UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDFISTRAR BEESMART ART-I
FORENSIC MEDICINE
Date: 04.01.2021 Time: 9.00 am to 12.00 pm (3 hours)
ANSWER ALL THE FIVE QUESTIONS
Answer each part in a separate answer book.
PART A
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A 7-year-old male child living in a foster home was admitted to the casualty ward with a history of fall and limping of the right lower limb. X-ray examination revealed a fracture in the lower limb and based on the fracture pattern treating doctor suspected possible maltreatment of the child.
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Briefly describe the type of long bone injuries that are resulted from child - maltreatment. (20 marks)
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List the possible pathological conditions that can be considered as a differential diagnosis in suspected bone fractures in children. (10 marks)
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List five important points in history that can give suspicion about a physical child - maltreatment. (10 marks)
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Briefly discuss three injury patterns in the skin that can be caused by physical child- maltreatment. (15 marks)
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During the history-taking child revealed a history of possible chronic sexual (anal) abuse. Briefly discuss the examination findings in chronic anal penetration (20 marks)
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As a part of the management of this child, a case conference was arranged by the judicial medical officer. List the members usually take part in a case conference of a diagnosed child abuse. (10 marks)
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Briefly discuss important points that are usually discussed in case conferences in diagnosed child abuse. (15 marks)
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A 23-year-old girl was found dead in an abandoned building. A nylon rope was found around the neck and her clothing was disturbed. She was last seen with her boyfriend at a night party on the previous day.
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PART B
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List the medico-legal issues in this case (15 marks).
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Discuss the external and internal findings of the ligature strangulation (30 marks).
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Discuss how would you confirm or exclude the sexual violence in this case (40 marks)
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List the samples that you may obtain during, the autopsy for toxicological analysis and mentions the drugs/substance that you would check in this case. (15 marks).
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The body of an identified adult male was missing from home for the past 3 days is found floating in a lake.
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Outline the possible circumstances. (20 marks)
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What autopsy findings may indicate that the body was surreptitiously disposed off in a lake? (20 marks)
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Discuss how you would establish that the death occurred in water including the possible causes and mechanisms of death. (60 marks)
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Define contrecoup injury of brain and describe the mechanism of prothretrotc (25 marks)
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Describe how you would differentiate a spontaneous from a traumatic intracerebral haemorrhage. (25 marks)
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A 40 years old male was brought to hospital in a state of altered consciousness. No proper history was available. Examination and investigations revealed a scalp contusion, skull fracture and a small extra dural haemorrhage. Glasgow Coma scale (GCS) was 12. He was observed and managed conservatively in neurosurgical unit and discharged on the third day.
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Define the term "Hurt" (10 marks)
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Discuss the terms Grievous hurt and Non grievous hurt. (20 marks)
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Discuss the medico- legal classification of injuries/category of hurt in the (20 marks)
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The death of a man who had been treated surgical/pm (aortic valve replacement and coronary artery graft) has been reported to the police for an inquest. The family of the deceased all alleges that
- The surgeon's poor skill death,
- The surgery was unnecessary,
- The mechanical heart valve used was improperly manufactured and sterilized
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Briefly describe the medical negligence (20 marks)
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State four (4) criteria needed to fulfilled to prove a case of medical negligence (20 marks)
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Briefly describe how you would establish medical negligence in the case mention above? (40 marks)
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Outline defenses for a doctor against medical negligence allegations (20 marks)
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