PHASE II MBBS – FOURTH INTERNAL ASSESSMENT – DECEMBER 2024

FORENSIC MEDICINE & TOXICOLOGY

ANSWER KEY

1. Mrs. R., a 50-year-old woman from the USA on a trip to Pondicherry reported to OPD with
history of vaginal bleeding and pain during walking. History revealed that, allegedly her
local guide who used to be her sexual partner over the last 2 months, had oro-vaginal
intercourse in the previous night at her hotel room. She had pain and noticed blood-tinged
urine after the act. He neither stopped the act on the complaint of dyspareunia nor helped
her to bring to the hospital despite her request – he fled away from the room in the early
morning, leaving her alone. Now, she has reported herself to gynecology OPD.

Answer the following questions:

a. Discuss briefly the medical role of the gynecologist attending the above case of
sexual assault. (2 marks)
b. Outline the initial steps to be taken by the doctor, including the importance of
obtaining informed consent for medicolegal examination in the above case (3
marks)
c. Discuss briefly about the procedure for forensic evidence collection, preservation
and transmission to FSL in such a case. (5 marks)

Answer:
1a: Role of the gynecologist in a case of sexual assault

Medical Care:

 Provide immediate assessment and treatment for the patient's injuries. She must be treated as a
priority case by all staff and doctors.
 Ensure dignity and respect to survivors of rape should at all times.
 Address psychological trauma by offering compassionate care and, if necessary, referring the
patient to a counselor.

1b:
i. Initial resuscitation/first aid.
ii. Establish a rapport with the survivor and informed consent.
iii. Detailed history taking.
iv. Medical examination—general physical and local.(184 BNSS/164A CrPC)
v. Age estimation (physical/dental/radiological)—if requested by the investigating agency.
vi. Documentation.
vii. Treatment of injuries.
viii. Evidence collection.
ix. Packing, sealing and handing over the collected evidence to police.
x. Testing/prophylaxis for sexually transmitted disease, HIV, Hepatitis B and pregnancy.
xi. Psychological support and counseling.

Importance of Consent:

 The consent form should be signed by the survivor if she is ≥12 years of age, and the
guardian/parent if she is < 12 years.
 In case of persons with mental disability, their informed consent should be sought and obtained
after providing the necessary information and adequate time. Assistance of a friend/
colleague/care-giver can be taken in forming the decision.
 Consent should be obtained before the examination, collection of specimens, release of
information to authorities and taking of photographs. The form should be signed by the survivor,
a witness and the examining doctor.
 Consent for Medical, medicolegal examination- evidence collection from all regions(breast
vagina anus oral) and for treatment
 Inform about informed refusal
1c:
Collection of Evidence:

 Use a standard sexual assault evidence collection kit(SAFE Kit).

 Document all injuries, including bruises, abrasions, or lacerations, with detailed notes and
photographs (if permitted).
 Collect biological samples: Vaginal swabs, cervical swabs, and oral swabs for the detection of
semen or saliva.
 Blood and urine samples for toxicology testing (if substance-facilitated assault is suspected).
 Nail scrapings or clippings for DNA analysis.
 Gather clothing worn during and after the assault (if not bathed inner garments too), if available,
in separate paper bags.
Preservation of Evidence:

 Store samples in sterile, sealed containers with clear labelling (patient details, date, and time).
 Maintain a proper chain of custody with documentation to ensure evidence integrity.
Transmission to Forensic Science Laboratory (FSL):
  Prepare a detailed medicolegal report summarizing findings and samples collected.
 Hand over evidence to law enforcement with a receipt for chain-of-custody documentation.
 Ensure timely transport of samples to the FSL under appropriate storage conditions (e.g.,
refrigeration for biological samples).

2. Short notes (5x5=25)

a) What is the Locard Principle of exchange? Write the importance of trace evidence in
criminal Investigations.
Locard principle
 “Whenever two objects come into contact, there is an exchange of materials between
them”.
 This principle emphasizes that no interaction can occur without leaving a visible or
microscopic trace.
Importance of Trace evidence:
 Trace evidence refers to small but measurable materials transferred during the
commission
of a crime. Examples include hair, fibers, paint, glass, soil, and gunshot residue.
Importance:
 Linking Suspects to Crime Scenes
 Corroborating Testimonies
 Reconstructing Events
 Identifying Weapons or Tools
 If trace evidence does not match a suspect, it may help clear them of suspicion.
 Providing Investigative Leads

b) Write the methods of procuring criminal abortion (5)

1. Methods of inducing abortion under the MTP Act

A. During the first trimester

(i) medical methods

- prostaglandins
- antiprogesterones
- prostaglandins and antiprogesterones
- methotrexate and misoprostol
(ii) surgical methods
- dilatation and curettage
a) rapid method
 b) slow method
- vacuum aspiration
B. During the second trimester
(i) medical methods
- prostaglandins, oxytocin
- intra-amniotic instillation of
a) hypertonic saline (20%)
b) hyperosmotic urea
c) prostaglandins
- extra-amniotic instillation of
a) 0.1% ethacrydine lactate
b) prostaglandins
(ii) surgical methods
- dilatation and evacuation (D&E)
- abdominal hysterotomy
- hysterectomy

Methods for inducing Criminal Abortion

♦ Abortifacient drugs
- Ecbolics
- Emmenagogues
- Genitourinary irritants
- Reflex uterine stimulants
- Plant irritants
- Inorganic irritants
♦ Mechanical violence
- General violence
- Local violence
(a) unskilled interference
(b) semi-skilled interference

c) Write short notes on battered baby syndrome (5)

 Definition: Battered baby syndrome (BBS) is a medical condition in young children
who have received serious physical abuse, often from a parent or caregiver.
 Common Injuries:
 Fractures: Rib fractures, long bone fractures, skull fractures
 Head injuries: Subdural hematoma, subarachnoid hemorrhage, retinal hemorrhages
 Soft tissue injuries: Bruises, lacerations, burns
 Behavioral Indicators:
 Failure to thrive
 Developmental delays
 Excessive crying or irritability
  Fear of adults
 Social withdrawal
 Medical Examination:
 Detailed history of the injury or illness
 Thorough physical examination
 Radiological investigations (X-rays, CT scans)
 Ophthalmological examination
 Legal Implications:
 Child abuse is a criminal offense
 Mandatory reporting laws require healthcare providers to report suspected cases of
child abuse
 Legal proceedings may involve criminal charges against the abuser and child
protection measures
 Prevention:
 Public awareness campaigns to educate parents and caregivers
 Early intervention programs to identify and support families at risk
 Community-based support services for families
 Differential Diagnosis:
 Accidental injuries
 Congenital bone disorders
 Bleeding disorders
 Metabolic bone diseases
 Challenges in Diagnosis:
 Delayed presentation of symptoms
 Inconsistent or misleading history provided by caregivers
 Difficulty in distinguishing between accidental and non-accidental injuries
 Medico-legal Importance:
 Accurate diagnosis and documentation of injuries
 Timely reporting to child protection authorities
 Providing expert testimony in legal proceedings
 Ethical Considerations:
 Balancing the child's best interests with legal obligations
 Maintaining confidentiality while ensuring child safety
 Collaborating with child protection agencies and law enforcement

d) Civil and criminal responsibility of a Mentally unsound person (5)

 Definition of Mental Unsoundness:
o A legal concept that refers to a person's inability to understand the nature and
quality of their actions or to distinguish between right and wrong.
2.  Civil Responsibility:
 o Contractual Capacity: A mentally unsound person may lack the capacity to
enter into contracts.
o Tortuous Liability: A mentally unsound person may be liable for torts if they
can understand the nature of their actions.
3.  Criminal Responsibility:
o M'Naghten Rule: A person is not criminally responsible if they did not know the
nature and quality of their act or did not know it was wrong.
o Irresistible Impulse Test: A person is not criminally responsible if they were
unable to control their actions due to mental illness.
o Durham Rule: A person is not criminally responsible if their act was a product of
mental disease or defect.
o Substantial Capacity Test: A person is not criminally responsible if they lacked
the substantial capacity to appreciate the wrongfulness of their conduct or to
conform their conduct to the requirements of law.
4. Indian Penal Code:
o Section 84 of the Indian Penal Code provides that a person is not guilty of an
offense by reason of unsoundness of mind if, at the time of the act, they were
incapable of knowing the nature of the act or that the act was wrong.
5. Burden of Proof:
o The burden of proof lies on the accused to prove that they were mentally unsound
at the time of the offense.
6. Medical Examination: - A medical examination may be conducted to assess the mental
state of the accused.
7. Expert Testimony: - Expert testimony from psychiatrists or psychologists may be
crucial in determining the mental state of the accused.

e) Briefly describe the principles behind polygraph testing and its limitations in forensic
science.

 Definition: Polygraph testing, often referred to as a "lie detector test," is a technique that
measures physiological responses to specific questions.
 Physiological Parameters Measured:
 Heart rate
 Blood pressure
 Respiration rate
 Skin conductance
 Theory Behind Polygraph Testing:
  The assumption is that deception causes physiological changes that can be detected by
the polygraph.
 The polygraph examiner analyzes these changes to determine if a person is being truthful
or deceptive.
 Types of Polygraph Techniques:
 Control Question Technique (CQT): Compares responses to relevant and control
questions.
 Guilty Knowledge Test (GKT): Measures physiological responses to information only
the perpetrator would know.
 Limitations of Polygraph Testing:
 Subjectivity: Interpretation of polygraph results can be subjective and influenced by the
examiner's experience and bias.
 False Positives and Negatives: The test may incorrectly identify innocent people as
guilty or guilty people as innocent.
 Lack of Scientific Validity: The reliability and accuracy of polygraph testing have been
questioned by many experts.
 Countermeasures: Individuals can learn techniques to manipulate the polygraph and
avoid detection of deception.

3. Brief Answer Questions (5x3=15)

a) Hallucination
 Definition: A sensory perception that has no basis in external reality.
 Types: Visual, auditory, tactile, gustatory, olfactory.
 Causes: Physiological, psychological, and substance-induced.
 Medical significance: Implications for mental health disorders, substance abuse,
and forensic psychiatry.
b) Forensic applications of Blood & Blood stains
 Bloodstain pattern analysis: Interpretation of bloodstain patterns to reconstruct
crime scenes.
 Blood typing and DNA analysis: Identification of individuals and linking them to
crime scenes.
 Blood alcohol content analysis: Determination of intoxication levels.
 Other forensic tests: Serological tests, toxicological analysis.
c) Hydrostatic test
 Purpose: To determine whether a newborn infant was born alive or stillborn.
  Procedure: Immersion of the lungs in water to assess buoyancy.
 Limitations: Not always conclusive, especially in cases of premature infants or
infants born with respiratory distress.
 Other tests: Histological examination of the lungs
d) Medicolegal aspects of Sodomy in India
 Definition: Anal intercourse, often involving force or coercion.
 Legal implications: Criminal offense under Section 377 of the Indian Penal Code.
 Medical examination: Collection of evidence, including physical examination,
swabs, and photographs.
 Psychological impact: Trauma, anxiety, depression, and other mental health
issues.
e) Enumerate grounds for medical termination of pregnancy
 The continuation of pregnancy involves a risk to the life of the pregnant
woman or causes grave injury to her physical or mental health
 Caused by the unwanted pregnancy in the following situations is presumed to
cause grave injury to the mental health of the pregnant woman:
o rape or incest
o failure of any device or method used by a married woman or her
husband for the purpose of limiting the number of children
 Substantial risk that, if the child was born, s/he would suffer from such physical
or mental abnormalities as to be seriously handicapped