student study guide forensic medicine cims multan

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Student Study Guide

Forensic Medicine

CIMS Multan

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Sr# Table of Content Page#

1. Introduction of Department and Subject 03

2. Details of Faculty 07

3. Curricular Map 09

4. Learning Outcomes 11

5. Detailed Content 16

6. Teaching and Learning Strategies 20

7. Assessment Methods 33

8. Table of Specification 35

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Introduction of

Department and

Subject

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DEPARTMENT

Laboratory

Tutorial Room

Lecture Hall

Departmental Library

Audio Visual System

Maintenance and Cleanliness

Fire and Safety

Offices area, computer and internet facility

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SUBJECT

FORENSIC MEDICINE:

It is the branch of medicine, dealing with the application

of medical knowledge to establish facts in civil or

criminal legal cases, such as an investigation into the

cause and time of a suspicious death.

Forensic Medicine arises from a long tradition of links

between the law and medicine and now embraces a

wide variety of needs and skills intertwining medicine,

pathology, science, the law, and ethics.

Forensic Medicine include legal aspects of medical

practice including medical ethics and medical aspect of

law, having in its folds other aspects such as personal

identity, accidental and criminal trauma including death,

criminal sexual behavior and its consequential problems

such as pregnancy and abortion and forensic aspects of

toxicology.

https://www.sciencedirect.com/topics/medicine-and-dentistry/forensic-medicine

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Details of Faculty

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Head of the Department:

Associate Professor

Dr. Asif Jamil Ansari

Demonstrators:

o Dr. Younis Ansari

o Dr. Filza Ali

o Dr. Khadija Irfan

o Dr. Kainat Adnan

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Curricular Map

FORENSIC MEDICINE

Introduction

Legal Aspects of Medical Practice

Law, Courts, Evidence in courts

Autopsy and Exhumation

Thantology

Personal Identity

Asphyxia and Drowning

Traumatology

Sexual offences

Serological Examination

Forensic Psychiatry

TOXICOLOGY

General Toxicology

Special Toxicology

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Learning Outcomes

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Learning Outcomes:

Introduction to Forensic Medical Sciences

Describe the role of Forensic Medicine / Sciences in Crime detection,

especially in crimes involving human life & body in national as well as

international context.

Thanatology

Identify the causes, manner, mode, mechanisms, medicolegal aspects

and indicators of death.

Correlate between the physicochemical changes occurring in various body

tissues after death under different environmental conditions to the medico-

legal aspects of sudden and unexpected deaths.

Traumatology – I

Correlate the mechanisms of wound production to their medico-legal

aspects.

Identify different ammunitions

Appraise the nomenclature, wound Ballistics and medico-legal

aspects of mechanical injuries

List and debate on the laws in relation to causing Bodily harm,

Wounding and Homicide

Distinguish between ante-mortem and post-mortem wounds

Diagnose the manner of death( suicidal, homicidal and accidental)

Classify wounds

Relate the mechanisms of wound production to their medico-legal

aspects.

Classify firearm injuries.

Identify different ammunitions

Appraise the nomenclature, wound Ballistics and medico-legal

aspects of mechanical injuries

List and debate on the laws in relation to causing Bodily harm,

Wounding and Homicide.

Distinguish between ante-mortem and post-mortem wounds.

Diagnose the manner of death( suicidal, homicidal and accidental)

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Traumatology – II

Differentiate among the various possible etiologies of Regional Injuries,

of Head (Scalp, Skull, Brain) and Face, Vertebral column and its

contents, Neck, Chest, Abdomen, Limbs, Bones and Joints and Special

trauma (Transportation injuries, Police torture, and Deaths in Custody)

Compare and contrast Heat, Cold, Electrical injuries with emphasis on their medico legal aspects.

Recognize signs of violent death, mechanical, chemical and

environmental asphyxia death and their medico legal implications.

Interpret injuries caused by blast

Personal Identity

Distinguish between living and dead, decomposed and mutilated from

burnt bodies, skeletal and fragmentary remains by using appropriate

parameters of personal identity.

Use different techniques (Dentistry: Radiology, Neutron Activation

Analysis etc.) and objective methods of (Osteometry, Dactyloscopy,

DNA Technique, Super imposition photography etc.).

Determine the age, sex and race of an individual by various methods

with their medico-legal aspects.

Critique on methods to trace the evidence, Lockard’s Principle of

exchange and its medico-legal significance.

Biological Specimens/ Serology

Appraise the forensic importance of Biological specimens (Blood,

Semen, Salvia, Vomitus, Breath, Urine, and Hair).

Collects, preserve, dispatch various human body specimens

Violent Deaths Due to Asphyxia

Define, Classify and detect the anatomical, physiological, biochemical

and pathological signs of violent death, mechanical, chemical and

environmental asphyxia death and their medicolegal implications.

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Sexual Offences /Reproduction

Assess the sexual offences and relate it to relevant Sections of Law

(Zina and Hudood Ordinance)

Differentiate between natural and unnatural sexual offences

Address the causes of common sexual perversions

Distinguish between Impotence, Virginity, Pregnancy and criminal acts

during delivery(their medico-legal aspects, examination procedure and

reporting)

Appraise the procedure of performing clinical l examination of victim and

assailant in case of sexual offense, collect specific specimens and write

a required certification.

Appraise the relevant sections of law, Medico-legal aspects applicable to

miscarriage; and be able to.

Crime against New-Born, Infants and Child.

Identify infanticide and criminal and non-accidental violence or abuse to

a newborn, infant or child.

General Toxicology

Relate the cases of toxicology to its related laws

Manage toxicological cases in acute and chronic exposure

Interpret acute and chronic cases of poisoning in living and dead

Differentiate between the different sources, mechanism of action, sign

and symptoms and management of poisoning

Analyze the autopsy findings of a case with poisoning with emphasis on

its medico legal aspects

Special Toxicology

Study of Poisons/drugs prevailing in our society along with medico-legal

aspects is recommended. Emphasis must be given to the following

poisons/drugs:

Alcohol

Opiates, Opioids and other narcotics

Salicylates and paracetamol

Hypnotics and Sedatives

Stimulants (Cocaine), cannabis

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Poisonous Plants (Aconite, Belladonna, Hyoscyamus, Stramonium,

Digitalis, Ergot, Mushrooms, Nux Vomica, Oleander, Tobacco)

Venomous insects (Snakes)

Inorganic elements, Antimony, Arsenic, lead, Mercury, Phosphorus

Volatile Poisons and corrosives (Carbon monoxide, Hydro carbons,

Cyanides, Sulphuric Acid,

Oxalic Acid, Carbolic Acid and Alkalis)

Pesticides, Herbicides and Insecticides and others

Forensic Psychiatry

Distinguish between true and feigned insanity.

Advise on procedure of restraint of the mentally ill.

List limitations to civil and criminal responsibilities of mentally ill.

Medical Ethics, consent & negligence

Apply ethical principles of medicine as physicians/ in their clinical

clerkships according to national as well as international code of ethics

Law in relation to medical man

Identify the principles of inter professional and patient interaction in

clinical practice

Correlate the medical ethics while examining patient to medical

negligence and professional misconduct

Justify the guarding of professional secrets and privileged

communication.

Debate on legal and ethical aspect of organ transplantation

Employ the moral and ethical implications of medical procedures

(Artificial insemination, Therapeutic abortions, Euthanasia,

Biomedical research) in clinical practice

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Detailed Content

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1. Introduction to Forensic Medicine:

Role of Forensic Medicine / Sciences in Crime detection,

especially in crimes involving human life & body

2. Thanatology

Scientific concepts regarding death, medico-legal aspect of

Brain death, Indicators of Death, medico-legal aspects of

Sudden and unexpected deaths, causes, manner, mode and

mechanisms of death. Physicochemical changes subsequent to

death occurring in various body tissues and organs under

various environmental conditions.

To write a Certification of death according to WHO guidelines

Autopsy: Types, objectives, rules, and techniques and describe

procedure for post-mortem; Methods for Assessment of Fatal

period and post-mortem interval. Post-mortem artifacts. Risks

and Hazards of autopsy, and Autopsy Protocol. Procedure for

selection and reservation, labeling and dispatch of Biological

and non-Biological materials for laboratory examination; and

collect relevant samples.

Exhumation procedures, and its value and limitations

3. Traumatology – I

Mechanical Injuries:

Mechanisms of wound production, classification of wounds,

wounds produced by conventional weapons and their medico-

legal aspects.

Firearms, Ammunition, Classification, Nomenclature, wound

Ballistics and medico-legal aspects.

Medico-Legal Considerations:

Suicide, homicide and accident

4. Traumatology – II

Regional Injuries, of Head (Scalp, Skull, Brain) and Face,

Vertebral column and its contents, Neck, Chest, Abdomen,

Limbs, Bones and Joints and Special trauma such as:

Transportation injuries, Police torture, and Deaths in Custody.

And should be able to determine the medico legal aspects of

Heat, Cold, Electrical injuries.

Blast injuries: Recognition and interpretation of injuries caused

by blast

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5. Personal Identity

Parameters of personal identity, methods of identifying living,

dead, decomposed, mutilated and burnt bodies, and skeletal

and fragmentary remains,

Special techniques (Dentistry: Radiology, Neutron Activation

Analysis etc.), and objective methods of identification

(Osteomtery, Dactyloscopy, DNA Technique, Super imposition

photography etc.).

Methods of determination of age, sex and race by various

methods with their medico-legal aspects.

Methods to trace evidence, Locard’s Principle of exchange and

its medico-legal significance.

6. Biological Specimens/ Serology

Forensic importance of Biological specimens (Blood, Semen,

Salvia, Vomitus, Breath, Urine, Hair).

Method of their collection, preservation, dispatch and the

common laboratory tests

7. Violent Deaths Due to Asphyxia

Define, Classify, causes of; and detect the Anatomical,

Physiological, Biochemical and Pathological signs of violent

death; and of Mechanical, chemical and environmental

asphyxia death and their medico legal implications

8. Sexual Offences /Reproduction

Sexual Offences and Relevant Sections of Law (Zina and

Hudood Ordinance)

Natural and unnatural sexual offences

Medical examination of victim and assailant, collection of

specific specimens.

Common sexual perversions and their cause.

Approach to Impotence, determination of Virginity, Pregnancy

and criminal processes during delivery, their medico-legal

aspects, examination procedure and reporting.

Miscarriage:

Crime against New-Born, Infants and Child.

Infanticide and criminal and non-accidental violence or abuse to

a newborn, infant or child

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9. General Toxicology

Scope of forensic aspects of toxicology.

Common Toxicants in our environments and their abuse

Sources of poisons

Mechanism of action of poisons

Sign and symptoms of poisoning

Management of poisoning

Autopsy findings of death due to poisoning Medico legal aspects

10. Special Toxicology:

Corrosives:

Sulphuric acid/

H₂SO₄

Nitric acid/ HNO₃

Hydrochloric acid/

HCl

Organic acid Poisons:

Oxalic acid

Carbolic acid

Vegetable acid

Poisons:

Hydrocyanic acid

Metallic Poisons:

Arsenic

Mercury

Lead

Non-metallic Poisons:

Phosphorous

Hypnotics and

Sedatives:

Barbiturates

Opioids: (Somni

ferrous poisons)

Opium/ Morphine

Animal Poisons:

Venomous insects:

Snake Bite

Spinal Poisons:

Strychnos/ Nux

Vomica

Cardiac Poisons:

Digitalis

Oleander

Aconite

Nicotine/ Tobacco

Vegetable Poisons:

Castor oil

Ergot

Marking Nut

Ratti Seeds

Capsicum Seeds

Deliriant Poisons:

Dhatura/

Belladonna

Hyocyamus Niger

Cannabis Indica

Analgesics and

Antipyretics:

Paracetamol

Aspirin

Alcohol:

Ethyl Alcohol

Methyl Alcohol

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Insecticides/

Pesticides/ Herbicides

Organophosphorous

Compounds

Asphyxiants:

Carbon monoxide

Stimulants:

Cocaine

11. Forensic Psychiatry

True and feigned insanity

Procedure of restraint of the mentally ill

Limitations to civil and criminal responsibilities of mentally ill

12. Medical Ethics, consent & negligence

Powers and jurisdiction of courts

Procedures for inquest and legal Procedures.

Important Legal terms

Application of relevant Legal sections of the penal code

Role of a medical doctor in the medico-legal system

Medical evidence in courts.

Document information to be prepared by a medical doctor for

legal procedures.

Procedure of Court attendance and recording of evidence

13. Law in relation to medical man

Law in relation to medical man

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Teaching & Learning

Strategies

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TEACHING & LEARNING STRATEGIES

Faculty discussions (meetings)

Discussion of previous topics

Muddiest point discussion in class (if any)

Feedback from students:

Verbal

Written

Assessment of students regularly (by taking class tests)

Video Lectures

Case Base Learning (CBL) Sessions

OSPE through e-learning (Socrative)

Practicals

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CBL Topics:

BLOCK – I

CBL No. 1 Introduction to Legal Medicine

Learning Outcomes:

By the end of this session the students will be able to: Define Forensic/legal Medicine and Forensic science. Briefly explain different types of law. State Different types of Courts and their power of jurisdiction. Briefly describe evidence, its types and admissibility in the

courts.

Learning Resources: Essential: Nasib R. Awan

Parikh Text Book of Forensic Medicine & Toxicology

Recommended: Principles of Forensic Medicine & Toxicology by GautamBiswas

CBL No. 2 Medico Legal Aspects of Death (Introduction)

Learning Outcomes:

By the end of class students will be able to: Define Death, sudden death and suspended animation. Differentiate between somatic and molecular death Briefly explain mode, manner, mechanism and cause of death Enumerate different signs of death. State various early changes in skin and eyes after death.




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CBL No. 3 Medico Legal Aspects of Death (Algor Mortis)

Case Scenario:

A 65 years old male was found dead in his bed in the afternoon.

According to the history given by his son, he was discharged from the

hospital on the same morning after being treated for the stage II

carcinoma of stomach. His relatives claimed that it was due to negligence

of the paramedical staff. As per records of his last vitals his axillary

temperature before death was is 97˚F. The body was sent for autopsy to

mortuary. The rectal temperature on receiving the body was 95°F…….

What is the reason behind this difference of temperature before and after death

and what is its medico-legal significance

Learning Outcomes:

Students will be able to:

Define Algor mortis and state its medico-legal importance

Briefly explain the method to measure the temperature of body after

death.

Enlist various factors affecting algor mortis.

Briefly describe Postmortem caloricity




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CBL No. 4 Medico Legal Aspects of Death (Livor Mortis & Rigor Mortis)

Case Scenario: Post Mortem Changes

The dead body of an unknown woman was found from the park in the

morning. There were marks of strangulation around her neck. She was last

seen by the people around 9 pm in the previous night with a man .The

body when examined at 7 am was still quite warm to touch ,stiffness was

present in eyelids and jaw but the limbs were quite flaccid. A series of

mottled patches of post mortem lividity on dependent parts of the body:

Learning Outcomes:

Students will be able to:

Define Livor mortis and state its medico legal importance.

Differentiate between Livor mortis and bruise.

State the mechanism of Rigor Mortis in the body after death and its

medico legal importance.

Enumerate the factors which modify the onset & duration of rigor

mortis.

Enlist the conditions simulating rigor mortis and differentiate them.




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CBL No. 5 Death due to Starvation, Cold & Heat

Case Scenario:

A police party raided a torture cell of gang of criminals. Many prisoners in

miserable plight were retrieved .Some fresh dead bodies were also found

from their basement.

Body A was of markedly emaciated elderly man. Body B was foundnear a

furnace in a closed small room with deep purple discoloration of body and

bluish red spots on some body parts.

A naked Body C was found from a locked deep freezer with its clothes aside. It was all stiff and red. Nose, cheeks, ears and hands had turned black.

Learning Outcomes:

By the end of the session students will be able to:

Define starvation and its types

Enlist its diagnostic postmortem findings and medico legal

importance

Define hypothermia ,mention types of cold injuries ,its S/S,

postmortem appearance and medico legal importance

Define and differentiate various types of heat effects on body

Its postmortem findings and medico legal importance



Recommended: Principles of Forensic Medicine & Toxicology by Gautam Biswas

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CBL No. 6 Mechanical Injuries (Abrasion & Bruise)

Case Scenario:

A lady in a badly injured condition went to police station and filed a case

against her husband. She claims that she has been badly beaten by her

husband. Police take notice of the case, husband was taken into custody.

The husband completely denies what his wife said and says that he is

absolutely innocent. Now the police take the lady (wife) to a forensic

expert for further looking into the case. When the doctor examines the

lady the doctor found;

Brush burns on her lower back

Belt marks on her back, legs and elbows

Bluish discoloration around her right eye

Bluish color bruises on arms

Learning Outcomes:


Define abrasion and bruise.

Enlist the features and different types of abrasions and different

types of bruises.

State the age of abrasions and the age of bruises according to their

color changes and their medico legal importance.

Differentiate between antemortem and postmortem abrasions.

Differentiate between antemortem and postmortem bruises.




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CBL No. 7 Mechanical Injuries (Incised & Lacerated Wound)

Case Scenario:

A college boy was brought to the hospital in semiconscious state and

having multiple bleeding wounds on his body. He told the doctor that he

was beaten by a group of his class fellows over some dispute.

On examination doctor found:

A small cut on the forehead with swelling

Some random reddish blue areas and superficially bleeding wounds

on his cheeks, elbows, knees and ankles.

Two soiled wounds with irregular margins were seen over his

shoulder blades and lower back where shirt was also torn.

One flapped irregular wound and a bluish area over upper left

quadrant of abdomen.

Multiple clean cut wounds over his arms and palms of hand.

A moderate patch of skin was completely absent from left lower leg

with tyre marks on surrounding area where he later developed

swelling.

He collapsed all of a sudden despite emergency treatment.

Learning Outcomes:


1. Define and identify incised and lacerated wound and identify their

weapons of assault/causative agents.

2. Briefly describe their characteristics and types

3. Differentiate between lacerated and incised wound.

4. Explain the medico legal importance of a lacerated and incised

wound.




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CBL No. 8 Mechanical Injuries (Stab Wounds)

Case Scenario:

In a quarrel between a son and his aged father, the son threw an ice

pick at the father which penetrated his left chest. There was hardly any

external bleeding from the entry wound. The old man complained of

distress in the chest and died before the doctor arrived. The cause of

death was cardiac temponade.

Learning Outcomes:

By the end of lesson students will be able to:

1. Define different types of stab wound.

2. Describe various characteristics of stab wound.

3. Enlist the complications of stab wounds.

4. Explain various steps involved in the examination of stab wound

and weapon.

5. State the medico legal importance of stab wounds.


Parikh Text Book of Forensic Medicine & Toxicology Page # 223


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CBL No. 9 Mechanical Injuries (Defense & Fabricated Wound)

Case Scenario:

A group of five friends brought 2 dead bodies to a police station which was found by them at the sea side. 1. One body was of 19 years old boy, his death was confirmed by

drowning but he was having following injuries: Multiple, superficial, parallel cuts on wrist of both hands. Slight patterned bruising over the neck region.

2. The other dead body was of 30 years old man with the following injuries: Cut throat Incised wounds on palmer surfaces of fingers of both hands. Stab wound on the dorsum of right hand Incised wound on the back

Identify the injuries in both dead bodies.

Learning Outcomes:

By the end of this session students will be able to:

1. Define defense wounds.

2. Enumerate common sites and types of defense wounds.

3. Define self-inflicted wounds.

4. Enlist common sites and features of self-inflicted injuries.

5. Briefly explain the medico legal significance of self-inflicted

wounds.




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CBL No. 10 Blast Injuries

Case Scenario:

A sudden explosion injured a 43-year-old male driver in his car. On

arrival to our A&E Department, the vital signs of the patient were

stable and he was alert. The patient complained of bilateral hearing

loss and pain over right ankle, left big toe and left hand. Physical

examination showed that left tympanum was perforated while the

right one was hyperemic. There were abrasions over left chest wall,

left hand and left thigh. There were also lacerations over right ankle

and left big toe. X-ray showed a foreign body in right ankle. Bed-side

abdominal ultrasonography did not reveal any free intraperitoneal

fluid.

Learning Outcomes:

By the end of this session students will be able to:

1. Define blast injury and classify different explosives.

2. Briefly explain the mechanism of blast wave and its phases.

3. Classify different types of injuries occurred due to blast.

4. State the medico legal importance of blast injuries.



Recommended: Principles of Forensic Medicine & Toxicology by Gautam

Biswas

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Practical Topics:

BLOCK – I

Sr# Topics Learning Outcomes 1. Medico Legal

Certificates Identify and write different formats of medical

certificates.

Enlist different kinds/ Types of Certificates

2. Medical Certificates & Death Certificates

Identify and write different formats of medical certificates.

Enlist different kinds/ Types of Certificates

Write Death Certificate according to WHO guidelines

3. Osteology – I State medico Legal Importance of radiology

Enumerate areas to be X-rayed for age estimation

Enlist Important Indices

Describe combined data for age estimation

4. Osteology – II Describe ossification of Bones for age determination.

Briefly explain the details of some important bones as regards their physical and sex identification.

State the age certification.

5. Trace Evidence (Blood)

Define forensic serology.

Briefly explain different types of examination of blood stains.

Identify the RBCs slides of human, sheep and camel bird.

Enumerate different types of blood groups.

State the medico legal importance of blood stains.

6. Trace Evidence (Hair)

Briefly explain the anatomy of hair.

State the medico legal importance of hair.

Differentiate between features of human and animal hair.

Identify different types of hair on microscope.

7. Trace Evidence (Semen & Saliva)

Briefly describe the characteristics of semen and saliva.

Explain the different types of examination of

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semen.

State the medico legal importance of seminal and salivary stains.

Describe different ways of specimen collection for hair, semen and blood.

8. Examination of an injured Person

Examine an injured person; certify nature, manner of cause, causative agent and dating of wounds. Link Sequelae of trauma to its original cause and search for the relationship of sequelae to pre-existing disease.

9. Autopsy (Prerequisite, Performa, Incisions)

Briefly explain the procedure to perform Autopsy& Medico legal Examinations

10. Viscera’s Collection, Preservation & Dispatch

Perform the procedure of preservation, dispatch of Biological and other evidentiary material.

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Assessment

Methods

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FORMATIVE ASSESSMENT

Class Test

Multiple Choice Questions

Short Essay Questions

Feedback

Verbal

SUMMATIVE ASSESSMENT

Modular Exams

MCQs + SEQs

Viva

OSPE

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Table of Specification

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TOS for FORENSIC MEDICINE

Time Allowed =03 hrs. (Including MCQs)

Marks of theory paper =90

Internal assessment =10

Total marks =100

Pass Marks =50

45 x MCQs (45 Marks) Time =1 hour

Q. No. 1, 2, 3, 4, 5, 6, 7, 8, 9

3x SAQs/SEQs (Recall) = 05 marks each

6x SAQs/SEQs (Application) =05marks each

Total Marks (45 Marks) Time = 2 hours

TOPIC

NUMBER OF MCQs (45)

Recall: 11 Application: 34

1 mark each

NUMBER OF SAQs/SEQs (09)

05 marks each

Thanatology/Autopsy 05 01

Personal identification Legal aspect of

Reproduction and sexual offences

05 01

Traumatology 13 03

Medical Ethics & Laws related to medical man

Forensic Psychiatry 06

01

General Toxicology 05 01

Special Toxicology 11 02

Total 45 (45 Marks) 09 (45 Marks)

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TABLE OF SPECIFICATION

PRE-ANNUAL/ANNUAL 3RD PROFESSIONAL EXAMINATION: PRACTICAL (2021)

Practical = 90

Internal Assessment = 10

Pass Marks = 50

General Viva Voce Lab Work Internal

Evaluation Total

Internal Examiner

External Examiner

Practical/ OSPE

Practical Notebook and

Forensic Daybook

Marks = 5 + 5

10 100

25 25 30

Theory: Internal Assessment (IA) Calculation

A B C D

ROLL No.

Name All Blocks/ Pre-annual

Exams or any other exam

Total marks of internal

assessment out of 10

Total Marks Sum of marks obtained x10/

sum of total marks in all internal exams

Practical: Internal Assessment (IA) Calculation

A B C D

ROLL No.

Name

OSPE / all practical class tests throughout the year /

pre-annual practical exams or any other exam

Total marks of internal

assessment out of 10

Total Marks Sum of marks obtained x10/

sum of total marks in all internal exams

student study guide forensic medicine cims multan

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