امتحانات الطب الشرعى

أمتحانات السنين من 2008 .. و
end round cases 2011
.........
June 2008

Forensic

1) a young 18 years old male was found dead in his room with an incised wound in the neck. huge amount of blood stains were seen on a mirror and on the ventral aspect of his clothes. a razor was seen nearby the body.

1- do you think this case was homicidal, suicidal or accidental ? and why ?
suicidal,
blood on the mirror indicates he was standing in front of it,
blood on ventral aspect of clothes,
a razor is found in place which is usually a character in suicidal cases

2- how could you confirm you suspicion through examination of the wound ?
site: up high above thyroid cartilage
number: single
hesitation mark: usually present
slanting

3- enumerate the causes of death from cut throat.
neurogenic shock, hge, venous air embolism, asphyxia or dealayed from glottic edema or pneumonia.

4- describe post-mortem findings which you could see in that case.
pale hypostasis , Internal and external signs of ashyxia and cadaveric spasm

5- how could you estimate the age of that male ?
by X-ray on the head of femur & the lower ends of tibia and fibula .. If the epiphyses of these regions are united then he is 18 yrs old or more
X-ray on the head of humerus and the lower ends of radius and ulna .. if the epiphyses of these regions are still not united then he is less than 20 yrs of age ..

6- what is the MLI of the age of 18 years old in males ?
first military service call, driving license, complete criminal responsibility, governmental employment & election voting rights.
----------------------------
A 21 years old girk with history of pschiatric disorders was admitted to a hospital showing severe extensive burns involving the face, chest, abdominal wall, arms & thighs. 2 old scars were seen at the ventral aspect of her left wrist. she died within 6 hours after being admitted to the hospital.

1- do you think this case was homicidal, suicidal or accidental ? and why ?
suicidal,history of pschiatric disorders
multiple previous attempts for suicide

2- how would you confirm the AM nature oh such burns ?
hypermia, vesicles filled with serum rich in albumin & chloride, soot in air passages, COHb in blood, hemoconcentration, signs of healing & sepsis are seen be NE or under microscope.

3- enumerate the possible causes of death in that case.
neurogenic shock, ashpyxia or injury of vital organs.

4- describe post-mortem findings which you could see in that case.
Evidence of AM burns of various degrees , Redness of the body " co HB in blood " , soot in air passage , haemoconcentration and skull thermal fracture may be seen

5- how could you estimate the age of that girl ?
by X-ray on the iliac crest & proximal end of clavicle .. If the epiphyses of these regions are united then she is 21 yrs old or more

6- what is the MLI of the age of 21 years old in females ?
age of civil rights.

---------------------

Toxicology
A 25 years old female with a history of epilepsy was admitted to hospital after ingestion of 20 tablets of her drug therapy. on examination, she was comatosed, pulse rate was 90/min. BP was 65/50 mm/Hg, respiration was slow deep & streturous, temprature was 36.3C and pupils were dilated reactive.

1- what is your provisional diagnosis ?
barbiturates toxicity.

2- how could you confirm this diagnosis ?
routine tests & serum barbiturate level.

3- what are the proper lines of ttt of that case ?
Supportive (ABC)
GIT decontamination
Elimination of poison from blood

====================

August 2008

Forensic
A 16 years-old male was involved in a quarrel. He was admitted to hospital with headache and vomiting. On examination, he was confused with scalp injury in the right tempro-parietal region. Few hours later, he passed into coma with unequal pupil size and the heart rate was 55 beats /minute.

1-What is your diagnosis?
Brain concussion followed by compression with lucid interval

2-What is the proper management of such case?(3 marks)
Must be hospitalized for few days with Measurement of BP, pulse, respiration, temp., conscious, motor power, reflexes & pupils (size, equality & reactivity) every 15 min.
Decompression operation is done if pulse falls below 60/min. with the side of lesion detected by signs of lateralization , X-ray & CT not by scalp wound.

3-How can you diagnose the side of brain lesion?(2 marks)
from signs of lateralization , X-ray , CT scan and not by scalp wound

4-What are the possible sequelae of such case? (3 marks)
page 88

5-How can you verify that the age of the victim is 16 years? (2 marks)
X-ray :
- union of lateral epicondyle in the shaft
- union of upper end of ulna with the shaft
......................

Toxicology

A farmer had repeated vomiting, abdominal colic and diarrhea after taking his lunch which contains some farm vegetables. The examination revealed constricted pupils, muscular twitches, pulse was 60/minute, Bl.Pr. was 90/70 mm Hg., with sweating and cripitations all over the chest.

1- What is your provisional diagnosis and differential diagnosis?
organophosphorus compounds toxicity
DD >> morphine , carbolic acid , pontine hge

2- What is the action of the suspected poison?
irreversible choline esterase inhibitor >> increase acetyl choline level peripherally & centrally.

3- What is the proper treatment of such case?
* Prophylactic
* Curative (atropine sulphate, oximes, keep patent airway, GIT decontamination & gastric lavage).

======================================
June 2009

Forensic

an 18yrs old farmer was shot to death in his field . Two suspects were arrested , one of them had a Ghaffir gun & the other had a revolver . on examination , hypostasis was patchy & intraocular pressure was Zero .
Thee was a central hole surrounded by smaller holes covering an area of 4 cm in the precordium and there were no exit wounds .

a) how could you estimate the age of victim ?
by X-ray on the head of femur & the lower ends of tibia and fibula .. If the epiphyses of these regions are united then he is 18 yrs old or more
X-ray on the head of humerus and the lower ends of radius and ulna .. if the epiphyses of these regions are still not united then he is less than 20 yrs of age ..

b ) mention the time passed since death ..
3 hours passed since death because ; hypostasis is patchy , intraoccular pressure is Zero .

c) who is the assailant ? how could you prove that his weapon was the causal object ?
the assailant is the one with the Ghaffir gun .( non-rifled weapon )

Prove : because the Inlet is caused by a non-rifled weapon ( shots ) showing a central hole with dispersion .. while the revolver is a rifled weapon and will cause a single whole with no dispersion holes..

search for evidence of recent firing ( muzzle smell , swap )

compare the cartridge if present with the bore , type of the weapon ..

d) mention the distance of firing in this case ? what investigations should be done and what is it value ?
* Distance of firing :
2 meters ( central hole + 4 cm dispersion )

* Investigations :
1/ examination of fire arm combustion residues ..found on the victim , thumb and index of the assailant

-visible residues : powder marks , grease marks ..
- Non-visible residues :
nitrites , nitrates from gun powder , primer component ..
metal residues from the barrel ..
2/ X-ray : for

localization of shots
number of shots , dispersion .
documentation
3/ examination of clothes for : defects , firearm residues for estimation of distance , direction of firing

4/ Identification of the weapon

Examination of the weapon :
Fingerprints on the trigger

Full description of the weapon ( bore , type , license )

Muzzle smell , swap for recent firing

Compare the weapon with the cartridge , shots found in the scene ..

Examination of the cartridge :
compare the type , bore with the weapon . if it fits the weapon experimental firing is done and the 2 cartridges are compared for :

preliminary marks :

- striking needle grooves are compared for size , site , depth , shape

-Extractor hook marks

if they match then put them under comparison microscope and search for confirmatory marks ( minute scratches near percussion cap ) if they match then it's the causal weapon

Examination of the wound : central wound surrounded by 4 cm dispersion holes ..
-----------------------------------

Toxicology

A female aged 16 yrs was brought to Kasr Al Aini poison control center after attempting suicide by a drug . on examination , the patient was confused with history of repeated vomiting with and attack of hematemesis , temperature was 38 C , Bp was 100/80 , Pulse was 105/min . Resp rate was 32/min . Investigations revealed that ; PH 7.21 , HCO3 14ml Eq / L . prolonged prothrombin & bleeding time and on X-ray . gastric concertion were noted .

طبعا السطر اللي وضحلنا الحل بتاع الكيس هو :
prolonged prothrombin & bleeding time = Aspirin

1) what is the aced - base disturbance in this case ?
Metabolic Acidosis ( 7.21 )
N.B normal PH is 7.4

2) what is your provisional diagnosis ? why ?
Aspirin toxicity .. because : shows the clinical picture of aspirin toxicity ..
Prolonged prothrombin , bleeding time
Vomiting , hematemesis
increase respiratory rate .
Acidosis
Gastric concretion on X-ray caused by the large amounts of aspirin tablets .
Fever due to uncoupling of oxidative phosphorylation process by aspirin overdose .
3) Enumerate two other poisons that induce the same acid base disturbance ?
Remember the causes of acidosis : MUD PILES

M : Methanol
U : Uremia
D : Diabetic ketoacidosis
P : Paraldehyde, Phenformine
I : Iron , Isoniazide
L : Lactic acidosis
E : Ethylene glycol
S : Salicylates

4) What is the proper treatment of such case ?
1- Supportive treatment : ( ABC )
maintain the airway via nasal mask , entubation
maintain circulation and treat hypotension by Fluid infusion , Dopamine (5-15 mg/kg )
assess CNS functions ( the patient is awake )
2- prevent further exposure ( GIT decontamination ) :
Emesis by syrup of Ipecac
Gastric lavage by sodium bicarbonate ( helps in the condition of acidosis )
Activated charcoal and MDAC
Cathartics
Whole bowel irrigation
3- Poison Elimination :
Diuresis : Forced alkaline diuresis ( NaHCO3 1-2 mg/kg )
Dialysis in severe intoxication .
4- Symptomatic :
Acidosis : NaHCo3 I.V
seizures : Diazepam
Hyperthermia : cold foments
GIT irritation : demulcents
Bleeding tendencies : Vit K or blood transfusion .
Dehydration : I.V fluids

=======================

June 2010

Forensic :
A 23 yrs old female was found dead in a clinic . on examination the body was pale and small fetus was found beside the deceased whose length was 16 cm . at autopsy. the length of the uterus was 6 inches . the obstetrician claimed that this was a case of therapeutic abortion that has been complicated to death ...

a) How could you estimate the age of the victim ?
on autopsy :
union of the epiphysis of the medial head of the clavicle , iliac crest = she is >21yrs
starting of the union of the parietal suture so he is between 23-28 yrs
the medullary cavity doesn't reach the surgical neck of humerus .. so she is less than 28 yrs
eruption of the wisdom tooth ( 3rd molar ) ..

b ) is that fetus belongs to the victim ? why ?
yes ..
the length of the uterus is 6 inches so she was in the 4th month of gestation
the length of the fetus is 16cm that means that it has been aborted after 4 months of gestation ..

c) what are the possible causes of death in this case ?
1- Neurogenic shock ( symp , parasymp )
2- Haemorrhage ( 1ry )
3- Embolism ( air , amniotic fluid )
NB: we exclude late causes of death ..

d) what are the investigations requested by the medical examiner for this case ?
1- Details on the medical condition that needed the abortion to save the mother ..
2- The consent of the husband and the woman for the abortion
3- signs of pregnancy ( HCG , abdominal and breast changes )
4- signs of local violence :
Cervix : bruises , volsellum marks
vagina : remnants of abortion . etc...
5- Laboratory analysis for blood , urine , stools for any abortificient drugs
6 - examination of the fetus .. determining the age , macerated or not , precepitin test ..
7 - peritoneum for signs of Hge , sepsis, perforated uterus
8 - GIT : for inflamations by purgatives .
9 - uterus : size , contents , endomtetrium condition ..

e) Is there any medicolegal responsibility on the obstetrician ? why ?
Yes ..
because therapeutic abortion must be done in a well prepared hospital ..

-------------------------------
Toxicology
a young girl was admitted to the poisoning control center after she has ingested 50 tablets prescribed for her mother's cardiac condition . the girl had repeated vomiting with abdominal pain .on examination she was unconscious but responding to pain , pulse was 60/min , BP 90/60 and the respiratory rate was 12/min . ECG showed A-V block and serum K+ was 6 mEq/L ..

1) what is the electrolyte disturbance in this case ? Mention the mechanism
Hyperkalemia.. mechanism:
Inhibition of the Na/K ATPase leading to retention of sodium inside the cells and potassium outside ( Hyperkalemia )

2)What is your provisional diagnosis and Investigations needed to verify your diagnosis?state her coma stage ?
* Digitalis toxicity
* Investigations needed :
Serum digoxin level
Electrolytes level K+, Ca++
ECG for arrhythmias .
Kidney functions
* Coma stage 1 .. according to Reed coma scale

3) What is the proper treatment of such case ?
1-Supprotive :
ABC +
> Treat the electrolyte imbalance:
insulin with 5% glaucose for hyperkalemia
-disodium EDTA for hypercalcemia

>Antiarrhythmics :
Atropine for the A-V block
Lidocaine
Phenytoin
2- prevent further exposure ..
charcoal , cholestyramine ( to stop the enetro hepatic circulation )

REMEMBER : Drugs with enterohepatic circulation :
Bile To Deodnum

B: Barbiturates
T: TCA
D: Digitalis .

3 - Physiological antidote
Digibind .... ( check the book for details )

======================================

First end round exam 2011

In medico-legal report , the forensic examiner stated that " forensic examination of the corpse recovered from the river . How can the forensic expert reach these conclusion ?

A – cause of death is not drowning .
The examiner don't found this signs of drowning :
1 – Air passages :
contain froth finely beaten & foreign bodies from water (sand, weeds)
2 – stomach :
Contain unpalatable water and foreign bodies .
3 – Planktones :
They pass into the circulation to all organs and can be detected in the liver, brain or bone marrow .

B – he died since 3 weeks ."
Adipocere is formed after 3 weeks in water , it's a waxy yellow greasy material with characteristic odor that found in fatty areas of corpse .

=============================

second end round exam 2011


A man was hit in his right arm by a fass during a quarrel that lead to compound fracture . describe findings of examination of his skin and bone after 1 week, 3 weeks & 3 months . considering that there were no septic complication .

Healing of bone fructure :
After 1 week : organization of the blood clot in between the 2 fragments .
After 3 weeks : 1ry callus is formed in the organized clot .
After 3 months : complete healing with a firm callus .

Skin show cut wound :
After 1 week : new vessels start to grow towards the skin surface .
After 3 weeks : the scar is red .
After 3 months : the scar is coppery brown

=============================

Third end round exam 2011

In medico-legal report the forensic examiner stated that " the victim's examination and investigation revealed that she is 6-year old died from carbon monoxide toxicity , 12 hours ago " discuss how can he reach such conclusion

- She is 6-year old :
eruption of first permanent molars .

- Died from carbon monoxide toxicity :
p.m.p
-brain edema & congestion
-int.& ext. signs of asphyxia
-Lung , brain & heart complications ( necrosis & degeneration )

- 12 hours:
( rigor mortis and P.M. cooling )

===============================

Fourth end round exam 2011


A young women was found dead in her apartment . the medico-legal examiner stated that " she was pregnant in her 5th gestational month ,,, the cause of death is fatal extradural hemorrhage and the mode of death is blunt head trauma . moreover , the finger nail abrasion on her neck are postmortem in origin ".
She was pregnant in her 5th gestational month .

the examiner reaches this fact through the weight and length of uterus


5th gestational month ( +2 ) >>>> the length of uterus is about 7 inches


The cause of death is fatal extradural hemorrhage

The postpartum picture : asphyxia – heamatoma – fissure fracture – torn of M.M.A



The finger nail abrasion on her neck are postmortem in origin

NO redness , bruises or vital reaction
Correct the wrong part of examiner's report and describe how he had reach this conclusions
The mode of death is blunt head trauma >> correction :
The cause of death is blunt head trauma

امتحانات اشرعى

سبتمبر 2008
يونيو 2009
سبتمبر 2009
يونيو 2010
سبتمبر 2010
يوليو 2011

Forensic Exams.pdf
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]


Forenisc MCQ 2009 June.pdf
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]


cases
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]

cases answer 2
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]


Forensic End Rounds Exams.rar
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]


دول شوية اسئلة جت فى امتحانات الشرعى قبل كدة
حبيت احطهملكم علشان كلنا نستفيد منهم

Death & Postmortum changes
1. Sudden infant death syndrome
2. Definition & MLI of hypostasis
3. Difference between bruises & hypostasis.
4. Mummification & its MLI
5. Cadaveric spasm
6. MLI of putrefaction
7. Maceration
8. Post mortum eye changes
9. Rigor mortis & its medico legal importance
Medicolegal aspect of wounds
1. MLI of Abrasions
2. Finger nail abrasions & their medicolegal importance
3. Characters of cut wounds & Its age estimation
4. Suicidal & homicidal cut throat
5. Post mortem neck examination In case of cut throat
6. Contused or lacerated wounds (Laceration).
7. Stab wounds.
8. Subendocadial hemorrhage
9. Causes of death from wounds
10.Air embolism
11.Ante and post-mortem wounds (including abrasion and bruises)
12.Primary or neurogenic shock
HEAD INJURIES
1. Thermal fracture of the skull
2. Differential diagnosis between Thermal & traumatic head injuries
3. Types of skull fractures & their healing
4. Cerebral concussion
5. Compression by intracranial hemorrhage
6. Clinical picture of Cerebral compression
7. Lucid interval
8. Extradural hemorrhage.
9. Sequelae or side effects of Head injuries
FIREARM INJURIES
1. Estimation of distance of firing in cases of firearm injuries & factors
2. governing it.
3. Characters of near firing injury by a bullet
4. Describe the lesions in a shot injury at a distance of one meter
5. Percussion cap of firearm cartridge
6. Powder marks & their medicolegal importance
7. Difference between wounds in firearm injuries
8. Sequence of events after firing a cartridge
9. Compare homicidal, suicidal & accidental firearm wounds
10.Character of fire-arm wounds include differences between inlet and exit
11.wounds
12.Fire-arm cartridge
13.Difference between burns & scalds Ante-mortem burn
14.Give the differential diagnosis between the different types of thermal
Injuries .
15.Cause of death from burns
16.Causes of death from electric shock Picture.
ASPHYXIA
1. Ligature mark
2. Tardieu spots & silvery spots, traumatic asphyxia
3. Causes of death in hanging
4. Sure signs in diagnosis of drowning
5. Sure external signs only of drowning.

6. Discuss the diagnosis of asphyxia of drowning
7. Plankton & its medicolegal importance
SEXUAL OFFENCES
1. Conditions of consent in rape
2. Types of hymen
3. Signs of virginity and causes of rupture of hymen
4. Compare between a dentate hymen and an old ruptured hymenal tear
5. Compare a recent & an old hymenal tear
6. MLI of Sodomy
MESICOLGAL ASPECT OF PREGNANCY:
1. Signs of old delivery
2. External signs of recent delivery
3. Gravindex test of pregnancy
MEDICOLEGAL ASPECT OF ABORTION:
1. Dangers of abortion
2. criminal abortion
3. Discuss Hazards of criminal abortion
Infanticide
1. Medicolegal importance of umbilical cord
2. Hydrostatic floatation test of the lung
3. Signs of respiration as an evidence of live birth
4. Internal medical signs of Iive birth
5. External signs of live birth of newly born infant
Medical Ethics
1. Write short notes on malpractice
2. Discuss consent in medical practice
Blood stains
1. Medicolegal applications of blood groups
2. Micro chemical tests of blood
3. Precipitin test of blood
4. Heamolytic blood transfusion reaction
5. Give an account on "Blood Groups" and their "Medico legal Applications".
(Technique of grouping is not required)
6. Discuss incompatible blood transfusion.
7. How can you prove that a stain is seminal. Teichman's
8. Medicolegal applications of DNA finger printing
9. Rh factor
10.Teichman and takayama microchmical tests of blood
=======