skin colour? Ans. To determine age – in case of prisnors ( at the time of there release from the jail) 6. POCSO Act Ans: - Came into force on 19th^ June 2012. - Full form – Protection of children against sexual offences

  • Child is anyone <18 yrs age
  • The Act seeks to protect children from offences such as sexual assault, sexual harassment, and pornography.
  • Recent amendment in 2019. Penetrative sexual assault: Under the Act, a person commits “penetrative sexual assault” if he: (i) penetrates his penis into the vagina, mouth, urethra or anus of a child, or (ii) makes a child do the same, or (iii) inserts any other object into the child’s body, or (iv) applies his mouth to a child’s body parts. The punishment for such offence is imprisonment between seven years to life, and a fine. The Bill increases the minimum punishment from seven years to ten years. It further adds that if a person commits penetrative sexual assault on a child below the age of 16 years, he will be punishable with imprisonment between 20 years to life, with a fine.

Ans: Whenever two bodies come in contact, there is exchange of material between the two bodies.

8. What is mens rea & actus reus? Ans: Mens rea is the intent a person has behind committing a crime. Actus reus is the action the person takes to perform the criminal act. This is the physical action behind the crime. Both should be present to hold a person guilty of an offence. 9. Importance of asking bath, micturition, defecation changing clothes after the incident? Ans: It may cause disappearance of evidence like blood, seminal stains, foreign objects, etc. 10.What is sexual aversion syndrome? Ans: Aversion to sexual practice in general i.e. with all females. This condition is called as sexual aversion disorder. 11. Causes of impotence Ans: Learn 2 from each category Endocrine causes – Testicular failure (primary or secondary)

  • Hyperprolactinemia Disease of penis – Peyronie’s disease
  • Previous priapism
  • Penile trauma Disorders of CNS and spine – Anterior temporal lobe lesions Disease of spinal cord – Tabes dorsalis
  • Disease of dorsal root ganglia Vascular disorders – Leriche syndrome
  • Atherosclerotic occlusion or stenosis of the pudendal and/or cavernosa arteries
  • Arterial damage from pelvic radiation
  • Venous leak
  • Disease of sinusoidal spaces Drug induced – Histamine (H2) blockers e.g. cimetidine, Spironolactone, Ketoconazole, Clonidine, Beta blockers, Monoamine oxidase inhibitors, Tricyclic antidepressants, Barbiturates, Diazepam, Alcohol, Heroin, Tobacco, Methadone Age – impotence is generally observed at the extreme of age. Malformations and local acquired causes – presence of malformations or congenital anomaly or local acquired causes renders a person impotent. The malformations are:
  • Absence of male genital organ
  • Klinefelter’s syndrome
  • Cryptorchidism
  • Phimosis
  • Epispadias
  • Partial or total amputation of penis
  • Pre-pubertal castration – Inflammatory hydrocele
  • Filariasis of scrotum
  • Carcinoma of penis
  • Lesion of CNS or spinal cord including injury to spinal cord
  • Chronic disease – diabetes mellitus, autonomic neuropathy Functional or psychological cause
  • This is the most common cause of temporary impotence
  • Fear, timidity, anxiety, guilt sense, hypochondrias, sexual over indulgence etc. may be the reasons Also includes impotence quad hanc, sexual aversion syndrome & bridegroom impotence. 12. What is bulbocavernosus reflex? Ans: The bulbocavernosus reflex is mediated through the S2–S4 spinal cord segments that is elicited by electrical/mechanical stimulation of the dorsal penis/clitoris nerves