FMGE 2025 - Forensic Medicine Practice Questions

Q: A body brought for autopsy is cold and has developed rigor mortis in all 4 limbs and livor mortis at the back (fixed), but no signs of putrefaction. What will be the estimated time since death?

12-24 hrs. ***Correct Option: 12-24 hrs*** - At this stage, **rigor mortis** is typically fully established across all muscle groups (maximal development occurs around 12 hours) and has not yet started to resolve. - **Livor mortis** becomes **fixed** (non-blanching upon pressure) usually after 12 hours, placing the time since death beyond the initial 12-hour window. - **Putrefaction** has not yet begun, which is consistent with this timeframe as putrefactive changes typically start after 24 hours. *Incorrect Option: 6-12 hrs* - During this period, **rigor mortis** is still developing (maximal development is typically approached at 12 hours) and might not be present in all four limbs (starts in smaller joints/upper limbs). - **Livor mortis** is usually present but often still **unfixed** or only partially fixed, meaning it might shift or blanch with pressure. *Incorrect Option: 24-48 hrs* - Around 24 hours, **rigor mortis** generally begins to resolve (**passing off**) starting from the face and neck, contradicting the finding of full rigor in all four limbs. - This timeframe is when the first signs of **putrefaction** (e.g., green discoloration of the abdomen) usually become visible, which is stated to be absent in the body. *Incorrect Option: 36-48 hrs* - By 36 to 48 hours, **rigor mortis** is typically completely resolved (**secondary flaccidity**). - Putrefaction would likely be significantly advanced during this period, including potential signs like marked **marbling** or abdominal swelling.

Q: A 2-week-old infant is brought to the hospital. Parents report a history of a single fall, but X-ray reveals multiple fractures at different stages of healing. What is the most likely diagnosis?

Battered baby syndrome. ***Battered baby syndrome*** - The presence of **multiple fractures** at **different stages of healing** is the most definitive radiological sign of non-accidental injury, indicating repeated trauma over time. - There is a significant discrepancy between the history provided by the parents (a single fall) and the clinical findings, which is a major red flag for child abuse. *Osteogenesis imperfecta* - This is a genetic disorder characterized by brittle bones due to defective **collagen synthesis**, leading to fractures with minimal trauma. However, it does not explain the different stages of healing, which point to injuries occurring at different times. - Other clinical features, such as **blue sclerae**, hearing loss, and dentinogenesis imperfecta, would typically be present but are not mentioned in this case. *Accidental fall* - A single accidental fall would result in injuries that are all in the **same stage of healing**, which contradicts the X-ray findings in this infant. - The pattern and number of fractures are inconsistent with a simple fall, which usually causes a single, isolated injury like a linear skull fracture. *Birth trauma* - Injuries sustained during birth, such as a fractured **clavicle** or humerus, would all have occurred at the same time and thus be in the same healing phase. - At two weeks of age, any new fractures or fractures at different healing stages could not be attributed to the birth event.

Q: A doctor receives two summons, one to appear in court in a murder case and another to provide expert medical opinion. Which of the following should the doctor prioritise?

Appearance in the murder case. ***Appearance in the murder case*** - **Criminal cases, especially serious offenses like murder, take priority over civil matters** - Murder cases involve Section 302 IPC (serious criminal offense) and require immediate judicial attention - Courts give precedence to criminal proceedings over routine civil/administrative matters - The doctor has a legal obligation to prioritize serious criminal cases as they involve matters of justice and public interest *The summon received first* - Priority is NOT determined by chronological order of receipt - The nature and gravity of the case determines priority, not the timing of summons *Appearance for providing medical expert opinion* - This is likely a civil or routine administrative matter - While important, it takes lower priority compared to serious criminal cases like murder - Can typically be rescheduled more easily than criminal proceedings **Legal Principle:** In medical jurisprudence, when multiple summons are received, priority is given based on the gravity of the case: **Criminal cases > Civil cases**, and within criminal cases, serious offenses like murder take precedence over minor offenses.

Q: A deceased woman was sent for an autopsy. She was found dead in a locked room with a heat stove still running. What is the most likely cause of death?

CO poisoning. ***CO poisoning***- The context of a deceased person in a locked room with a running heat stove points strongly to inhalation of **Carbon Monoxide (CO)**, a colorless, odorless gas produced by incomplete combustion.- CO has a very high affinity for **hemoglobin**, forming **carboxyhemoglobin**, which impairs oxygen transport and causes death via chemical **asphyxia**.*Cyanide poisoning*- Cyanide prevents cellular oxygen utilization (histotoxic hypoxia) by non-competitively inhibiting **cytochrome oxidase** in the mitochondria.- While highly fatal, cyanide is usually associated with the smell of **bitter almonds** at the scene and is not typically produced by household heat stoves.*H₂S poisoning*- **Hydrogen sulfide (H₂S)** poisoning is characterized by a distinctive odor of **rotten eggs** and is frequently associated with occupational exposure (e.g., sewers or drilling).- This gas also causes tissue hypoxia by inhibiting cellular respiration, but the circumstances described favor simple CO production from combustion.*Aluminium phosphide poisoning*- **Aluminium phosphide (ALP)** liberates **phosphine gas** upon exposure to moisture or stomach acid, leading to systemic toxicity.- This type of poisoning is usually due to deliberate ingestion of pesticides and causes severe effects, particularly on the **myocardium**, which is inconsistent with the presented scenario.

Q: A man was abducted from his home, and his son subsequently claimed rights to his father’s property. As per Section 111 of the Bharatiya Sakshya Adhiniyam (BSA), until when is the son not entitled to claim inheritance?

7 years. ***7 years*** - Section 111 of the **Bharatiya Sakshya Adhiniyam (BSA)** (previously Sec 108 of the Indian Evidence Act) establishes the presumption of death after a person has not been heard of for **seven years**. - Inheritance claims based on the father's presumed death cannot be entertained until this mandated **seven-year period** has elapsed, as the person is legally presumed alive until then. *5 years* - This period is insufficient under the BSA to raise a legal **presumption of death** necessary for transferring property rights. - The minimum statutory period required for shifting the burden of proof regarding the existence of the missing person is longer than **five years**. *6 years* - Although close, **six years** does not meet the legal threshold established by **Section 111 of the BSA** for the presumption of death. - The burden of proof remains on the party asserting the death until the full **seven-year period** is completed. *10 years* - This duration exceeds the statutory period required; the courts can legally presume death and allow inheritance claims after the mandatory **seven years**. - Waiting **10 years** is unnecessary, as the right to claim inheritance based on presumed death arises immediately after the completion of the **seven-year requirement**.

Q: A person was found dead in a swimming pool. On autopsy, his stomach and lungs were filled with water, and there was evidence of mucoid froth at the nose and mouth. What is the most likely mode of death?

Wet drowning. ***Wet drowning***- The presence of water in the lungs and stomach confirms significant **aspiration of water**, which is the definitional characteristic of **wet drowning**.- **Mucoid froth** (or *foam*) at the nose and mouth is formed by the mixing of aspirated water, air, and pulmonary **surfactant** due to violent respiratory efforts and subsequent **pulmonary edema**.*Dry drowning*- Death is caused by sustained, irreversible **laryngospasm**, preventing water from entering the lower respiratory tract; thus, the lungs are typically congested but **dry**.- This scenario would not exhibit the volume of water in the stomach and lungs described, nor the formation of abundant pulmonary **froth**.*Near drowning*- This is a clinical term, used when a patient survives a drowning incident for at least **24 hours** after the submersion event.- It describes a **survival outcome** requiring resuscitation, not the pathological findings observed at **autopsy** for an immediate fatal drowning.*Cardiac arrest*- While cardiac arrest is the inevitable **terminal event** following the asphyxia of drowning, it is not the specific *mode* or mechanism of death described by the autopsy findings.- The findings (water in lungs/stomach, froth) specifically indicate death by **asphyxia** due to **fluid aspiration** (wet drowning).

Q: A patient presents with lung injury and tympanic membrane rupture following a blast exposure. These injuries are characteristic of which level of blast wave effect?

Level I. ***Level I*** - Level I, often equated with **primary blast injury**, results directly from the unique effects of the **blast overpressure wave** on the body. - Air-filled organs are most susceptible; **tympanic membrane rupture** is the most common primary injury, and significant **blast lung** (pulmonary contusion/hemorrhage) is the most lethal. *Level II* - Level II injuries, or **secondary blast injuries**, are caused by objects or fragments energized by the explosion impacting the victim. - These manifest as **penetrating injuries**, lacerations, or embedded foreign bodies, distinct from the pressure effects seen in the lung and ear. *Level III* - Level III injuries, or **tertiary blast injuries**, occur when the victim is displaced (thrown) by the blast wind and subsequently impacts a surface. - This mechanism typically causes blunt trauma, resulting in **closed and open fractures**, crush injuries, and significant blunt head trauma. *Level IV* - Level IV injuries, or **quaternary blast injuries**, encompass all other blast-related injuries not covered by the first three categories. - These include **burns** from flash fire, toxic inhalation exposure, exacerbation of chronic illnesses, and crush injuries from structural collapse.

Question 1

A body brought for autopsy is cold and has developed rigor mortis in all 4 limbs and livor mortis at the back (fixed), but no signs of putrefaction. What will be the estimated time since death?

Accepted Answer

12-24 hrs

Answer

24-48 hrs

Answer

6-12 hrs

Answer

36-48 hrs

Question 2

A 2-week-old infant is brought to the hospital. Parents report a history of a single fall, but X-ray reveals multiple fractures at different stages of healing. What is the most likely diagnosis?

Accepted Answer

Battered baby syndrome

Answer

Accidental fall

Answer

Birth trauma

Answer

Osteogenesis imperfecta

Question 3

A doctor receives two summons, one to appear in court in a murder case and another to provide expert medical opinion. Which of the following should the doctor prioritise?

Accepted Answer

Appearance in the murder case

Answer

The summon received first

Answer

Appearance for providing medical expert opinion

Answer

None of the above

Question 4

A deceased woman was sent for an autopsy. She was found dead in a locked room with a heat stove still running. What is the most likely cause of death?

Accepted Answer

CO poisoning

Answer

Cyanide poisoning

Answer

H₂S poisoning

Answer

Aluminium phosphide poisoning

Question 5

A man was abducted from his home, and his son subsequently claimed rights to his father’s property. As per Section 111 of the Bharatiya Sakshya Adhiniyam (BSA), until when is the son not entitled to claim inheritance?

Accepted Answer

7 years

Answer

10 years

Answer

5 years

Answer

6 years

Question 6

A person was found dead in a swimming pool. On autopsy, his stomach and lungs were filled with water, and there was evidence of mucoid froth at the nose and mouth. What is the most likely mode of death?

Accepted Answer

Wet drowning

Answer

Dry drowning

Answer

Cardiac arrest

Answer

Near drowning

Question 7

A patient presents with lung injury and tympanic membrane rupture following a blast exposure. These injuries are characteristic of which level of blast wave effect?

Accepted Answer

Level I

Answer

Level II

Answer

Level III

Answer

Level IV

FMGE 2025 — Forensic Medicine