FORENSIC MEDICINE

PRACTICAL SPOTTERS

Collected & Written by:

Sarokar Parajuli (19th MBBS)
Anish Bhattarai (19th MBBS)
 Contents

Page no ( Go to Bookmarks)

1. Identification
2. Injuries
3. Thanatology
4. Toxicology
5. Miscellaneous topics
6. Instruments and Weapons
7. Short and Long Answer Questions
8. Notes of Age estimation and Sex identification
 Identification

1.

Tattoo mark
Dye used : Indigo , Cobalt , Carbon , vermillion ,
cadmium, India ink etc

Complication : septic infection,abscess,gangrene,TB

,syphillis, leprosy,AIDS

MLI :
Recognised even in dead bodies and body recovered
from water when epidermis is removed

2 Fingerprints :
Arch
Loop (most common)
Whorl
composite
MLI : Identification
Selling and buying property
Official documentation

3 Sex : Male because body is greater than double the

length of manubrium.
Age : >10 months ( viable child )
 INJURIES
1. -Subconjunctival Hemorrhage
-The upper and lower eyelids show patchy ecchymoses,
the conjunctiva is suffused with confluent hemorrhages
-Seen in Strangulation
-Cause Respiratory obstruction and venous congestion
due to great constricting force
Venous obstruction due to constricting force →
impaired drainage→ increased pressure in smaller
venules - rupture of venules and capillaries →
subconjunctival hemorrhage
- Color change- Bright red→ yellow→ disappears ( color
change is due to Hemoglobin being kept oxygenated
by air )

2. Patterned Abrasion
There are 3 parallel running abrasions on the thigh
running from the level of mid-thigh to slightly above
knee joint.
- Cause: Impact/Pressure abrasions reproducing the
pattern of object causing it.
- MLI
a) Suggests the instruments with which the injury
was inflicted.
b) Direction of force - Usually has to be at right
angle to the skin.

3. Stab Injury (All double-edged weapons)

There are 3 stab wounds on lateral side of back,
slit like with clean well-defined margin present over
an area of about 12cm2
length < width due to skin stretching
dept is the greatest dimension.
-Types
-Puncture - soft tissue
-Penetrating - viscera /cavity
-Perforating - through and through puncture
Characters: Length <width of weapon; depth is
greatest
Single edged= tear drop shaped
Double edged= elliptical/slit like
MLI
1. Nature of weapon used
2. Direction of force
3. Manner of death Unnatural - Accidental
/Suicidal/Homicidal
Fishtailing - Small splits on the skin at each end of
the corner seen with stab injury by blunt end of a
weapon.
4. Graze Abrasion
- There are reddish black parallel / longitudinal
abrasions on lateral aspect of abdomen, hip and
thighs
Brush burn - Involves wider area - Violent lateral
rubbing against a surface

Friction burn - Extensive superficial reddened

excoriated area w/o serous ooze /bleeding caused
by tangential contact with a smooth surface/ if skin
is covered with clothing. ( Mostly element of
thermal change is present)

MLI :
1. Direction of force/site of impact
2. May indicate serious internal injury
3.Manner of injury may be known.

5.

6. Splinter Injury
There are multiple ragged irregular puncture marks
on the surface of the skull with soiling of its margins.
- Splinter injury from bomb blast
Types of Blast injuries
- Primary (caused by blast waves)
- Secondary (caused by shrapnel)
-Tertiary (blast wind throwing people against solid
objects)
- Quaternary( Flashburns, crushinjuries, fall from
explosion)
Marshall's triad- Bruises, abrasions, Punctate
laceration with tattooing of the body.
 7. Drowning
- There is brownish white lathery froth coming out
of the mouth and nostrils.
- The hair appears wet.
Other external signs
1. Cutis anserina - erector pilorum contraction.
2. Washerwoman's hands
3.Cadeveric spasm.
4.Light pink ( PM staining)
Internal Signs
1. Ballooning and edema of lungs.
2. Paltauf's hemorrhage
3.Edema aquosum/emphysema aquosum

8. Entry wound
There is a circular puncture wound on the surface of
the scalp on the left side behind and above the helix
of ear. There are no additional wounds. There is a
narrow rim of abrasion around the wound.

→ entry wound of bullet - probably a rifled firearm

→ a distant shot

9. Avulsion laceration
There is a significant separation of leg from the
thigh around the level of knee joint with damage to
the muscles and fracture of long bones.
- Produced due to shearing force delivered at an
acute angle to detach a portion of a traumatized
surface or viscus.

MLI
→ direction of force applied
cause of death → Road traffic accidents.

10. Entry wound on skull

The skull shows a well-defined circular hole on the
outer table. The margins are inverted.Beveling of
margin seen.
Entry wound Exit wound
Inverted Everted
Abraded margin Margin with ragged
flaps
More range= smaller More range= Larger
size size

MLI - Weapon used,Direction of impact

11. Foreign body on trachea
Trachea shows a black colored foreign body causing
obstruction of the respiratory tract.

→Cause of death - Choking

→ Cafe coronary - Accidental choking due to a bolus
of food completely obstructing the larynx; seen in
alcoholics

Management if possible- Heimlich maneuver

12. Exit wound

There is a circular puncture wound on the surface of
the skull (occipitalbone) with associated linear
fracture of skull radiating from the hole. The
overlying scalp layers are lacerated with bleeding.

MLI
Type of weapon - Rifled firearm
Distance of shot

13. Linear fracture

There is a large linear fracture on the surface of the
skull involving the parietal bone of left side.
MOA : -Forcible impact against a broad resisting
surface ( like hard ground surface i.e RTA ).
-Blow with a hard blunt object having relatively
broad striking surface.

MLI:
Direction of impact (Usually a direct blow)
Cause of death
Type of weapon used (Blunt hard object)

14. Burn
(2nd picture) There is severe burn on the chest and
abdomen with destruction skin and
fascia(incl.muscles), charring is seen.
(1st picture) There are severe burns involving whole
of the lower limbs, arms, forearm hands as well as
upper and lower trunks and back of face. Blackening
of body surface on rt. arm, forearm, lower trunk and
back of upper thigh.
Face is swollen and distorted

Other External signs

1.Puglistic attitude
2.Swollen and distorted face.
 3. Degloving/destocking

Internal
1. Extradural hematoma
2. Soot in larynx, trachea bronchi (Surest)
3. Curling's ulcer in stomach

15. Cut throat

There is a large gaping wound on left side of the
lower neck below thyroid cartilage with associated
bleeding and laceration of underlying structures.
Other smaller wounds present on right lower neck,
left face, below the mandible and at the level of
thyroid.

MLI
-Manner of death - Homicidal (most likely )
-Weapon used
-Direction of injury

16. Depressed Fracture

There is a fracture of temporal bone of right side
with driving in of the fractured segment.

MLI
Cause of death
Weapon- Heavy weapons like hammer, axe, brick /
chopper.

17. Firearms
1. Pistol
Rifled firearm
Missile - Bullet
Muzzle velocity = 300-360m/s
Accommodates 6-10 cartridges

Shotgun
Choking - When distal end of a shot gun is narrowed
to increase accuracy of shot, velocity and force
Muzzle velocity 240-300m/s
Missile- Pellets

Riffle (AK 47)

Automatic submachine gun (rifle)
Missile - Bullet
Firing speed - 600 - 800 shot/min
Muzzle velocity - 715 m/s
18. Stab wounds
There are 3 stab wounds on the upper back over an
area of 5-6 cm2. They are spindle shaped.

Type of weapon – Double-edged weapon

19. Hanging
A deep ligature mark is seen above the thyroid
cartilage which is continuous and running across the
lateral aspect of neck.

Cause of death:
Asphyxia, Venous congestion,cerebral anoxia, vagal
inhibition, fracture of cervical vertebrate

External:Petechial hemorrhages, Le facie

sympathique, Blue swollen tongue, saliva dribbling
from angle of mouth, urine and feces escaping from
sphincters.
Internal - Dry white tissue under the marks
Hemorrhage in strap muscles, platysma, SCM
congested lungs, subpleural ecchymoses, fracture of
hyoid bone

20. Burn injury

Extensive burn involving arms,chest, bilateral legs
and face with peeling of outer skin in the legs and
thighs.
Clothes are burnt with charring in lower aspect.
(Refer to spot no. 14)

21. Active Defense (4-5)

Multiple lacerations present on palmar aspect of
hand on the index,middle,ring and little fingers as
well as the palm.

Defense wounds
- Active
- Passive = ulnar surface of forearm, wrist, muscles
& back of hands.
22. Scratch Abrasion
MLI:
Site of impact / direction of force
Nature of injury
Age of injury

23. Imprint Abrasion

There are 4-5 irregular parallel running abrasions
seen on anterior aspect of upper trunk reddish in
color.

MLI:
Type of vehicle
Nature of injury
Direction of impact
Age of injury
Cause of death

24. Most. probably infanticide (??) (Homicidal throat

cut.)

25. Electrical injury

These are multiple burns with charring of skin of
hand. Peeling of skin seen along with 2-3 round-oval
shallow craters with ridge of skin about 1-3 mm
around their circumference (Joule Burn)
Factors affecting injury:
1.Type of current (AC>DC)
2.Amount of current (Deaths at >200V)
-10mA currents muscle contraction
-100ma currents fatal
3. Path of current
4. Duration of current
5. Resistance
Internal Findings
a)Zenker'sdegeneration
b) Petechial hemorrhage (line of passage of current)
c) Bone pearls / wax drippings (melting of Calcium
Phosphate)
Cause of death:
-Paralysis (Respiratory arrest) if medullary centers
-Ventricular fibrillation
-Circulatory failure
-Respiratory failure
26. Corrosive Poisoning

External Findings Burning and excoriation of both

hands, black colored patch seen at lower jaw. Lips
are swollen and excoriated
Corrosive poisons H2S04, HN03,HCL
Fatal Dose of
H2s04= 5-10 ml
HNO3 =10-15ml
HCL= 15-20ml

MLI –
-Manner of death
-Type of poison

27. Suicidal Cut Throat

Large gaping wound at the front of the neck with
laceration of underlying structures, multiple small cuts
seen in the surroundingarea .

MLI –
Manner of death
Nature of injury

Suicidal Homicidal
Level Above thyroid cartilage On or below T.C
Direction Oblique Transverse
Hesitation Present Absent
cuts
Defense Absent Present
wound

28. Bullet injury of lungs (Entry and Exit wounds)

29. Multiple small reddish circular holes on the right

shoulder and arms.
A large spindle shaped gaping wound on right lower
lateral trunk

Shot Gun Injury + Stab wound

Type:Pellet injury
Shot:Distant shot
30. Shotgun cartridge

Missile :Pellets
Contact shot: Muzzle imprint, singeing, back spatter
Close range - Injury,tattooing,blackening,
Near range - Rat hole / cookie cutter appearance (30-
90cm)
Satellite hole - 2-4m
Distant shot - No central hole
Wad injury (4-7 ft)

31. Finger with Electrical Burn

32. Entry wound in skull

33. Findings:
There is a large linear gaping wound on the surface
of the heart with injury to underlying musculature

 Stab injury to heart

Cause of death
-Vagal inhibition
-Ventricular Fibrillation
- Hemorrhagic shock
-Cardiac tamponade

MLI
Manner of death
Direction of impact
Type of weapon

34. Corrosion of stomach

The mucosa of the stomach is black in color with
charring and necrosis of surface epithelium

- Strong acid poisoning

MLI:
Manner of death
Type of poison

35. Pond Fracture

There is a smooth concave depression on the upper
surface of skull with no fracture line

- Children <4 years of age

Structures Not affected:Inner table ,meninges

-Obstetric forceps are the most common cause of pond

fracture.

36. Washer woman's foot

There is wrinkling of the skin of plantar surface of
foot with bleaching of epithelium & soddening of
skin.

MLI
Time of death - 12-48 hours
Cause of death
Manner of death
37. There is detachment of whole surface of skin of
proximal part of foot exposing the underlying
muscles & fascia.

Grinding / Avulsion laceration

Shearing force applied at acute angle to detach off a
portion of traumatized tissue

MLI
Direction of force applied
Cause of death

38.
Multiple small circular holes all over the surface of
anterior and left lateral parts of chest and abdomen

Shot Gun Injury–

--Pellet injury
--Distant shot

39. There is blackening of whole of the surface of

trachea and larynx probably due to deposition of
soot.

This is the surest sign of ante-mortem burn injury.

 Thanatology
1 Marbling of skin
- The skin of the leg shows linear branching pattern
which is brownish in color.

- First appears in shoulder

-Decomposition of hemoglobin to
sulphmethemoglobin by bacteria ( Clostridium welchii
) in the blood vessels giving greenish or greenish brown
color.

MLI
time since death 36-48 hours.

2 Decomposition

There is swelling & distension of eyes, faces & cheeks

with extensive blackening & peeling of skin as well as
purging of contents from mouth & nose
3 Adipocere
This is the sample of a foot showing dry, cracked,
yellow appearance of its surface.

- Adipocere of foot - unsaturated fatty acids of body

are converted into higher fatty acids like
hydroxystearic acid, palmitic acid and stearic acid

MLI

Time of death 3 weeks - 3 month

Surest sign of death
Preserves facial features - helps in identification.

4 Livor mortis
The skin over the buttocks & back of upper trunk
appears pale in color with reddish discoloration of
lower back shoulders, hands & back of neck

Mechanism: Gravity - collection of blood in dependent

parts due to gravity.
 TOXICOLOGY
1. - Cardiac Poison
Yellow oleander;Pila kaner; Cerebra thevetia

Active principle - Thevetin, thevotoxin, peruvoside, cerberin

Fatal Dose - 8-10 seeds;15-20g Root.
Antidote: Atropine, Adrenaline, Noradrenaline
Cause of death:Ususally peripheral circulatory failure
MLI :
Suicidal poison
Abortifacient drug
Used as love philter
To reduce swelling
For venereal disease

2. Organic Plant Irritant

Active principle - Semicarpol,Bhilawanol
Fatal dose : 5-10gm
Clinical feature
Local : Irritation , painful blister, itching , lesion resembles bruise.
Ingestion : Less irritant action,
Large dose : Blisters on throat, Severe GIT irritation,
Dyspnea, Tachycardia, Hypotension, Cyanosis
Treatment :
Gastric Lavage
Demulscent drinks
When applied externally wash with lukewarm water
containing antiseptics.
MLI :
To produce false bruise
For criminal abortion
Juice may be thrown on the body to cause injury
Used by malingers to produce ophalmia.

3. Cardiac Poison
Active Principle : Digitoxin,digoxin,digitalin and digitonin.
Fatal dose : 15 to 30 mg of digitalin, 4mg of digitoxin, digitoxin 10mg ,
leaf 2g
Signs and symptoms : GIT : Anorexia , nausea , vomiting.
Cardiac : Arrhythmias,extrasystole
Endocrine : Gynecomastia ,
VIsual : Transient amblyopia
CNS :Headache
TReatment :
1.Stomach wash with tannic acid
2.Activated charcoal in repeated doses.
3. Digoxin specific antibody fragments one vial iv. 30 min
4. Arbus precatorius ( Organic Plant Irritant )
Active Principle : Abrin(toxalbumin) , Abrine, Abraline (glycoside), A
lipolytic enzyme
Fatal dose : 90-120mg of abrin injected or 1-2 crushed seeds
Clinical features :
On Ingestion :
 symptoms may be delayed from a few hours to 2-3 days.
 Irritation of upper GIT
 Nausea, vomiting
 Bloody diarrhea
 Weakness
On injection in man
 Painful swelling and ecchymosis
 Inflammation and necrosis of muscle and regional lymph node
 Faintness, vertigo, vomiting, anroexia, fever
 Convulsions may occur before death from cardiac failure
Treatment :
 Gastric Lavage
 Activated charcoal
 Purgative
 Sodium Bicarbonate 10g orally
MLI :
 Cattle poison ( SUIS )
 For homicide
 Malingering to produce conjunctivitis
 Abortifacient
 Arrow poison

5. Tobacco (Nicotiana Tabacum )

Cardiac Poison
Active principle: Nicotine, anabasine, nornicotine & lobeline.
Fatal dose : Nicotine : 60-100mg , Tobacoo- 15-30gm
Signs and symptons
a) Acute :
 CVS : Tachycardia followed by bradycardia, hypotension
 Respiratory : Tachypnea followed by respiratory depression
 GIT : Burning acid sensation , nausea , vomiting, abdominal pain
 CNS : Headache, restlessness,confusion
b) Chronic :
 RS : Cough , wheeze, dyspnea, chronic bronchitis & lung cancer
 CVS : Anemia, palpitations, irregularity of heart
 GIT : Anorexia, vomiting and diarrhea
 CNS : Impaired memory , blindness, tremors
Treatment :
 Gastric lavage with charcoal, KMNO4
 Purgatives
 Cardiac monitoring
 Atropine
 Chronic poisoning: Clonidine
MLI :
 Accidental poisoning
 Common drug of addiction
 Malingering
6. Dhatura fastuosa (Dhaturaseeds and capsule)
Deliriant poison
Active principle- Atropine,Hyoscine, hyoscyamine
Fatal dose: 0.6-1g (100-125 seeds) or 15-30 mg Hyoscine
Symptoms: Dry mouth, Dilated pupils, Dry hot skin,
Dysphagia,Dysarthria, Drunken gait, Dilatation of cutaneous blood
vessels, Delirium, Drowsiness, Diminished bowel sounds, Distention of
urinary bladder(retention)
Antidote: Physostigmine
MLI:
- Stupefying poison for rape, robbery,kidnapping
- Abortifacient
-Chinese herbal medicine
-Adulterant in liquor

7. Poppy seeds
Papaversomniferum

Seeds are non-poisonous

Opium is made from dried juice obtained from unripe capsule.
Creamish in color

MLI:
Used as food, flavoring agent & sometimes sprinkled over food

8. Chilli seeds
Capsicumannum
Active principle - capsaicin, capsicin
Fatal dose: Not necessarily fatal
MLI
Thrown into eyes during robbery, for defense
used in food for flavoring

Chilli seeds vs Dhaturaseeeds

Chilli seeds Dhatura seeds

1 Small & thin Large and thick
2 Smooth surface Depression on the surface
3. Rounded Kidney shaped
4. Pale yellow Dark brown
5. Pungent taste Double edged
6. On cut section On cut section, embryo is
embryo is curved curved outwards
inwards like "6"
 9. Cannabis (Deliriant Poison )
Cannabissativa/indica
Active principle - Delta-9 Tetrahydrocannabinol
Fatal dose: 2g Charas, 8g Ganja, 10g Bhang, 30mg/kg
Pure THC

MLI:

- Most poisonings are accidental.

-Aphrodisiac agent
- Used to strengthen nerves before committing a crime.

From leaves: Bhang

From resin: Hashish, Charas
From leaves & flowers - Ganja/Marijuana
Hash oil - Oil extract mixed with tobacco & smoked

10. Poppy capsule (Somniferous poison)

Papaversomniferum capsule - are poisonous
Opium is made from dried juice obtained from unripe capsule.
Fatal dose - 2g opium, 50mg codeine, 200mg morphine.
Active principle
Phenanthrene - Morphine, codeine,Thebaine, Fentanyl, Pethidine,
Methadone.
Isoqinolones- Papaverine, Noscapine
MOA - binds to opioid receptors & inhibits synaptic transmission in
both CNS & PNS
Antidote - Naloxone
MLI –
-Ideal suicidal poison
-Street drug
-Infanticide poison
-Folk remedies, herbal medicine in some parts of the world.

11. Calotropis/Calotropisgigantea(Organic Plant Irritant)

Active principle:uscharin, calotorpin,calactin,calotoxin

Fatal dose is uncertain (0.12mg/kg??)

MLI –
-Indian medicine
-Introduced into uterus as an abortifacient
-Infanticide poison
-Produces artificial bruise
12. Castor seeds (Organic plant irritants)
Ricinuscommunis
Active principle - Ricin (toxalbumin)
Toxalbumin- It is a toxic protein resembling bacterial toxin in action
and causes agglutination of red cells with some hemolysis and antigen
reaction.
Ricin blocks protein synthesis through RNA polymerase inhibition.
Fatal dose - 5-10 seeds 50-100mcg

MLI
Accidental poisoning in children
Homicidal poison
Used by terrorists

13. Nuxvomica seeds (Spinal poison)

Active principle -Brucine, Loganin, Strychnine
MOA - Blocks post ganglionic uptake of glycine by brain stem and
spinal cord, mainly acts on anterior horn cells ( Esp. Renshaw cells of
Spinal cord ).
Symptoms: Bitter taste, Uneasiness, Muscle twitching, Risus
sardonicus, Opisthotonos (Hyperextension of back),
Emprosthotonus(bends forward),Pleurosthotonus (bends to the side)
Fatal Dose - 50-100mg (1 whole crushed seed )
Antidote- Phenobarbital sodium, sodium amytal
MLI -
-Homicidal poison
-Seeds are used for killing cattle
-Aphrodiasiac

14. Aconite root (Cardiac poison)

Aconitumnapellus
Active principle- Aconitine,
psuedoaconitine,indaconitine,picraconitine,mesaconitine,bikhaconitine
Fatal dose: 1 root; 2-5mg of aconitine;250mg extract;2-30ml of
tincture
Hippus: alternate contraction &dilatation of pupil (seen in early stages
of poisoning)
Death: Respiratory paralysis, cardiac arrest
MLI
Ideal homicidal poison (in the past)
Abortifacient
Cattle poison
Arrow poison
15. Quinine (Cardiac Poison)
- From cinchona bark (Cinchonapubescens)
MOA - Protoplasmic poison with sclerosing&anesthetic effects.
Causes CNS depression
Fatal dose: 2-8g
Cause of death -Respiratory failure
Treatment: Lavage with MgSO4
Ventricular Tachycardia treated with Magnesium I.V
MLI
-Medicinal overdose
-Can cause accidental poisoning
-Abortifacient

16. Copper sulphate (Metallic Irritant poisons)

(Blue vitriol, Blue stone, nilatutia)

MOA
- Oxidizes heme iron to form methemoglobin causing cyanosis

Symptoms- Metallic taste, Ptyalism, Blue/green vomitus, Renal failure,

Jaundice, rhabdomyolysis, Methemoglobinemia, Circulatory collapse,
shock

Fatal dose: 20g

Treatment: 1% Potassium Ferrocyanide lavage

D penicillamine is chelating agent of choice

MLI:
-Common suicidal poison
-Used as antidote in phosphorus poisoning

17. Ryle's /Nasogastric Tube

It is used for gastric lavage.
Used as feeding tube in individual who cannot swallow.
18. Boa's / Gastric lavage tube
Used to perform gastric lavage.

19. Mercuric Sulphide (Metallic irritants )

(Cinnabar/Vermillion)
Symptom: precipitation of intestinal mucosal proteins and mucosal
necrosis causing bloody diarrhea and shock.
Fatal dose: 1-2gm
Treatment: lavage with sodium formaldehyde sulfoxylate
BAL is chelator of choice
Features of chronic poisoning
Tremors
Mercurial etherism
Mercuria lentis
Acrodynia
Minimata disease

MLI:Accidental ingestion by children

20. Lead tetroxide (Metallic irritant )

(Vermillion)
MOA: combines with sulphydryl groups & interferes with
mitochondrial oxidative phosphorylation, ATPase, Ca dependant
messengers & enhances oxidation & cell apoptosis.
Fatal dose:
Treatment:
-Lavage with 1% Na2SO4 /MgSO4
-Irrigation of bowel with polyethylene glycol
-CaCl2/Ca-gluconate
-CaNa2EDTA is chelator of choice
(Vit C is Natural Chelating agent)
MLI
1. Accidental ingestion by children
21. Cantharides (Spanish fly) (Organic Animal irritants)
Canthrasisvesicatoria
Active principle - Cantharidin
Symptoms - Burning of mouth, vomiting of blood-stained material,
pain in abdomen, dull loin pain, priapism in males and abortion in
females
Fatal dose: 15-30 mg
MLI:
Used as counterirritant to the skin in the blistering plaster.
as hair oils to promote growth
Aphrodisiac
Abortifacient

22. Scorpion (Organic Animal Irritants)

Mesobuthustamulus
MOA: Causes release of large amount of catecholamines
Direct effect on myocardium.
Symptoms: swelling, radiating pain, paresthesia, hypoesthesia, profuse
sweating, salivation, lacrimation, muscle, fasciculation

Treatment -
Pressure immobilization
Prazosin therapy
Scorpion antivenom
Ca- gluconate
Barbiturate

23. Krait snake (Organic Animal Irritant)

- Characteristics: small head scales, large belly scales with creamy
whiteunderbelly, central row of hexagonal scales at back, largest 4th
infralabial
Type of poison- Neurotoxin
causes ptosis, dysarthria,dysphagia, quadriparesis,respiratoryparalysis
and death
Active principle:Cholinesterase, Neurotoxins
Fatal dose: 2.5-6 mg
Treatment:Polyvalent antisnake venom (max 20vials IV every 1-2 h)
Sutherland wrap:
pressure immobilization technique without impeding arterial or venous
flow (Insinuation of at least 1 finger)

24. Cobra
- Hooded with spectacle marks, 3rd labial touches eye and nasal shields
Fatal dose: 15mg
Symptoms: Heaviness of eyes, blurred vision, paresthesia, dizziness,
vertigo, hyperacusis, congested conjunctiva, goose flesh, ascending
paralysis, respiratory failure and death.
Everything else same as above
25. Camphor
Fatal dose - 2g
Symptoms - Drowsiness, generalized seizures, coma

MLI
Accidental poisoning in children is common in India.
 INSTRUMENTS AND WEAPONS
1 Councilman's blade
Usually used to cut the skull bone
Also used to cut other bones whenever
necessary.

2 Enterotome
-is an autopsy instrument
-Used to cut intestines and other hollow viscera
(eg.Esophagus,stomach etc. )

3 Metallic Catheter
- Used to drain fluid from body cavities,
pericardial sac, urinary bladder etc.

4 Scissors
-is an autopsy instrument
-used to cut tissue
5 Toothed forceps
-Used to hold the fascia and other tissue while
dissecting.

6 Blunt forceps
- Used to hold the tissue while dissecting and to
hold other objects like gauze pieces, foreign
bodies etc.

7 Brain knife
-is used to cut any large soft organs like
brain,kidney,liver etc.

8 Scalpels
-It is used for making incisions.
-For fine dissection
-To reflect fascia
9 Dissection knife
- Used for dissection tissues.

10 Chisel and hammer

-Used to loosen the skull
- Used to lift the skull flap

11 Osteometer
It is used to measure length of bone.
 WEAPONS
1 - Knife
Type of weapon : Light weapon
Handle - Plastic
Blade - Metal
Blade - 3 edges ; 1 pointed end , 1 blunt edge , 1
sharp edge
Pointed end - Penetrating wound ; perforating
wound ; stab wound
Sharp edge - Incised wound
Blunt edge - Laceration , Bruise , fracture
,Abrasion
Handle - Bruise,fracture , laceration

2 Butcher's knife :
Type of weapon : Heavy weapon
Handle - Wooden
Blade - Metal
Blade - 1 not so sharp edge; 1 blunt edge
Not so sharp edge - Laceration ; fracture ; chop
wound ; abrasion
Blunt edge - Laceration , Bruise , fracture
,Abrasion
Handle - Bruise,fracture , laceration

3 - Sickle ( Hasiya)
Type of weapon : Light weapon
Handle - Wooden
Blade - C shaped , metallic
Blade - 1 sharp edge, 1 blunte edge, 1 pointed
end
Pointed end - Penetrating wound ; perforating
wound ; stab wound
Sharp edge - Incised wound
Blunt edge - Laceration , Bruise , fracture
,Abrasion
Handle - Bruise,fracture , laceration

4 - Saw(Aara)
Type of weapon : Light weapon
Handle- wooden
Blade - Metal
Blade - serrated sharp edge , blunt edge
Serrated sharp edge : Incised wound , laceration
Blunt edge - Laceration , Bruise , fracture
,Abrasion
Handle - Bruise,fracture , laceration
5 Arrow
Type of weapon : Light weapon
Stick - Wooden
Blade - Metal
Blade - 1 pointed end , 2 sharp edge
Pointed end - Penetrating wound ; perforating
wound
Sharp edge - Incised wound
Handle - Bruise,fracture , laceration,abrasion

6 Type of weapon : Light weapon

Metallic chain
Types of injuries: Pressure abrasion, Tramline
bruise , imprint abrasion , fracture , laceration

7 - Axe
Type of weapon : Heavy weapon
Handle - Wooden
Blade - Metal
Blade - not so sharp edge; blunt edge
Not so sharp edge : chop wound , fracture ,
laceration
Blunt edge - Laceration , Bruise , fracture
,Abrasion.
Handle - Bruise, fracture, laceration.

8 -Ligature
Type of weapon: Light weapon made of jute
withbraided rope at one side and a broad surface
on other side.
Types of injuries: Pressure abrasion, Imprint
abrasion, Fracture, Laceration.

9 -Ligature
Type of weapon: Light weapon
Black cloth which is tied at one end to form a
ligature.
Types of injuries: Pressure abrasion, Imprint
abrasion, Fracture, Laceration.
 MISC

2
3

5
6

8
9

10
 SHORT AND LONG QUESTIONS
Q.1

X- ray plate no:

The given X-ray is an AP view of Pelvis.

General Observation

1. There is appearance of ossification centre of head of femur, greater trochanter and lesser trochanter.
(Appearance of ossification centre of head of femur =1 year, Greater Trochanter = 4 years, Lesser Trochanter= 14
years)

2.There is fusion of secondary ossification centre of triradiate cartilage (Fusion of triradiate cartilage = 13 - 15
years)

3. The ossification centre for iliac crest has appeared but not fused (Fusion of iliac crest = 20 year)

Opinion - After careful examination, I am of the opinion that the x-ray belongs to individual of age 14-20 years.

MLI of this age -

License- 18 years

Marriage- 20 years

Voting- 18 years

Consent- 18 years
Q.2

The given hip bone belongs to a male because:

1.Sciatic notch is deep and narrow

2. Acetabular fossa is large and directed laterally

For age:

Look for fusion at iliac crest (rough/smooth?)

If smooth >20 years

If rough, <20 years

Q.3

Female because :

1. Sciatic notch is wide and shallow

2. Acetabular fossa is smaller and directed anterolaterally

For age : Same as above

(Refer below )
Q.4

Male because:

1. The angle between body and ramus is acute.

2. Condyles are larger and muscular ridges are more prominent.

(Refer below)
Q.5

X-ray plate no.

The given X-ray is an AP view & lateral view of wrist joint

1.There is appearance of ossification centre of lower end of radius (AOOC of LE of radius - 2 years)

2. There is no appearance of OC of Lower End of ulna (AOOC of Lower end of ulna = 6 years)

3.The ossification centre for only capitate (2 month)

Hamate (3 month) & Triquetrum (3 years)

4. Ossification centre of base of 1st metacarpal has not appeared (6-7 years)

After careful examination i am of the opinion that the given x-ray belongs to an indiviudal of age 3 - 6 years.
Q.6

X-Ray Plate no.

General appearances

1. There is Appearance of ossification center of Lower end of radius (2 years)

2. There is no appearance of OC of Lower End of ulna (AOOC of Lower end of ulna = 6 years)

3.Appearance of ossification centre of capitate (2 months) & hamate (3 months) but not of triquetrum (3 years)

4. Ossification centre of base of 1st metacarpal has not appeared (6-7 years)

After careful examination I am of the opinion that the given x-ray belongs to an individual of age 2-3years.
Q.7

X- ray plate no.

The given X ray is an AP view of wrist joint.

General appearance

1. The ossification centre of Lower end of radius has appeared (2 years )

2. The ossification centre of Lower end of ulna has appeared (6 years )

3.The ossification centre of all 8 carpal bones have appeared (10-12 years)

4. The secondary ossification centre for radius and ulna have not fused (Age of fusion of wrist is 19 years)

After careful examination i am of the opinion that the given x-ray belongs to an individual of age 10-19 years
Q.8

X- ray plate no.

The given X ray is an AP view of wrist joint.

General appearance

1. The ossification centre of Lower end of radius has appeared (2 years)

2. The ossification centre of Lower end of ulna has appeared (6 years)

3. The secondary ossification center of base of first metacarpal has appeared. (6-7 years)

3.The ossification centre of all 7 carpal bones have appeared. The ossification centre for pisiform has not
appeared. (10-12 years)

4. The secondary ossification centre for radius and ulna have not fused (Age of fusion of wrist is 19 years)

After careful examination I am of the opinion that the given x-ray belongs to an individual of age 6-12 years
Q.9

X - ray plate no.

The given X-ray is an AP view of elbow joint.

General Appearance

1. There is appearance of ossification centre of medial epicondyle (5-7 years)

2. There is appearance of ossification centre of Upper end of radius (5 years)

3. There is appearance of ossification centre of Upper end of ulna (9 years)

4.There is appearance of ossification centre of Trochlea (10 years)

5.There is appearance of ossification centre of Lateral epicondyle (11 years)

6.There is no fusion of secondary ossification centres of elbow joint. (Age of fusion of elbow is 16 years)

After careful examination i am of the opinion that the given x-ray belongs to an individual of age 11-16 years
Q.10

X- ray plate no.

The given X-ray is an AP view of Hip joint.

General Appearance

1. There is appearance of ossification centre of Head of Femur.(1 year)

2. There is appearance of ossification centre of Greater Trochanter.(4 years)

3.There is appearance of ossification centre of Lesser Trochanter. (14 years)

4. There is no fusion of secondary ossification centres of triradiate cartilage.(<15 years)

After careful examination I am of the opinion that the given x-ray belongs to an individual of age 14-15 years
Q.11

The given sternum belongs to a male because :

1 It is longer and narrower

2. Body is twice the length of manubrium

For age:

Primary ossification centres for 4 pieces of the body of sternum have appeared & fused (25 years)

Xiphoid process has fused with body of sternum (40-45 years)

Manubrium has fused with body (50-60 years)

Therefore, I am of the opinion that this sternum belongs to a male of age >50 years.
Q.12

The given sternum belongs to a male because :

1 It is longer and narrower

2. Body is twice the length of manubrium

Age :

1. Primary ossification centres for 4 pieces of the body of sternum have appeared & fused ( 25 years )

2. Xiphoid process has not fused with body of sternum (<45 years)
Q.13

X - ray plate no.

The given X-ray is an AP view and a lateral view of elbow joint.

General Appearance

1. There is appearance of ossification centre of medial epicondyle (5-7years )

2. There is appearance of ossification centre of Upper end of radius (5 years)

3. There is appearance of ossification centre of Upper end of ulna (9 years)

4.There is appearance of ossification centre of Trochlea (10 years)

5.There is appearance of ossification centre of Lateral epicondyle (11 years)

6.There is no fusion of secondary ossification centres of elbow joint. (<16 years)

After careful examination I am of the opinion that the given X-ray belongs to an individual of age 11-16 years
Q.14

X - ray plate no.

The given X-ray is an AP view of knee joint.

General Appearance

1. There is appearance of ossification centre of Upper End of tibia (At birth)

2. There is appearance of ossification centre of Lower end of fibula (1 year)

3.There is appearance of ossification centre of Lower end of fibula (1 year)

4.There is appearance of ossification centre of Upper end of fibula (4 years)

5.There is no fusion of secondary ossification centres of ankle joint. (<17 years)

After careful examination i am of the opinion that the given x-ray belongs to an individual of age 4-17 years
Q.15

Female sacrum
Features:

 Broad, short
 Anterior concavity (sharp curve forward )
 Short with five segments
 Broad ala and short body

Male sacrum
Features

 Narrow
 Long
 Flat curve(uniform curvature)
 Five or more segments
 Broad body and short ala
 Q.16

Male skull

Features :

1.General appearance Rugged, heavier

2. Muscle marking More prominent
3.Supraorbital ridge More marked
4.Glabella Prominent
5.Mastoid process Larger
6.Orbits Square
7.Nasal bone Larger

Female Skull

Feature Female
1.General appearance Rounded and smoother,
lighter
2. Muscle marking Less prominent
3.Supraorbital ridge Less marked or may be
absent
4.Glabella Small or absent
5.Mastoid process Smaller
6.Orbits Rounded
7.Nasal bone Smaller
8.Teeth Smaller
Q.17

X - ray plate no.

The given X-ray is an AP view of shoulder joint.

General Appearance

1. There is appearance of ossification centres of head of humerus , greater tubercle and lesser tubercle . (AOOC of
Head of humerus = 1 year , G.T = 3 , lesser tubercle = 5 years )

2. Ther is AOOC of Acromian process . ( AOOC of Acromian process=14-15 years )

3. Secondary ossification centre has fused with shaft of humerus . (Fusion of shoulder joint = 18 years )

After careful examination i am of the opinion that the given x-ray belongs to an individual of age more than 18
years
Q.18

X - ray plate no.

The given X-ray is an AP view of ankle joint.(Lt)

Rt. Lateral view

General Appearance

1. There is appearance of ossification centres of calceneum tuberosity (6-8 years )

2. There is appearance of ossifciation centres of lower ends of tibia and fibula . (AOOC of lower end of tibia &
fibula = 1 year )

3. Secondary ossification centre of calceneum tuberosity has not fused with body of calceneum . (Fusion of
calceneum tuberosity = 14-16 years )

4.The secondary ossification centres of tibia and fibula have not fused with their primary ossification centres. (
Age of fusion of ankle joint is 17 years )

After careful examination i am of the opinion that the given x-ray belongs to an individual of age 6-16 years.
 NOTES OF AGE ESTIMATION

Age of ossification of joints

WESHKA- Order to draw the line

W- Wrist Joint

E- Elbow joint

S-Shoulder joint

H-Hip joint

K- Knee joint

A-Ankle joint

Bone Lower end Upper end

Radius 2 years 5years
Ulna 6 years 9 years
Tibia 1 year At birth ( 10 month )
Fibula 1 year 4 year

Elbow
Medial Epicondyle - 5-7 years

Lateral Epicondyle - 11 years

Trochlea - 10 years

Capitulum - 1 year

Hip (1-4-14)
Head of Femur- 1 year
Greater Trochanter 4 years

Lesser Trochanter - 14 years

Tri-radiate cartilage 13-15 years

Iliac Crest - 20 years

Ischiopubic ramus - 6 years

Wrist
She LooksToo Pretty Try To Catch Her

Scphaoid
Lunate
Triquetrum
Pissiform
Trapezium
Trapezoid
Capitate
Hamate
Sternum

Skull

Sacrum

S1 Ends at (20-21 years of age )

S2

S3

S4

S5 Fusion starts at S5
Mandible
 Teeth
FDI Method

2123

2123

Temporary

UR5 UL 6
2102
2102
LR8 LL7
 Temporary Teeth

S.N Tooth Age of eruption

1 Central incisor lower 6 mo
2 Central incisor upper 8mo
3 Lateral incisor upper 10 mo
4 Lateral incisor lower 12mo
5 First molar 14mo
6 Canine 18mo
7 Second molar 20-30 mo

Permanent Teeth
Mnem. Mother Is In Bed Baby Cries Milk Milk

S.N Mnem. Teeth Age of eruption

1 M M1(1st molar) 6 yrs
2 I Incisor(Central) 7 yrs
3 I Incisor(Lateral) 8yrs
4 B P1 Bicuspid (1st premolar) 9yrs
5 B P2 Bicuspid (2nd premolar) 10yrs
6 C Canine 11yrs
7 M M2 (2nd molar) 12yrs
8 M M3 (3rd molar) 17-25yrs
Mandible

Feature Male Female

1.Size larger smaller
2.Symphysis menti (chin) Square round
3.Angle between body Acute Obtuse
and ramus
4.Condyles Larger Smaller

5.Ascending ramus Broader Smaller

6.Coronoid process More prominent Less prominent

Pelvis

S.N Feature Male Female

1. General Smaller and Wider and
deeper shallower
2. Subpubic Narrow and Broad , inverted U
arch triangular shaped
3. Pubic bone Long and Broad and
narrow rectangular
4. Pubic Higher; Bigger Lower , Wider
symphysis
5. Sciatic Deep and Wide and shallow
notch narrow
6. Obturator Large and Small and triangular
foramen oval/round
7. Acetabulum Larger Smaller
8. Acetabular Large and Small and directed
fossa directed anterolaterally
laterally
9. Sacrum Narrow; long; broad; short;
flat curve anterior concavity
10. Pelvic inlet Triangular of Ovoid/circular
heart shaped
11. Muscle More Smooth and gracile
marking prominent or
rugged

Skull
Feature Male Female
1.General appearance Rugged, heavier Rounded and smoother,
lighter
2. Muscle marking More prominent Less prominent
3.Supraorbital ridge More marked Less marked or may be
absent
4.Glabella Prominent Small or absent
5.Mastoid process Larger Smaller
6.Orbits square Rounded
7.Nasal bone Larger Smaller
8.Teeth Larger Smaller