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List the factors affecting the formation of rigor mortis?

1. Environment warm or cold 2. Low glycogen level
3. Muscle activity (i.e. exercise, electrocution)

Define rigor mortis, what is the mechanism, what is the

medicolegal importance of it?
1. Definition:
One of the recognizable signs of death that is caused by a chemical change in the muscles after death causing the
limbs of the corpse to become stiff and difficult to move or manipulate
2. Mechanism:
ATP is required to: 1. bind to myosin and release the actin filaments 2. calcium reuptake to the sarcoplasmic
reticulum after death there is no breathing so oxygen is depleted and no ATP is produced ,lactic acid starts to
build up in the cells & because of both low PH and no ATP the actin and myosin fibers bind together and no ATP
to release actin from myosin and to reuptake calcium, so there is sustained contraction until breakdown of the
muscles by the digestive enzymes

3. Medico-legal importance:
A. Estimated time of death B. Guess the cause of death C. Know position of death D. its a sure sign of death

Compare between Mummification and adipocere?

1. Adipocere:
A. A chemical change in the body fat
B. It occurs in subcutaneous fat of the cheeks ,breast, buttocks & may occur in internal organs
C. It needs months to occur and occurs partially
D. Moisture is necessary
E. The optimum conditions for the formation of adipocere:
1. Wet, warm environment 2. Bacterial activity (C. perfiringes)
F. It is a grayish, greasy material
G. may be dry, brittle, & have an odor similar to that of ammonia
2. Mummification:
A. Drying & shriveling of the tissues
B. The optimum conditions are dry & warm climate
C. Once the changes are complete, the body will remain in that condition indefinitely
D. Also seen in newborn infants (sterile)
E. No growth of micro organisms

What are the medicolegal benefits of hypostasis (livor mortis)?

A. Estimated time of death
B. Guess the cause of death
C. Know position of death
D. Its a sure sign of death

As a forensic medicine doctor write down the questions you

should answer regarding a "fire death"?

1. Is there any heat-related contraction and thighs
2. Is there any post-mortem splitting of fragile burnt skin
3. Is there any fire- and heat-related fractures
4. Is there any heat-related extradural hemorrhage

Mention the medicolegal cases that need autopsy?

1. When the death occurs during experiment
2. When the cause of death may affect legal matters
3. When death unexpected during any medical procedure
4. When the reason for death was not diagnosed before
5. If there is concerns about reason may cause death like genetic causes
6. If there is questions about death that appear due to natural causes

Note: Autopsy= necropsy or post-mortem examination

What are the features of suicidal knife wounds?

1. Certain sites like: A. Throat B. Wrist C. Anterior chest
2. Multiple wounds but there is usual cut that is the most deep
3. In throat suicidal injury throwing back the head moves the carotid
bundle under the protection of the sternocleidomastoid muscles
4. Deliberate cutting of the wrists is rarely effective as a sole method of
suicide but it is a common injury
5. Suicidal injury of the chest are almost always stab wounds
6. Stab wounds of the neck are uncommon in suicide

What are the differences between Stab wounds and Slash


1. Slash Wounds :
superficial wounds where the length is greater than the depth
2. Stab Wounds: Deep wounds where the depth is greater than the
length tend to come into contact with vital organs

Compare between lacerations and incised wounds?


Incised wounds

Trace evidence


Shape is not according to causal agent blunt

trauma on bony prominence

Shape is according to Cause

Sharp object cut wound

Ragged edge

Everted edge

Rarely self-inflected

May be self-inflected

Mention 6 factors that affect wound healing?

1. blood Supply
2. Infections
3. Age
4. Nutritional status
5. inter-current diseases
6. Drugs e.g. Steroids, Immunosuppressives

Mention the features of non-accidental injuries?

1. Injury in non-ambulatory i.e. totally dependent child
2. Injury and history given are incompatible
3. Delay in seeking medical attention
4. Multiple fractures with no family history of osteogenesis imperfecta
5. Retinal hemorrhage
6. Torn frenulum
7. History of household falls resulting in fracture

Compare between Bruises & Hypostasis?


What is the difference between abrasion and contusion?

1. Abrasion= wearing off of the skin
2. Contusion= the skin is not broken

Note: contusion = bruise

Write short notes about lacerations?

A. Lacerations bleed profusely because the skin surface is split or torn following blunt trauma
and the force causes the full thickness of the skin to be damaged
B. Common sites of lacerations are those with underlying bony support e.g. Above the
eyebrows, on the scalp and face or over the knees
C. Lacerations have ragged wound edges & as they have been torn apart and not neatly incised
like in a surgical wound
D. If the wound is examined closely:
1. The ragged edges can be visualized 2. Crushing 3. Bruising hairs driven into the tissue
4. Tissue strands (i.e. nerves, fibrous brands, vessels) may cross the depths of the wound
E. Medico-legal importance:
1. Shape and size not usually related to causal 2. Rarely self-inflected
3. Trace evidenced in wound (i.e. rust or dirt)

Mention the types of abrasion?

1. Abrasions caused by Tangential impact (e.g. graze , scratch , brush)
2. Abrasions caused by Vertical impact (e.g. crushing abrasions)

What are the features of suicidal firearm injury?

1. Wound within arm reach
2. Circular unless over a bony area such as the head
3. Muzzle mark on the skin surface if the gun is pressed hard against the skin
4. Pattern may be Imprinted pattern from a fore-sight or self-loading mechanism
5. Slight escape of smoke
6. Local burning of skin and hair
7. Bruising around the entry wound

List the factors that affect the extent of injury by firearm?

1. Distance from the body 2. Weapon used 3. way of injury (i.e. homicide or suicide

Discuss the medico-legal importance of bruises?

1. Patterned bruises may connect the victim and the object or weapon
2. the age of the injury can be determined
3. the degree of violence may be determined
4. in case of fall, sand, dust or mud may be found on the body
5. the manner of injury may be known from it's distribution

Define asphyxia?
A condition of severely deficient supply of oxygen to the tissue that
arises from abnormal breathing

What are the classical Signs of Asphyxia?

1. Petechial hemorrhages in the skin of the face and in the lining of the
2. Congestion and edema of the face
3. Cyanosis of the skin of the face
4. Right heart congestion
5. Abnormal fluidity of the blood

Mention the types of mechanical asphyxia?

1. Smothering
2. Choking
3. Manual i.e. Throttling
4. Strangulation

List the external signs for death by hanging?

1. Composition of ligature
2. Width and multiplicity of ligature
3. The weight of the body suspended and the degree of the suspension
4. The tightness of encircling ligature
5. The length of time body has been suspended
6. Position of the knot
7. Slipping of ligature during suspension

What are the post-mortem findings seen in each hanging &

Level in the neck

At or below thyroid
Soft and red

Above thyroid
Pale, hard, Parchment-like

Mention the causes (Mechanisms) of death in case of hanging?

1. Asphyxia 2. Venous Congestion 3. Cerebral ischemia
4. Cervical fracture 5. Reflex vagal inhibition

Write in details about hanging?

Definition: Suspension of the body by the neck
Causes of death:
1. Cerebral ischemia 2. Vagal cardiac inhibition 3. Mechanical anoxia
4. Transection of the spinal cord
Some of the features that may be found in the case of Hanging:
1. Protrusion of the tongue 2. Dribbling of saliva
3. Hypostasis of the lower half of the body
4. Neck is Elongated and the head is tilted to the opposite side of
suspension point
5. Ligature marks (HIGH UP in the neck, OBLIQUE, INCOMPLETE, has an
IMPRINT of the ligature)

Discuss Chemical Asphyxia?

Chemical asphyxia is the third major category of asphyxia death in which
the oxygen is able to reach the bloodstream, however a toxin prevents
Oxygen transportation in the blood or oxygen utilization by the cells
This asphyxia is caused by CO most common or cyanide less common

Mention the mechanism of Chemical Asphyxia caused by CO?

CO is an odorless, colorless and non-irritating gas, when its inhaled into
the lungs it defuses quickly into the blood stream by binding to Hb
causing poisoning of Hb that effectively shutting down the blood ability
to transport oxygen to the cells causing death

Write briefly about sexual asphyxia?

Sexual asphyxia is a type of autoerotic asphyxia that describes those
fatalities occurring during some form of solitary sexual activity due to
the use of a device, appliance or restraint that causes neck compression
leading to cerebral hypoxia with the aim of heightening the sexual

Such deaths, which usually involve men occur predominantly as a result

of failure of safety devices

What are the potential dangerous activities that can terminate

either in asphyxia or in reflex cardiac arrest?
1. Hanging
2. Compression of the neck
3. Stimulation of glottis
4. Drowning
5. Suffocation
6. Sexual asphyxia
7. Walking into an atmosphere of irrespirable gas

Define sudden death?

It is the death of an individual within 24 hours of the onset of a

Mention the cardiovascular causes of sudden death?

1. MI 2. Cardiac Tamponade 3. Arrhythmia 4. Cardiomyopathies
5. Valvular heart disease 6. Aortic dissection

What are the causes sudden death from cardiac diseases?

1. Coronary artery insufficiency
2. Ischemic heart disease
3. Hypertensive heart disease
4. Aortic valve disease
5. Anomalies of the coronary circulation
6. Polyarteritis
7. Cardiomyopathic enlargement
8. Congenital heart diseases
9. Functional abnormalities

Talk about SIDS (sudden infant death syndrome) and what are
the risk factors?

1. its the syndrome in which healthy infants (1 month - 1 year) die from
unknown causes usually during sleep most deaths occur between 2
4 months of age & incidence increases during cold weather & its
more in boys
2. Risk factors:
A. Smoking B. Drinking C. Drug use during pregnancy
D. Poor prenatal care E. Poor prenatal nutrition F. Stomach sleeping
G. Prematurity low birth-weight H. No breast feeding
I. Mothers < 20 years old J. Smoke exposure following birth
K. Overheating from excessive sleepwear and bedding

Whats the difference between cellular death & somatic death?

1. Cellular death:
Cells and tissues are no longer functioning or have metabolic activities
Different tissue die at different rate depending on oxygen
2. Somatic death (brain death):
Irreversible cessation of brain function followed by cessation of
functions of the heart and respiratory system i.e. the person is
unconscious, not aware of surrounding environment and he is unable
to appreciate sensory stimuli or initiate any voluntary movement

Write notes about Cardiomyopathy?

1. Cardiomyopathy is a group of diseases that affect the heart muscle
2. Types:
A. Hypertrophic cardiomyopathy is an inherited disease of cardiac
muscle sarcomeric proteins its the leading cause of sudden cardiac
death in young athletes
B. Dilated cardiomyopathy is a dilatation of the chambers with
thinning of the ventricular walls
C. Arrhythmogenic right ventricular cardiomyopathy is an inherited
condition which is characterized by predominantly right-ventricular
thinning with fibro-fatty myocyte replacement.
D. Restrictive cardiomyopathy is evident fibrotic thickening of the
endomyocardium which lead to decrease the myocardiac

What are the Complications of coronary atherosclerosis?

1. Rupture of ulcer atheromatous plaque
2. Sub-intimal hemorrhage
3. Thrombosis

What is the mechanism of action of Cocaine?

Ans: Norepinephrine-serotonin-dopamine reuptake inhibitor

Mention the causes of death caused by cocaine?

1. Acute MI
2. Respiratory failure
3. Stroke
4. Cerebral hemorrhage
5. Heart failure

Regarding Alcohol:
A. What is the effect of alcohol in CNS?
Ans: Depression of CNS

B. Give 2 factors that decreases absorption of alcohol?

Ans: 1.Food in the stomach 2. Higher concentration of alcohol

C. What are the signs of acute intoxication?

Ans: 1. Loss of memory 2. Confusion 3. Disorientation 4. In-coordination
5. Slurring 6. Stupor 7. Coma

D. What are the causes of death in chronic alcoholics?

1. Trauma 2. Incidental natural disease 3. Alcohol related liver disease
4. Acute intoxication 5. Obscure cause of death 6. hypothermia 7. Suicide

List the pathological effects of alcohol on the body?

1. Insomnia
2. Depression
3. Dementia
4. High blood pressure
5. Erectile dysfunction in men
6. Changes in menstrual cycle in women
7. Bleeding from GI tract

Describe the effect of ethanol on the central nervous system?

1. Low dose: A. Excitement B. Behavioral disinhibition
2. High dose: CNS depression (including respiratory & cardiac centers)

What liver diseases caused by ethanol consumption?

1. Fatty liver disease
2. Alcoholic hepatitis
3. Cirrhosis
4. Liver failure

Write how the alcohol drinking is related to legal issues ?

Mention the effects of alcohol on health and its correlation to
Forensic medicine?
What is the medico-legal importance of ethanol?

1. A drunk guy driving the car accident death to forensic clinic
2. A drunk guy kills death to forensic clinic

What are post-mortem signs of alcohol consumption?

1. Post-mortem redistribution of unabsorbed alcohol in the stomach (or in the
airways following aspiration of stomach contents) passing by diffusion into
central blood vessels (heart, inferior vena cava, pulmonary artery, pulmonary
veins, aorta) leading to up to 400% difference between central &peripheral sites
Blood should be taken from peripheral veins (femoral vein in pelvis) to avoid
this possible artifact
2. Post-mortem Microbial alcohol production:
Bacteria & yeast present in the bloodstream acting on glucose and lactate can
result in spurious alcohol production in the body or within a specimen tube (in

Compare between cocaine and heroin?

Effect on the CNS
Mechanism of action

Main cause of death

Best metabolite for analysis
best body fluid sample

norepinephrine &
reuptake inhibitor
Sudden cardiac

-opioid agonist

Urine (early),
Blood (late)



Define child abuse?

All forms of physical, emotional, sexual abuse, neglect or other
exploitation resulting in actual or potential harm to the child's health,
survival, development or dignity

Mention the types of child abuse?

1. Sexual abuse
2. Physical abuse

Mention the risk factors for child abuse with example on each?
1. Child-related:
A. Being either < 4 years old or an adolescent B. Being unwanted or failing to fulfil the expectations of parents
C. Having special needs i.e. crying persistently or having abnormal physical features
2. Caregiver-related:
A. Difficulty bonding with a newborn B. Not nurturing the child C. Having been maltreated themselves as a child
D. Lacking awareness of child development or having unrealistic expectations E. Misusing alcohol or drugs
F. Being involved in criminal activity F. Experiencing financial difficulties
3. Relationship-related:
A. Physical, developmental or mental health problems of a family member B. Lacking a support network
C. Family breakdown D. Violence between other family members E. Being isolated in the community
F. A breakdown of support in child rearing from the extended family
4. Community-related:
A. Gender and social inequality B. Lack of adequate housing or services to support families and institutions
C. High levels of unemployment or poverty D. The easy availability of alcohol and drugs
F. Inadequate policies and programs to prevent child maltreatment, child pornography, child prostitution & child
G. Social and cultural norms that promote or glorify violence towards others, support the use of corporal
punishment, demand rigid gender roles or diminish the status of the child in parentchild relationships
H. Social, economic, health and education policies that lead to poor living standards or socioeconomic inequality

List the indications that make you suspect child abuse?


How to prevent Child Abuse?

1. Visits by nurses to parents and children in their homes to provide
support, education & information
2. Parent education usually delivered in groups to improve childrearing skills, increase knowledge of child development & encourage
positive child management strategies
3. multi-component interventions which typically include:
A. Support and education of parents
B. Pre-school education
C. Child care

What are the risk factors for family violence?

1. Caregiver factors:
A. Personality characteristics and psychological well being B. Young Age
C. Substance abuse D. History of maltreatment E. Knowledge and attitude
2. Child factors:
A. Age 0-3 years old B. Disabilities
C. Other childhood problems e.g. aggression, attention
3. Family structure:
A. Being a single parent B. Stress C. Domestic violence D. Maternal conflicts
4. Environment factors:
A. Poverty B. Unemployment C. Violent society D. Lack of social support

How we can prevent family violence?

1. Raising awareness of the problem of family violence and establishing
social norms that make violence unacceptable
2. Connecting community residents to services
3. Changing social and community conditions that contribute to violence
4. Building networks of leaders within a community
5. Making services and institutions accountable to community needs

Talk about relationship between ethanol & family violence?

How does alcohol abuse affects family violence?

Write briefly about therapeutic abortion?

list the prerequisite to do therapeutic abortion?
Therapeutic abortion is the termination of pregnancy for medical
indications including :
1. Medical illness in the mother in which continuation of the pregnancy
has the potential to threaten the life or health of the mother
2. If there is a genetic condition in the embryo or fetus which is
incompatible with life (e.g. sever case of certain genetic condition,
sever case of profound mental impairment)

What are the causes of death for a women in a childbearing


Complications of pregnancy like:
1. Induced abortions
2. Ruptured Uterus
3. Amniotic fluid embolism
4. Ruptured ectopic gestation