NEET-PG 2013 - Forensic Medicine Practice Questions

Q: Minamata disease is caused by toxicity of:

Mercury. ***Mercury (Correct Answer)*** - Minamata disease is a severe neurological syndrome caused by **mercury poisoning**, specifically from the consumption of fish and shellfish contaminated with **methylmercury**. - The disease was first identified in Minamata Bay, Japan, resulting from the release of industrial wastewater containing methylmercury. - **Clinical features** include: ataxia, dysarthria, constriction of visual fields, sensory disturbances, and in severe cases, convulsions and death. *Arsenic (Incorrect)* - **Arsenic poisoning** is associated with symptoms like **garlic breath**, skin lesions (hyperkeratosis, Raindrop pigmentation), and neurological damage, but it does not cause Minamata disease. - Exposure typically occurs through contaminated water or occupational settings. *Antimony (Incorrect)* - **Antimony toxicity** can manifest with symptoms such as nausea, vomiting, cardiac arrhythmias, and skin inflammation. - It is not linked to the distinct neurological syndrome known as Minamata disease. *Lead (Incorrect)* - **Lead toxicity** (plumbism) primarily affects the nervous system, kidneys, and hematopoietic system, leading to symptoms like **abdominal pain**, **wrist drop/foot drop**, and anemia. - While it causes neurological damage, it has a different clinical presentation and is not associated with Minamata disease.

Q: Which one of the tissues putrefies late?

Prostate. ***Prostate*** - The **prostate** is a glandular organ that contains a significant amount of **fibrinous connective tissue**, which is less susceptible to rapid decomposition. - Its relatively **acidic internal environment** also contributes to slower bacterial proliferation and, therefore, delayed putrefaction compared to other organs. *Liver* - The **liver** is rich in **parenchymal cells** and blood, making it a good substrate for bacterial growth and enzymatic degradation leading to early putrefaction. - Its metabolic activity continues shortly after death, releasing enzymes that contribute to **autolysis** and subsequent putrefaction. *Brain* - The **brain** has a high **water and lipid content**, which makes it highly susceptible to rapid autolysis, particularly by its own lysosomal enzymes. - It also has a rich blood supply, providing ample nutrients for **anaerobic bacteria**, accelerating decomposition. *Stomach* - The **stomach** contains a high concentration of **digestive enzymes** (e.g., pepsin, hydrochloric acid) which, post-mortem, contribute to rapid autolysis of its own tissues. - The presence of food contents and abundant bacteria within the stomach lumen further accelerates the process of **putrefaction**.

Q: Dilated pupil with coma is seen in which poisoning?

Dhatura. ***Dhatura*** - **Dhatura poisoning** is characterized by an **anticholinergic toxidrome**, leading to symptoms like **dilated pupils (mydriasis)**, dry mouth, flushed skin, tachycardia, and altered mental status progressing to coma. - The dilated pupils are a direct result of the **muscarinic receptor blockade** in the eye, preventing parasympathetic innervation. *Opium* - **Opium poisoning** typically causes **pinpoint pupils (miosis)**, respiratory depression, and central nervous system depression leading to coma. - This effect is due to the **opioid agonists** stimulating mu-opioid receptors. *Mushroom* - Mushroom poisoning can present with various toxidromes depending on the species; however, some muscarine-containing species can cause **miosis** (pinpoint pupils), salivation, and bradycardia, while others may cause delirium or hepatic failure. - **Dilated pupils** are not a characteristic feature of the more common deadly mushroom poisonings that lead to coma. *Pilocarpine* - **Pilocarpine** is a **direct cholinergic agonist** that stimulates muscarinic receptors and typically causes **miosis (constricted pupils)**, increased secretions, and bradycardia. - It would not lead to dilated pupils or coma in the manner described.

Q: Concealment of birth is punishable under:

Sec. 318 IPC. ***Sec. 318 IPC*** - This section of the **Indian Penal Code (IPC)** specifically deals with the **concealment of birth by secret disposal of dead body**. - It punishes anyone who, by **secretly burying or otherwise disposing of the dead body of a child**, endeavors to conceal the birth of the child. *Sec. 320 IPC* - This section defines **"grievous hurt"** under the IPC. - It lists various types of injuries that constitute grievous hurt, such as **emasculation**, permanent privation of sight or hearing, fracture or dislocation of a bone, etc., and is unrelated to concealment of birth. *Sec. 317 IPC* - This section pertains to the **exposure and abandonment of a child under twelve years** of age by a parent or person having care of it. - While it deals with offenses against a child, it specifically addresses abandonment rather than the concealment of a dead body after birth. *Sec. 312 IPC* - This section addresses **causing miscarriage**. - It punishes anyone who voluntarily causes a woman with child to miscarry, which is distinct from the act of concealing a birth by disposing of a dead child's body.

Q: Sexual asphyxia is seen in cases of:

Masochism. ***Masochism*** - **Sexual asphyxia** (also known as autoerotic asphyxiation or hypoxyphilia) is a dangerous practice where an individual intentionally reduces oxygen supply to the brain during sexual activity to enhance sexual arousal through cerebral hypoxia. - This practice is associated with **sexual masochism disorder**, where sexual gratification is derived from experiencing pain, suffering, or potentially life-threatening situations. - The oxygen deprivation creates a sense of euphoria and heightened arousal, but carries significant risk of accidental death. - This is considered a particularly dangerous form of masochistic sexual behavior. *Sadism* - **Sexual sadism disorder** involves deriving sexual pleasure from inflicting pain, suffering, or humiliation on others. - The focus is on causing distress to another person, whereas sexual asphyxia is typically self-inflicted (autoerotic) or involves the practitioner being the one deprived of oxygen. *Voyeurism* - **Voyeuristic disorder** refers to obtaining sexual pleasure from secretly observing unsuspecting individuals who are naked, disrobing, or engaging in sexual activity. - It does not involve any form of physical risk, asphyxia, or oxygen deprivation. *Fetishism* - **Fetishistic disorder** is a paraphilia where sexual arousal and gratification are primarily associated with inanimate objects (e.g., shoes, underwear) or specific non-genital body parts. - This condition does not involve asphyxiation; the focus is on a particular object or body part as the source of sexual pleasure.

Q: Marshall's triad is seen in:

Explosive injury. ***Explosive injury*** - Marshall's triad components, including **blast lung**, **abdominal hemorrhage**, and **tympanic membrane rupture**, are characteristic injuries of explosions, especially those involving pressure waves. - The triad highlights distinct patterns of organ damage caused by the high-energy transfer from blast forces. *Lightning injury* - Lightning injuries can cause diverse effects like **cardiac arrest**, **neurological damage**, and **burns**, but they do not typically present as Marshall's triad. - The primary mechanism is electrical, leading to distinct injury patterns different from blast trauma. *Gunshot injury* - Gunshot wounds create localized tissue damage along the projectile's path and a temporary cavity, but they do not cause generalized blast effects or the specific triad of Marshall. - The injury severity depends on the **caliber**, **velocity**, and **trajectory** of the bullet. *Drowning injury* - Drowning is characterized by **respiratory impairment** resulting from submersion or immersion in liquid, leading to **hypoxia** and multi-organ failure. - Its pathophysiology and presentation are entirely distinct from explosive trauma.

Q: Which of the following snakes is most commonly associated with hematologic abnormalities following envenomation?

Viper. ***Correct Answer: Viper*** - **Viper venom** contains **hemotoxic components** including **metalloproteinases** and **serine proteinases** that directly activate clotting factors - This leads to **consumptive coagulopathy** characterized by **thrombocytopenia**, **hypofibrinogenemia**, and prolonged coagulation times - Clinical manifestations include spontaneous **bleeding**, **ecchymoses**, **hemorrhage** at the bite site, and in severe cases, **disseminated intravascular coagulation (DIC)** - Viper envenomation is the **classic cause** of hematologic abnormalities among snake bites *Incorrect: Sea snake* - Sea snake venoms are primarily **neurotoxic** and **myotoxic**, causing paralysis and muscle damage - While they can cause **rhabdomyolysis** and subsequent **renal failure**, significant primary hematologic abnormalities are not their hallmark feature *Incorrect: Krait* - Krait venom is predominantly **neurotoxic**, leading to **flaccid paralysis** and **respiratory failure** - Does not typically cause the significant widespread **coagulopathies** seen with viper envenomation *Incorrect: Cobra* - Cobra venom primarily contains **neurotoxins** and **cytotoxins**, causing **paralysis**, **tissue necrosis**, and localized pain - While some cobras can cause minor local bleeding, they do not generally induce the severe and systemic **hematologic abnormalities** characteristic of viper bites

Q: Which of the following is used in the second-line management of strychnine poisoning?

Barbiturates. ***Barbiturates*** - As a **second-line treatment**, barbiturates like phenobarbital are used to control **refractory seizures** and muscle spasms in strychnine poisoning when benzodiazepines are insufficient. - They enhance the effect of **GABA**, leading to central nervous system depression and muscle relaxation. *Physostigmine* - This is an **acetylcholinesterase inhibitor** and is primarily used to reverse the anticholinergic effects of certain poisonings, not strychnine. - It would worsen seizures by increasing **acetylcholine**, which can cause tremors and convulsions. *Naloxone* - Naloxone is an **opioid antagonist** used to reverse opioid overdose, which presents with respiratory depression and pinpoint pupils. - It has no role in treating strychnine poisoning, which primarily causes **muscle spasms** and seizures. *Diazepam* - Diazepam, a **benzodiazepine**, is the **first-line treatment** for seizures and muscle spasms in strychnine poisoning. - It works by enhancing the effects of **GABA** at the GABA-A receptor, thereby reducing neuronal excitability.

Q: Contributory negligence is negligence due to:

Patient only. ***Patient only*** - **Contributory negligence** specifically refers to negligence on the part of the **plaintiff** (the patient) that contributed to their own injury. - This doctrine can reduce or bar recovery for damages if the patient's own actions played a role in causing the harm. *Doctor only* - This describes **medical malpractice**, where the healthcare provider's negligence directly causes harm to the patient. - While a doctor's negligence is a primary concern in healthcare, it doesn't align with the legal concept of *contributory* negligence, which attributes fault to the injured party. *Both doctor and patient* - This scenario relates to **comparative negligence**, a legal doctrine where fault is apportioned between multiple parties (e.g., doctor and patient). - Contributory negligence, in its strict form, implies the patient's negligence alone contributed significantly enough to preclude full recovery, rather than shared fault. *Hospital administrator and doctor* - This refers to negligence stemming from actions of the hospital administration (e.g., systemic failures, inadequate resources) and individual medical errors by the doctor. - While both can be liable for negligence, this does not represent the patient's own contribution to their injury, which is the core of contributory negligence.

Q: Stellate wound is produced with firearm in:

Contact shot. ***Contact shot*** - In a **contact shot**, gases and matter from the gun barrel are forced directly into the wound, causing the skin to stretch, tear, and burst outward, creating a **stellate or star-shaped wound**. - The hot gases and unburnt powder entering the wound create an exit for themselves, often leading to these characteristic irregular, radiating tears. *Close shot* - A close shot involves the skin being close to the muzzle but not directly touching, leading to a circular or oval wound with a surrounding area of **singeing**, **soot deposition**, and **powder tattooing**. - While there is gas effect, it's not as confined or forceful behind the skin as in a contact shot, thus not typically producing a stellate wound. *Distant shot* - A distant shot occurs when the muzzle is far enough from the target surface that only the **bullet strikes the skin**, leaving a relatively clean, circular or oval entry wound without significant singeing or tattooing. - The effects of gas and unburnt powder are not present at the wound site in a distant shot. *Range within 60 cm* - While a range within 60 cm (approximately 2 feet) can encompass close shots, it's a broad category and doesn't specifically define the conditions necessary for a stellate wound. - A stellate wound requires conditions more specific to a contact shot, where the muzzle is pressed against the skin.

Question 1

Minamata disease is caused by toxicity of:

Accepted Answer

Mercury

Answer

Arsenic

Answer

Antimony

Answer

Lead

Question 2

Which one of the tissues putrefies late?

Accepted Answer

Prostate

Answer

Liver

Answer

Brain

Answer

Stomach

Question 3

Dilated pupil with coma is seen in which poisoning?

Accepted Answer

Dhatura

Answer

Opium

Answer

Mushroom

Answer

Pilocarpine

Question 4

Concealment of birth is punishable under:

Accepted Answer

Sec. 318 IPC

Answer

Sec. 320 IPC

Answer

Sec. 317 IPC

Answer

Sec. 312 IPC

Question 5

Sexual asphyxia is seen in cases of:

Accepted Answer

Masochism

Answer

Sadism

Answer

Voyeurism

Answer

Fetishism

Question 6

Marshall's triad is seen in:

Accepted Answer

Explosive injury

Answer

Lightning injury

Answer

Gunshot injury

Answer

Drowning injury

Question 7

Which of the following snakes is most commonly associated with hematologic abnormalities following envenomation?

Accepted Answer

Viper

Answer

Sea snake

Answer

Krait

Answer

Cobra

Question 8

Which of the following is used in the second-line management of strychnine poisoning?

Accepted Answer

Barbiturates

Answer

Physostigmine

Answer

Naloxone

Answer

Diazepam

Question 9

Contributory negligence is negligence due to:

Accepted Answer

Patient only

Answer

Doctor only

Answer

Both doctor and patient

Answer

Hospital administrator and doctor

Question 10

Stellate wound is produced with firearm in:

Accepted Answer

Contact shot

Answer

Close shot

Answer

Distant shot

Answer

Range within 60 cm

NEET-PG 2013 — Forensic Medicine