NEET-PG 2024 Practice Questions

Q: What is the sequence of rigor mortis in the human body?

Head to foot. ***Head to foot*** - Rigor mortis follows **Nysten's Law**, progressing in a **descending pattern** from head to feet. - Begins in smaller muscles with higher metabolic activity: **masseter (jaw), eyelids, and facial muscles** (2-4 hours post-mortem). - Then progresses to **neck → upper extremities → trunk → lower extremities** (completing over 12 hours). - This sequence relates to muscle size, ATP depletion rates, and surface area-to-volume ratios. *Centre to periphery* - This pattern does **not accurately describe** rigor mortis progression. - While smaller muscles are affected first, the progression follows a **craniocaudal (head-to-foot) direction**, not a radial center-to-periphery pattern. - The anatomical distribution is vertically sequential, not centrifugal. *Foot to head* - This is the **opposite of the established progression** described by Nysten's Law. - Lower extremity muscles develop rigor mortis **last**, not first. - This would contradict classic forensic pathology observations. *Simultaneously* - Rigor mortis is a **time-dependent sequential process**, not simultaneous. - Different muscle groups deplete ATP and accumulate calcium at **varying rates over several hours**. - The progressive nature (2-4 hours onset, 12 hours peak, 36-48 hours resolution) demonstrates it cannot be simultaneous.

Q: From a medico-legal perspective, in cases of sexual assault involving a female victim, what type of court proceeding is typically used to record medical evidence and testimony to protect the victim's privacy?

In camera proceedings. ***In camera proceedings*** - **In camera proceedings** (Latin for "in chambers") refer to court hearings conducted in **private**, with the public and media excluded, to protect the victim's privacy and dignity. - Under **Section 327(2) of CrPC**, cases of sexual offences against women must be conducted in camera to prevent further trauma and ensure the victim can provide testimony comfortably. - This legal provision ensures **confidentiality** of victim identity and prevents public disclosure of sensitive medical evidence and testimony. - The proceedings are still officially recorded and form part of the legal record, but occur in a closed, private setting. *Open court proceedings* - **Open court proceedings** allow public and media access, which would severely compromise the victim's privacy and cause additional psychological trauma. - Such public exposure is specifically prohibited in sexual assault cases under Indian law to protect the **victim's identity** and well-being. *Closed court proceedings* - While this term might seem similar, **"closed court"** is not the standard legal terminology used in Indian jurisprudence for sexual assault cases. - The specific term **"in camera"** is used in Section 327 CrPC and judicial pronouncements, making it the precise medico-legal answer. *Hearing at a different location* - Changing the location does not inherently provide the **legal framework** for privacy protection that in camera proceedings mandate. - This option lacks the formal legal status and procedural safeguards that Section 327 CrPC provides through in camera hearings.

Q: Police brought a person from a railway track with features of dry dilated pupils, dry skin, slurred speech, and altered sensorium. What is the most likely cause of poisoning?

Datura. ***Datura*** - **Datura poisoning** presents with anticholinergic symptoms including **dry dilated pupils**, **dry skin**, **tachycardia**, altered mental status (**altered sensorium**), and **slurred speech**. - The classic mnemonic "hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter" describes the systemic effects of **anticholinergic toxidrome**. *Morphine* - **Opioid poisoning**, such as with morphine, typically causes **pinpoint pupils**, **respiratory depression**, and **CNS depression**. - Skin is usually **cool and clammy**, not dry. *Cannabis* - **Cannabis intoxication** typically causes **conjunctival injection** (red eyes), **tachycardia**, increased appetite, and euphoria or anxiety. - While it can alter perception, it generally does not lead to significantly **dilated pupils**, dry skin, or profound slurred speech in the manner seen with anticholinergics. *Alcohol* - **Alcohol intoxication** leads to **CNS depression**, slurred speech, ataxia, and sometimes nausea/vomiting. - **Pupils** are typically normal or slightly constricted, and the skin is often flushed and warm, not significantly dry or pale.

Q: A child was born 8 months after the father's death. The grandparents filed a case claiming that the baby is not their son's, but DNA testing confirmed paternity. What is the child called?

Posthumous child. ***Posthumous child*** - A **posthumous child** is one born after the death of its father. - In most legal systems, such a child is considered an heir and has rights equivalent to those born before the father's death, especially after paternity is confirmed. *Suppositious child* - A **suppositious child** is one who is falsely substituted for another, typically with the intent to defraud or claim an inheritance under false pretenses. - This term does not apply here as paternity was confirmed by DNA testing, indicating the child is genuinely linked to the deceased father. *Fabricated child* - The term **fabricated child** implies the child does not exist or was created through fraudulent means, often in the context of false claims or elaborate schemes. - In this scenario, the child is real and paternity has been verified, making "fabricated" an inaccurate description. *Illegitimate child* - An **illegitimate child** is historically defined as one born outside of marriage between its biological parents. - While the father died before the child's birth, the question does not provide information about the parents' marital status, and the term primarily refers to marital legality rather than the circumstances of the father's death.

Q: In a medicolegal examination, an 18-year-old male claims he is 16 years old. Which joint X-ray should be done to estimate his age?

Knee and wrist. ***Knee and wrist*** - **Bone age determination** using hand/wrist and knee radiographs is a standard method for estimating skeletal maturity across a wide age range, including late adolescence. - The **epiphyseal fusion** in these joints provides reliable indicators for age estimation up to and slightly beyond 18 years, particularly the **distal radius, ulna, and knee epiphyses**. *Head & shoulder* - While glenohumeral fusion occurs later, **skull sutures** are not reliable for precise age estimation in this age group, and shoulder fusion may not be as precise as wrist/knee for this specific age. - The **skull and shoulder** are generally not the primary sites chosen for age estimation in late adolescence due to less distinct and less consistent markers compared to other joints. *Elbow and ankle* - Although the elbow and ankle joints undergo fusion, the **wrist and knee provide a more comprehensive and widely validated set of ossification centers** for age estimation in the 16-18 year old range. - While useful, these sites may not offer the same level of detailed assessment for skeletal maturity as the combination of **wrist and knee**. *Elbow & hip* - **Hip fusion** (e.g., ilium, ischium, pubis) happens relatively early, making it less useful for distinguishing between 16 and 18 years old. - The **elbow alone** may not provide sufficient distinct markers for accurate age estimation in this specific late adolescent age group, unlike the wrist, which has multiple carpal and epiphyseal centers.

Q: A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?

MTP can be carried out up to 24 weeks. ***MTP can be carried out up to 24 weeks*** - The **Medical Termination of Pregnancy (Amendment) Act, 2021**, allows termination of pregnancy up to **24 weeks** for certain vulnerable groups, including survivors of sexual assault and minors. - As a 14-year-old victim of sexual assault, she falls under the category which permits MTP up to 24 weeks. *One doctor is involved* - For pregnancies between 12 and 20 weeks, the opinion of **two registered medical practitioners** is required for MTP. - Beyond 20 weeks up to 24 weeks, as in this case, the opinion of **two registered medical practitioners** is also mandatory. *MTP done in 2nd trimester only when mother's life is in danger* - While danger to the mother's life is a valid reason for MTP, the **MTP Act 2021** has expanded the grounds for MTP in the second trimester (beyond 12 weeks) to include other categories like **sexual assault survivors** and **minors**, even if the mother's life is not immediately in danger. - The primary consideration here is the **vulnerability** of the pregnant person, not solely imminent danger to life. *MTP cannot be more than 20 weeks* - This statement is incorrect as per the **Medical Termination of Pregnancy (Amendment) Act, 2021**. - The Act raised the upper gestation limit from 20 to **24 weeks** for specific categories of women, including victims of sexual assault and minors, aligning with the current case.

Q: A 27 -week pregnant woman with a fetus diagnosed with congenital anomalies is considering a Medical Termination of Pregnancy (MTP). Whose presence is not required for the authorization of MTP in this case?

B. Lawyer. **B. Lawyer** - The **Medical Termination of Pregnancy Act (MTP Act)** in India specifies the medical professionals required for MTP authorization. A lawyer's presence is not mandated for this medical decision. - Legal authorization involves medical personnel and, in certain cases, a **Medical Board**, but not legal professionals directly in the authorization process. *A. Obstetrician* - An **obstetrician** or gynecologist is a medical expert specializing in pregnancy and childbirth, making their presence crucial for assessing the patient's and fetal condition. - The **MTP Act** requires the opinion of at least two registered medical practitioners, especially for pregnancies beyond 20 weeks, making an obstetrician essential. *C. Pediatrician* - In cases of **fetal anomalies**, a **pediatrician** (or a neonatologist) is highly likely to be part of the Medical Board formed to evaluate the anomaly and assess the prognosis for the child. - Their expertise helps in understanding the **severity and potential outcomes** of the congenital anomaly, informing the MTP decision. *D. Sonologist* - A **sonologist** (radiologist performing ultrasound) is critical for accurately diagnosing and detailing the **congenital anomalies** through imaging. - Their report provides essential **diagnostic information** that forms the basis for the MTP decision, especially in cases where anomalies are the primary concern.

Q: A pregnant female at 37 weeks of gestation with a history of prosthetic heart valves is currently taking warfarin. She comes for a routine antenatal check-up. What is the appropriate management advice?

Switch to low molecular weight heparin. ***Switch to low molecular weight heparin*** - **Warfarin** is **teratogenic** and carries a significant risk of **fetal bleeding** and **malformations**, especially close to term. Switching to **low molecular weight heparin (LMWH)** is crucial at 37 weeks. - **LMWH** does not cross the placenta, making it a safer alternative for anticoagulation in late pregnancy for women with prosthetic heart valves. *Immediate induction of labor* - While delivery is approaching, immediate induction of labor without addressing the **warfarin** use directly puts the fetus at high risk of **bleeding complications** during delivery. - This option does not specify concurrent management of the anticoagulation, which is the primary concern. *Perform LSCS (Lower Segment Cesarean Section)* - Similar to induction of labor, performing a C-section while the mother is on **warfarin** significantly increases the risk of **maternal and fetal hemorrhage**. - A C-section is an invasive procedure, and the immediate priority is to switch the anticoagulant rather than select the mode of delivery without addressing the current medication. *Continue the same medication* - Continuing **warfarin** at 37 weeks is highly dangerous due to the increased risk of **fetal intracranial hemorrhage** during labor and delivery. - This approach disregards the well-established **teratogenic effects** and **bleeding risks** associated with warfarin in late pregnancy.

Q: A 25 -year-old male presented to the emergency department with head trauma due to a road traffic accident. In the hospital, the patient developed seizures, and an emergency CT scan revealed widespread cerebral edema. Which of the following is the diuretic of choice for cerebral edema in this patient?

A. Mannitol. ***Mannitol*** - **Mannitol** is an osmotic diuretic that creates an osmotic gradient, drawing water from the brain parenchyma into the intravascular space, thereby reducing **cerebral edema**. - Its rapid onset of action and ability to cross an intact blood-brain barrier sparingly makes it the drug of choice for acute management of elevated intracranial pressure due to **cerebral edema**. *Spironolactone* - **Spironolactone** is a potassium-sparing diuretic that primarily acts on the distal tubules to inhibit aldosterone, leading to sodium and water excretion. - It is unsuitable for acute cerebral edema as its diuretic effect is too slow and it does not create the necessary osmotic gradient. *Furosemide* - **Furosemide** is a loop diuretic that inhibits sodium-potassium-chloride co-transporter in the loop of Henle, leading to significant diuresis. - While it can remove fluid, it does not create the same osmotic gradient as mannitol and is less effective at rapidly reducing **intracranial pressure** directly related to cerebral edema. *Hydrochlorothiazide* - **Hydrochlorothiazide** is a thiazide diuretic that primarily acts on the distal convoluted tubule to inhibit sodium reabsorption. - Its diuretic action is too slow and relatively mild for the acute management of severe conditions like **cerebral edema**. *Acetazolamide* - **Acetazolamide** is a carbonic anhydrase inhibitor that reduces CSF production and has a role in chronic management of idiopathic intracranial hypertension. - However, it is not suitable for acute cerebral edema following trauma as its onset is too slow and its diuretic effect is relatively weak compared to osmotic diuretics.

Question 1

What is the sequence of rigor mortis in the human body?

Accepted Answer

Head to foot

Answer

Centre to periphery

Answer

Foot to head

Answer

Simultaneously

Question 2

From a medico-legal perspective, in cases of sexual assault involving a female victim, what type of court proceeding is typically used to record medical evidence and testimony to protect the victim's privacy?

Accepted Answer

In camera proceedings

Answer

Open court proceedings

Answer

Closed court proceedings

Answer

Hearing at a different location

Question 3

Police brought a person from a railway track with features of dry dilated pupils, dry skin, slurred speech, and altered sensorium. What is the most likely cause of poisoning?

Accepted Answer

Datura

Answer

Morphine

Answer

Cannabis

Answer

Alcohol

Question 4

A child was born 8 months after the father's death. The grandparents filed a case claiming that the baby is not their son's, but DNA testing confirmed paternity. What is the child called?

Accepted Answer

Posthumous child

Answer

Suppositious child

Answer

Fabricated child

Answer

Illegitimate child

Question 5

In a medicolegal examination, an 18-year-old male claims he is 16 years old. Which joint X-ray should be done to estimate his age?

Accepted Answer

Knee and wrist

Answer

Head & shoulder

Answer

Elbow and ankle

Answer

Elbow & hip

Question 6

A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?

Accepted Answer

MTP can be carried out up to 24 weeks

Answer

One doctor is involved

Answer

MTP done in 2nd trimester only when mother's life is in danger

Answer

MTP cannot be more than 20 weeks

Question 7

A 27 -week pregnant woman with a fetus diagnosed with congenital anomalies is considering a Medical Termination of Pregnancy (MTP). Whose presence is not required for the authorization of MTP in this case?

Accepted Answer

B. Lawyer

Answer

A. Obstetrician

Answer

C. Pediatrician

Answer

D. Sonologist

Question 8

A pregnant female at 37 weeks of gestation with a history of prosthetic heart valves is currently taking warfarin. She comes for a routine antenatal check-up. What is the appropriate management advice?

Accepted Answer

Switch to low molecular weight heparin

Answer

Immediate induction of labor

Answer

Perform LSCS (Lower Segment Cesarean Section)

Answer

Continue the same medication

Question 9

A 30-year-old drug addict presents to the emergency department with signs of unknown drug poisoning. The patient exhibits dilated pupils, diaphoresis, tachycardia, and tremors. On examination, the blood pressure is 180/110 mmHg, and the heart rate is 120 beats per minute. What is the most likely diagnosis?

Accepted Answer

Cocaine intoxication

Answer

Dhatura poisoning

Answer

Cannabis poisoning

Answer

Alcohol intoxication

Answer

Amphetamine intoxication

Question 10

A 25 -year-old male presented to the emergency department with head trauma due to a road traffic accident. In the hospital, the patient developed seizures, and an emergency CT scan revealed widespread cerebral edema. Which of the following is the diuretic of choice for cerebral edema in this patient?

Accepted Answer

A. Mannitol

Answer

B. Spironolactone

Answer

C. Furosemide

Answer

D. Hydrochlorothiazide

Answer

E. Acetazolamide

NEET-PG 2024

Forensic Medicine

OB/GYN

Obstetrics and Gynecology

Pharmacology