FORENSIC CASES

.:. A man was found dead on the beach. On examination, a ligature mark was found around the neck with goose wrinkled skin. Internally, bruising of subcutaneous tissues and muscles of the neck and dislocation of the hyoid bone were found.
a. What is the most probable cause of death in such case? prove your opinion b. Describe the character of ligature mark . .c. What is the medico-legal importance of the hyoid bone in such case?

.:. A man was found dead in the street. On examination, a rope was found around his neck and a stab wound was seen in the abdomen. Hypostasis was pale in color and fixed. Head, . neck and chest were stiff.
a. What is the possible cause of death in such case? b. \-'Thatis the manner of death? Why? c. What are the characters of the wound in such case? d. What is the postmortem interval?

.:. A man with blood group A, married a woman with blood group B. After 1 year, the women delivered a child with blood group AB, but the father denied that this child is his son. a. Can this baby be the man's son? b. What are the other investigations should be done? .:. A 19 years old female was found dead in a clinic. On examination, her body was pale &a small fetus (16 cmin length) was found beside her body, the length of the uterus was 6 inches. The obstetrician claimed that this was a case of therapeutic abortion and has been complicated to death. . a- How could you estimate the age of the victim? b- Does the fetus belong to the victim? Why? c- What are the possible causes of death in this~ase? d- What are the investigations requested by the medical examiner for this case? e- Are there any medicolegal responsibilities on the obstetrician? Why? .:. A 25 year old female notified the police that her neighbor kicked' her in the abdomen & alleged abortion of her 20 weeks fetus. She presented a mass of flesh & blood in a piece of cloth, as being the product of abortion. a- How would you examine this female? Mention the investigations needed to find out the nature of the presented tissue. b- How could you estimate the period of gestation of 20 weeks in pregnant female? c- Mention the possible dangers of criminal abortion.

139

.:. A 23 year old man entered the hospital after car accident; the doctor examined him and found the pulse 120 min, blood pressure 90/ 60, pale sweaty skin, weak reflexes on both sides of the body with no signs of lateralization. The doctor discharged the patient, after 24 hours the patient became comatose and died. a- What is the diagnosis of this case? How can you estimate the age? b- Is there any medico-legal responsibilities on the doctor? Why? c- What is the management must be done for this case? d- What is the cause of death in this patient? .:. 25 years old female was admitted to the hospital with severe skin burns involving the face, chest, abdominal wall, forearms and thighs, there were multiple cut wounds on her wrist. Her mother said that she was taking antidepressant drugs due to psychological disease. 2 days later, the girl died. a- What is the manner of death in this case (suicidal, homicidal or accidental)? b- What is the extent of bum? c What are the possible causes of death in this case? .:. A charred body of a male 21 years old was found, on examination, a fissure fracture was found in the frontal bone with extradural hemorrhage which was small and not filling the extradural space, soot was found in the trachea. a- How can you estimate the age of the victim? b- How could you know if it is ante or post mortem burn? c- What are other post-mortem manifestations of this case? d- How could you know if the skull fracture is due to bum or head trauma? .:. A 23 years old female was found dead in the kitchen near the electric dish-washer (with exposed electric wire). Examination of her body revealed an inlet injury in her right hand and an exit in her left foot. a- How can you estimate the age of this female? b- What is the possible cause of death? • c- What is the post-mortem picture found in it? .:. A 7 years old boy was found dead in a graveyard with a rope tied around his neck. Autopsy revealed Irregular areas of 3,d degree skin burns on the face, upper and lower extremities and soot around nostrils and evidence of sexual assault. a- How could you prove that the boy was sexually assaulted? b- Describe the character of ligature marks in such case. c- How could you prove that this was postmortem or antemortem burn?

140

.:. A cadaver of a girl 16 years old reported that she is having antemortem deep cut wound crossing the anterior surface of the neck from side to side. The victim has been also sexually assaulted before death. a- How could you verify the age of the victim? b- Describe the wound in her neck. c- What is the most probable cause of death in such case? d- How can you prove that she was sexually assaulted? .:. A 7 years old boy was kidnapped. A 21 years old neighbor was accused of committing the crime and was arrested. a- How could you estimate the age of both victim and the accused? b-What is the medico-legal importance of both ages. ),:-How can you detect the sex of both using X-ray? .:. A young female was found dead in the desert. On examination, the basi-occiput and basi-sphenoid suture was closed. a- How could you estimate the age of the victim? b-What other criteria can help you to estimate this age? c- How can you detect the sex of the victim? .:. 18 years old female notified the police that she was rapped by a 30years old man. a- How could you estimate the age of both victim and the accused? b- What is the medico-legal importance of the age of this female?

141

TOXICOLOGY

CASES

.:. A 27 old year male is brought to ER. He is barely responsive and cannot give any history. There were multiple empty pill bottles near his bed, including bottles of lorazepam, arnitryptiline, zoldipem, and paroxetine. There was crude note, written by , the patient, which is interpreted as a suicide note Physical Examination revealed the following: Pupils: dilated poorly reactive Dry mucous membrans, P: 112,BP: 102/45 ,RR: 6 (sonorous) ,T: 3S.3° Pulse oximeter 92% .Chest: Clear bilaterally Cardiovascular: Tachycardic without murmur's, or gallops Abdomen: Soft. Bowel sounds absent Neurologic withdraws to deep pain GCS: 7.Skin: Dry and flushed; no sweat in axilla ReG indicating sinus tachycardia,QRS 40 mlsec of widening and rightward deviation of the terminal the QRS complex.

a- Which toxidrome do these findings represent? b- Which of the previous drugs is most likely responsible c- What is the MOST APPROPRIATE d- What is the appropriate therapeutic intervention intervention for this presentation? / at this time? & why? for this patient?

.:. 2 years old child was brought to emergency department after drinking a disinfectant liquid. On examination, he was in coma, pupils are constricted .pulse was 120/min .respiratory rate was 40/min. Urine was few and its colo r changed to green on exposure to light.
a- What is your diagnosis? b- Explain the change in urine color. c- How can you treat this case? d- Mention another poison that causes pinpoint pupil & its mechanism of action .

•:. 2 years old child swallowed a household product from the bathroom, he vomited blood tinged fluid. He was transported to the hospital complaining of burning pain in his mouth with dysphagia, white eschars around the mouth, diarrhea, his pulse was 120/min., and his blood pressure was SO/50
a- What is your diagnosis? b- What are the investigations needed for this case? c- What are the proper lines of treatment in such a case?

.:. A 21 year old male was admitted to ER with flushed face, dry skin, and dilated fixed pupil. His pulse was ISO/minute, blood pressure IS0/l00, and respiratory rate 40/min.
a- What is the possible diagnosis of this case? b- What are other clinical manifestations c- How can you manage this case? that can be present?

142

!.:. 18 year old male was admitted to the hospital with vomiting, constricted pupils, shallow respiration. His blood pressure was 80/50, and then he passed into coma and respond only to painful stimuli. Chest X-ray shows pulmonary edema.
a- What is the possible diagnosis? b- What is the degree of coma? c- How can you manage this case?

'.

.:. A 50 year old male with chronic heart failure, was admitted to ER with nausea and vomiting, his pulse was SO/min, blood pressure was 80/50, and ECG shows bradycardia. Laboratory investigations show hyperkalemia.
a- What is the possible diagnosis of this case? '·'-c'_.b_ hat are other clinical manifestations W that can be present?

c-

How can you manage this case?

"'-,

.:. 18"ye{lr old female was transferred to the ER after attempting suicide by rat poison having a'v,ery bitter taste; she suffered from tonic convulsions, blurred vision, vomiting, diaphoresis; .and hyperthermia.
a- What is the possible diagnosis of this case? b- What is the differential diagnosis of this case? c- How can you treat such a case?

.:. A 68 year old female with a history of congestive heart failure, and atrial fibrillation presents with a chief complaint of feeling "weak and dizzy" after ingesting a handful of her "heart pills" 3 hours prior. Physical examination reveals the following: pulse=48B/min ( bradycardia, Irregular), Blood pressures= 90/60 Respiratory Rate= 24 T= 37.2C .Lungs: Crackles at bases bilateral ECG: Rate of 40-50/mjn with 3:1 A-V block ,normal Na level(145 meq/L) and, hyperkalemia (K=5.9) .
a- What is your provisional b- What is the differential diagnosis diagnosis of this patient?

c- How would you treat the hyperkalemia? d- What is the best antidote in such case? List its indications .

•:. A 53-year-old man presents to the emergency department after taking the first dose of a medication prescribed to him by his private physician "for opioid withdrawal." He states that he last used heroin this morning, along with some methadone. He denies the use of alcohol, cocaine or other drugs of abuse. In the ED, he is agitated and diaphoretic. His heart rate is 112/min, RR 22/minute, and he is normotensive and afebrile. His finger stick blood glucose is 100 mgldL, and the pulse oximeter reads 100% saturation on room air. His pupils are mildly dilated at 5 mm and they are reactive. His mucous membranes are moist; he has prominent, active bowel sounds and while in the ED he has an episode of diarrhea. His ECG shows sinus tachycardia at a rate of 112/minute, without axis or ischemic changes.
a- What is your provisional diagnosis and differential 143 diagnosis?

b- In your opinion what was his doctor prescribed? c- How could you properly manage such case? d- Is there any legal liability for the treating physician? Justify you answer? .:. A 16-year-old girl with a history of epilepsy ingested a large quantity of unknown medications in a suicide attempt. She was brought to the hospital in status epilepticus, Although the patient was given a benzodiazepine, she continued to seize. A 15 mg/kg loading dose of phenytoin was given, but intermittent seizures persisted. A continuous infusion of a short-acting barbiturate was initiated, and her motor activity normalized. A bedside electroencephalogram (EEG) revealed electrical evidence of seizure activity, although no overt motor activity was noted concomitantly. Hypotension developed over a period of several hours and continued despite the administration of vasopressor agents. / The patient died. / a- What is the differential diagnosis of drug-induced seizures? b- What is the mechanism by which each particular toxin produces seizures? c- What antidotes, if any, should be used in the management of a patient with status epj,repticus?
J'

.:. 2 year old boy presents to the emergency department with a chief complaint of bloodtinged vomiting. His mother was tending to her newborn infant when the patient climbed up and grabbed his mom's bottle from the counter. He was able to open the bottle and thinking that the pills looked like candy, he ate them. Examination revealed the following: Vital signs: Temperature 36.9, Pulse 120 regular rhythm, Respiration 30, BP 88/60, weight 12kg (10th percentile). He is alert, and being carried by mom. His skin is pink and warm with good perfusion and capillary refill. His oral mucosa is moist and there are no lesions. His neck is non-tender. Lungs are clear with good aeration. His abdomen is soft and slightly tender in the upper quadrants, with active bowel sound and no guarding. His distal pulses are strong and his distal extremities are warm. He is responding appropriately to mom. An abdominal series reveals radiopaque tablets in the stomach and intestine. a- What is your provisional diagnosis? and differential diagnosis b- What are the lab investigations that should be carried out c- What diagnostic/therapeutic test could be performed to assess the severity of this child's toxicity? .:. A depressed 27 year old man ingested an entire bottle of aspirin tablets (#200, 325 mg each). He vomited a few times at home. In the ER 3 hours later he appears anxious, slightly diaphoretic. BP 110/80, HR 120/min, RR 32/min, Temp 37.2°C. a- Calculate the total ingested dose. b- What initial laboratory work-up is indicated? c- How would you treat this patient?

144

,. ,.

---_

·:·30 year old worker was brought to the emergency room by his friends after ingestion of unknown fluid. They gave the history of vomiting, abdominal pain and ocular pain followed by blindness. On examination, the patient was comatose and responding to painful stimuli with deep and rapid respiration. The pH of blood was 7.21 a- What is your provisional diagnosis? Why? b- What is the metabolic disorder in such case? Justify your answer? c- Explain the cause of coma? Determine its grade? d- How could you treat this case? -"'-. ,~~:.A driver was stopped by the police after car accident. He has abnormal behaviors, he is ..... talkative with slurred speech, he has tremors in his hands, hiccough and can't walk on a straigM line. a- What -IS your provisional diagnosis? Why? b- What is ill> stage of this toxicity? c- How could yo trear this case? .:. A worker in glass factory was admitted to the hospital with colic, vomiting and rice water diarr-hea. He was diagnosed as a case of cholera but the bacteriological test was ve.2 days later, he complained of tremors, convulsions, peripheral neuropathy and coma. Serum creatinine was elevated & liver enzymes were higher than normal. a- What is the possible diagnosis for this case? b- How can you treat such case? c- What are the laboratory findings that can be found in other workers who work for20 years in this factory? .:. A man who works in batteries factory, was transferred to the hospital complaining of colic relieved by pressure and constipation. On examination, there was a blue line at the gingival margin, foot and wrist drop, ataxia and tremors. Blood examination showed punctuate basophilia, Urine examination showed aminoaciduria, phosphaturia and glucosuria. a- What is the possible diagnosis for this case? b- How can you manage this case? .:. A worker in thermometer factory, entered the hospital with vomiting and diarrhea with blood and mucous. His blood pressure was 90/60, pulse was 120/minute, urine analysis showed albumin and blood casts. a- What is the possible diagnosis for this case? b- How can you manage this case? c- What are the clinical findings that can be found in other years in this factory? workers who work for 10

145

.:. A farmer was admitted-to the hospital complaining of salivation,vomiting, abdominal cramps, wheezy chest, and the pulse rate was 60/min.His pupils were constricted with characterized smell allover his body. a- What is your diagnosis? b- What are the investigations that can be done? c- What is the proper management of this case? .:. A fireman exposed to smoke inhalation during fire. He was transported to emergency room. On examination he was comatose with cherry red skin. His pulse was SO/minute, blood pressure was 80/50, with gasping respiration. a- What is your diagnosis? b- What is the proper management of this case?
/

----

.:. In winter a. husband and his wife were found fainted in their room, they. were burning some wood for warmth. They were suffering from headache, nausea, vomiting & dyspnea. Few minutes later they suffered from coma with convulsions and their respiratory rate were depressed. a- What is your diagnosis? b-What are the laboratory investigations needed in this case? c- What is the proper management of this case? .:. A patient presented to the poison control center with descending paralysis, dysphagia, dry mouth, dysarthria, and 3rd nerve palsy. There was a history of' ingestion of canned food. a- What is the most likely diagnosis of this case? What is the causative agent? b- What other clinical manifestations that can be found? c- How can you treat this case?

~-

146

Sign up to vote on this title
UsefulNot useful