Professional Documents
Culture Documents
Psychiatry and Forensic TND
Psychiatry and Forensic TND
• Anhedonia: Loss of capacity to experience
pleasure in old activities.
• Alexithymia: inability to understand emotions
of others and inability to express emotions of
self.
• 2. A clinician asked his patient, what do you
know about Albert Einstein?
• Patient replies, science is a branch of study
which is based on facts, observation and
experiments. Which type of formal disorder
patient has?
a. Circumstantiality
b. Loosening of association
c. Incoherence
d. Tangentiality
Ans: D
All 4 options are disorders of form of thought:
• Tangentiality: answer will be related to question
in some distant way and the goal of thought is
never reached. Patient will not speak the exact
answer.
• Patient understands that question was something
related to science (A.Einstein).
• Circumstantiality: Unnecessary details and goes
round and round before reaching to final goal.
• Loosening of association: connection is lost
between components of a single thought.
• Incoherence: total lack of organization so that
the thought is incomprehensible and doesnot
convey any meaning.
3. Which of the following is wrong about
delusion?
a. False and Unshakeable belief
b. Psychosis
c. Form of thought
d. Persecutory type is the most common
Ans: C
Delusion is a disorder of CONTENT OF
THOUGHT & not the form of thought.
• It is false, unshakeable and unexplained belief.
• 4. A person refuses to cough openly as he
thinks that his cough will blow away the
entire city. Which type of thought disorder is
this?
a. Delusion of grandiosity
b. Delusion of enormity
c. Non-bizarre delusion
d. Nihilistic delusion
Ans: B
• DELUSION OF ENORMITY: patient believes that some of his
activities may cause catastrophe (eg; his cough may blow away the
entire city, so he will resist his cough). Sometimes nihilistic
delusions are associated with Delusion of enormity.
• NIHILISTIC DELUSION/COTARD’S SYNDROME/DELUSION OF
NEGATION: patients may deny the existence of their body, mind etc.
• Nonbizarre delusion: false, but can possible
DELUSION OF Grandiosity: Patient beliefs that he is the most
powerful person.
• 5. A patient was asked by a psychiatrist that
what does he understand by saying “God
helps those who help themselves”? What
does clinician want to assess?
a. Judgement power
b. Concentration level
c. Abstract thinking
d. Insight
Ans: C
Abstract thinking can be assessed by:
• Similarities testing
• Proverb testing
Judgement can be assessed by;
• Test judgment
• Personal judgement
• Social judgement
• 6. Mental status examination can be assessed
by all except;
a. Attitude of patient towards the examiner
b. Flow of speech
c. Memory
d. Brain imaging tests
Ans: D
• Brain imaging tests like CT scan and MRI are biological investigations
and not the mental status examination (MSE).
• MSE:
• 1. General appearance.
• 2. Speech ( rate & tone)
• 3. Mood & Affect
• 4. Perception
• 5. Thought
• 6. Cognition: HIGHER MENTAL FUNCTIONS
• 7. Insight
• 8. Judgement
• 7. Electra complex is seen in;
a. Boys of 1-3 years of age
b. Girls of 1-3 years of age
c. Boys of 3-5 years of age
d. Girls of 3-5 years of age
Ans: D
Phallic stage(3-5years) of psychosexual stages of development:
• OEDIPUS COMPLEX – seen in boys of 3-5 years, attraction for
mother
• ELECTRA COMPLEX – seen in girls of 3-5 years, attraction for father
Extra points: Phallic stage
• Penis becomes the organ of principle interest to children of both
sexes.
• Castration anxiety
Sigmund Freud: father of Psychoanalysis
• Topographical theory of mind: Conscious, Preconscious and
Unconscious
• Structural theory of mind: Id, Ego, Superego
• 8. A clinician is diagnosed with advanced stage
of cholangiocarcinoma. After the diagnosis, he is
trying to avoid his painful emotion of being
diagnosed with cancer, by having a long
conversation with his treating physician
regarding pathophysiology of his cancer. Which
type of defence mechanism is this?
a. Altruism
b. Isolation of affect
c. Intellectualization
d. Reaction formation
Ans: C
• Altruism: satisfying internal needs by helping
others
• Intellectualization: excessive use of intellectual
process to avoid the painful emotions
• Reaction formation: transformation of feelings
into exact opposite
• Isolation of affect: removing the feelings
associated with a stressful life event.
• 9. A psychotic patient has affective flattening,
apathy, anhedonia and avolition. What is the
pathology of his symptoms?
a. Increase of dopamine in mesolimbic tract
b. Increase of dopamine in mesocortical tract
c. Decrease of dopamine in mesolimbic tract
d. Decrease of dopamine in mesocortical tract
Ans: D
• Pathophysiology of schizophrenia:
• Increase of dopamine in mesolimbic tract:
causes positive symptoms (delusion and
hallucination)
• Decrease of dopamine in mesocortical tract:
causes negative symptoms like avolition,
anhedonia, apathy, alogia etc.
10. Which of the following does not describe
the first rank symptoms of schizophrenia?
a. Voices arguing
b. Made impulse
c. Audible thoughts
d. Secondary delusion
Ans: D
• Delusional perception is one of the 11 first
rank symptoms of schizophrenia.
• Delusional perception is a type of PRIMARY
DELUSION and NOT the secondary delusion.
SCHENEIDERIAN FIRST RANK
SYMPTOMS are:
• Three auditory hallucinations:
1. Audible thoughts
2. Voices commenting on one’s action
3. Voices heard arguing
• Three made phenomenon:
4. Made affect
5. Made volition
6. Made impulse
• Three thought phenomenon:
7. Thought insertion
8. Thought withdrawal
9. Thought broadcast
• 10. Somatic passivity
• 11. Delusional perception
• 11. A person is repeatedly checking the odour
of his mouth and avoiding social situations.
He beliefs that he is emitting a foul body
odour and others are noticing it too. He is
suffering from which disorder?
a. Obsessive disorder
b. Anxiety
c. Olfactory reference syndrome
d. Social phobia
Ans: C
Olfactory reference syndrome: It is OCD related
disorder.
• It is a new entity in ICD-11.
• Patient beliefs that he is emitting a foul body
odour and others may notice it too. So he gets
conscious and avoid all social situations.
• 12. Which of the following is the differentiating
feature between obsession and delusion?
a. Obsessional idea is regarded as senseless by
patient
b. Delusion is ego dystonic
c. Obsessional idea is held on inadequate ground
d. Patient of delusion understands that he has
some problem
Ans: A
• Obsessions are considered senseless by the
patient whereas patient has full belief in the
delusions.
• Delusion is ego syntonic and Obsessions are
ego dystonic
• No insight is there in delusion.
• 13. A person has lost sight in one eye and he
is completely indifferent and least bothered
about it. This type of feeling of indifference is
seen in which type of psychiatric illness?
a. PTSD
b. Depression
c. Conversion disorder
d. Schizophrenia
Ans: C
• La bella indifference: is a phrase used to
describe the feeling of indifference which
patients of conversion disorders have towards
their symptoms.
• 14. A 24 year old girl presents with complaints
of pain of in abdomen & legs, headache, nausea
and vomiting for last 3 months. On physical
examination, she was normal. Further clinical
investigations were completely normal. Which
of the following conditions best describes her
diagnosis?
a. Hypochondriasis
b. Somatisation disorder
c. Conversion disorder
d. Somatoform pain disorder
Ans: B
• Hypochondriasis: patient has fear of having or idea that he/she has
one or more physical illness. Physical symptoms are not there.
• Somatoform pain disorder: only pain will be there, but in question,
patient has GIT symptoms too.
• Somatization disorder: multiple and variable physical symptoms for
which no adequate explanation is found.
• Main feature is presence of one or more somatic symptoms and
excessive thoughts about seriousness of symptoms and anxiety.
These are called as Somatic symptoms disorder
• Conversion disorders: Dissociative disorders
• 15. Which of the following drugs is a mood
stabilizer and has anti-suicide property?
a. Clozapine
b. Lamotrigine
c. Valproate
d. Lithium
Ans: D
• Lithium is the mood stabilizer which has anti-
suicidal property. It decreases suicide
attempts & suicides in a patient with bipolar
disorder.
• Clozapine has anti-suicidal property, but its an
atypical antipsychotic drug.
• 16. Cyclothymia is;
a. Severe form of bipolar disorder
b. Less severe and chronic form of major
depression
c. Double depression
d. Less severe form of bipolar disorder
Ans: D
• DYSTHYMIA: Less severe and chronic form of
major depression
• CYCLOTHYMIA: Less severe form of bipolar
disorder
• 17. A very famous and lovable football player
committed suicide. After that many college
boys started committing suicide. This is called
as;
a. Parasuicide
b. Physician suicide
c. Copycat suicide
d. Duplicate suicide
Ans: C
• Parasuicide: when a person is indulged into self
injuries, and doesn’t have intention to kill himself.
• Physician suicide: Doctors have higher risk of
suicide than general population. Among doctors,
psychiatrist > ophthalmologist >
anaesthesiologist.
• Copycat suicide: suicide of someone influences
the behaviour of others. Mostly seen in
adolescents.
• 18. Which of the following is the most
common illicit substance of abuse in India?
a. Tobacco
b. Alcohol
c. Cocaine
d. Cannabis
Ans: D
• Acc. to De-addiction centre, India, Jan 2019
• MC substance abuse in India – ALCOHOL
• MC illicit (illegal) use substance – CANNABIS
• 19. Which of the following belongs to cluster
C personality disorders?
a. Paranoid
b. Narcissistic
c. Avoidant
d. Histrionic
Ans:C
PERSONALITY DISORDERS
Cluster A:
• Paranoid
• Schizoid
• Schizotypal
Cluster B:
• Histrionic
• Narcissistic
• BPD
• Antisocial
Cluster C:
• Avoidant
• Dependent
• OCD
• 20. A 23 year old girl is getting frequent mood swings
without any reason. She often fights with her
relatives and easily gets rid of her relationships.
Sometimes she takes over dosage of medicines.
Which type of personality disorders she is suffering
from?
a. Paranoid
b. Schizotypal
c. Avoidant
d. Borderline
Ans: D
Borderline personality disorder:
• Always in state of crisis
• Mood swings
• Unstable relationships
• Self destructive acts (wrist slashing, over dosage of
medicines)
• Impulsive in spending, sex and substance use
• Use defence mechanism of splitting
• DBT: Dialectical Behaviour Therapy is used for BPD.
• Medicines: Antipsychotics, antidepressants and mood
stabilizers.
• 21. A person is admitted in psychiatry department
with the complaints of psychosis and negative
symptoms like anhedonia, apathy and avolition. He
has history of a substance for use for last 6 months.
Which of the following substances can cause these
symptoms?
a. LSD
b. Cocaine
c. Cannabis
d. All
Ans: D
Clinical scenario depicts SCHIZOPHRENIA like
symptoms.
Substances which can cause schizophrenia like
symptoms are:
• LSD
• Cannabis
• Amphetamines
• Cocaine
• Phencyclidine & other hallucinogens
• 22. A 17 year old girl was brought to a clinic with
complaints of weight loss and poor sexual
development. On history taking, she was
indulged into excessive exercising and dieting.
Which eating disorder, she is suffering from?
a. Bulimia nervosa
b. Anorexia nervosa
c. Binge eating disorder
d. Avoidant restrictive food intake disorder
Ans: B
ANOREXIA BULEMIA
NERVOSA NERVOSA
Fear of weight Yes Yes
gain and
inappropriate
ways of
preventing
weight gain
Weight loss Yes Normal
Poor sexual Yes Normal
development
Low interest in Yes Normal
sexual activities
Amenorrhea Yes Normal
Dental caries & Yes Yes
parotitis
Special features Peculiar food Callus on
handling knuckles
behaviour (Russel’s sign) –
- Callus on knuckes more prominent
can be seen
• 23. Which of the parasomnias occur during
REM sleep?
a. Pavor nocturnus
b. Somnambulism
c. Nightmare
d. Sleep talking
Ans: C
PARASOMINAS DURING NREM SLEEP;
• Pavor nocturnus (Night terror)
• Somnambulism ( sleep walking)
• Sleep related enuresis
• Bruxism (teeth grinding)
• Somniloquy (sleep talking)
PARASOMINAS DURING REM SLEEP;
• Nightmare
24. A 5 year old child with history of birth asphyxia
does not communicate well, has slow mental
and physical growth. He does not mix with
people, has limited interests and gets widely
agitated. What is the most probable diagnosis?
a. ADHD
b. Language disorder
c. Autistic disorder
d. Hyperkinetic child
Ans: C
Symptoms of AUTISTIC DISORDER:
• Impairment in social interaction
• Impairment of communication & language
• Restricted, repetitive & stereotyped
behaviour
• 25. What is the differentiating feature of
delirium and dementia?
a. Delirium has chronic and progressive
impairment
b. Cloudiness of consciousness is seen in dementia
c. Acute presentation and fluctuation of symptoms
are seen in delirium
d. Sundowning and flocillations are classic of
dementia
Ans: C
• Dementia (and not the delirium) has chronic
and progressive impairment
• Cloudiness of consciousness is seen in
Delirium (not in dementia )
• Acute presentation and fluctuation of
symptoms are seen in delirium
• Sundowning and flocillations are seen in
delirium
• 26. A 23 year old female is thinking that she
should always be appreciated by everyone,
otherwise her life will be worst. Which type of
cognitive distortion is this?
a. Emotional reasoning
b. Approval seeking
c. Fallacy of fairness
d. Mental filtering
Ans: B
• APPROVAL SEEKING: is a cognitive distortion, in which a patient has
a belief that he should always be liked and loved by others,
otherwise life would be terrible.
• Emotional reasoning: Eg; if i have bad feeling about a person, it
means he is really a bad person, even i have no evidence.
• Fallacy of fairness: Eg: You missed a flight due to heavy traffic and
you believe that life is always unfair to you.
• Mental Filtering: Picking a single negative detail while ignoring the
rest positive aspects.
Other cognitive distortions:
• Magnification & Minimization
• Jumping to conclusion
• Disqualifying positive
• 27. All of the following are true about PTSD
(post traumatic stress disorder), except;
a. Flashback & nightmares
b. Avoidance of related stimulus
c. Emotional numbing
d. Dissociative fugue
Ans: D
• Dissociative fugue: sudden, unexpected travel
away from home with inability to recall some
or all of one’s past.
• It is a type of dissociative disorder.
• 28. A 45 year old female feels uncomfortable in
using elevator and going to some crowded
places. What is the most appropriate line of
treatment?
a. SSRI
b. Exposure and response prevention
c. Flooding
d. Antipsychotic medications
Ans: B
Diagnosis: AGORAPHOBIA
Exposure & response prevention is the best line
of treatment for phobias.
• Pharmacotherapy: SSRIs, BZD, beta blockers
• 29. Patient believes that a familiar person can
change his/her physical appearances and
disguise her. What is the most probable
diagnosis according to the given picture?
a. Capgrass syndrome
b. Delusion of subjective
double
c. Fregoli syndrome
d. Nihilistic delusion
Ans: C
Fregoli syndrome: Patient believes that a familiar
person can change his/her physical appearances
and disguise as a stranger.
Syndrome of subjective doubles: patient believes
that he has many doubles who are living life of
their own.
Capgrass syndrome: patient believes that a
familiar person has replaced by an imposter
• 30. A 33 year old male, with mood disorder, is brought to
the emergency room with history of acute onset of fever,
excessive sweating, confusion, rigidity of limbs and
decreased communication for a day. O/E, he has
tachycardia and labile BP and investigations reveal
increased WBC counts and CPK enzyme levels. According
to his drug history, he is on 30 mg of haloperidol and 100
mg of lithium. What is the most probable diagnosis?
a. Lithium toxicity
b. Tardive dyskinesis
c. Neuroleptic malignant syndrome
d. Hypertensive encephalopathy
Ans: C
• Given side effects depict neuroleptic
malignant syndrome, which is an acute side
effect of typical antipsychotic drugs like
haloperidol.
• DOC is dantrolene.
• 31. What is the treatment protocol for a
schizophrenic patient, who is not responding
to clozapine?
a. Clozapine + haloperidol
b. Aripiprazole + fulphenazine
c. Continue with clozapine for more 6 weeks
d. Electro convulsive therapy
Ans: D
• Clozapine is the DOC for resistant
schizophrenia (not responding to typical and
atypical antipsychotics).
• if clozapine is not working then ECT is the
final choice of treatment.
• 32. What will be the preferred drug to treat
ADHD in a 5 year old boy, whose father has a
history of substance abuse?
a. Methylphenydate
b. Clonidine
c. Modafinil
d. Atomoxitine
Ans: D
• DOC to treat ADHD is stimulant drug
METHYLPHENYDATE.
• But it should be avoided in a patient who has
seizure and family history of substance abuse.
• In that case, non- stimulants should be
preferred.
• ATOMOXETINE is preferred over clonidine.
STIMULANTS NON-STIMULANTS
Methylphenidate, Atomoxetine
Dexmethylphenida (SNRI)
te
Modafinil Bupropion
Amphetamine Venlafaxine
Dextroamphetami Clonidine,
ne Guanfacine
• 33. A telecom engineer after taking up the job is
feeling guilty, hopeless and not able to
concentrate on work. His symptoms started 3
years back when he entered the college. What is
the most probable diagnosis?
a. Generalized anxiety disorder
b. Major depressive disorder
c. Adjustment disorder
d. Dysthymia
Ans: D
• Dysthymia: it is the presence of mild depressive
symptoms (not enough to diagnose a major
depressive episode) for a period of >2 years.
• Also known as persistent depressive disorder
• Presence of a depressed mood that lasts most of the
day and is present almost continuously with
associated feelings of inadequacy, guilty, irritability
and anger, withdrawal from society, anhedonia and
inactivity and lack of productivity.
• 34. Which of the following is a wrong statement
about postpartum depression?
a. Family history of mood disorder is usually
present
b. Thought of harming the baby is present
c. Suicidal thoughts may occur
d. Time of onset is 6-7 days after the childbirth
Ans: D
.
POSTPARTUM BLUES POSTPARTUM DEPRESSION
a. Panic attack
b. Generalized anxiety disorder
c. Obsessive compulsive disorder
d. Phobia
Ans: B
Generalized Anxiety Disorder:
• a pattern of frequent, persistent worry and
anxiety that is out of proportion to the impact of
the event or circumstance that is the focus of
worry.
• Sustained and excessive anxiety and worry
accompanied by either motor tension or
restlessness.
• Motor tension is most commonly manifested as
shakiness, restlessness and headaches.
• 36. One of the following is not a component
of cognitive triad of Beck?
a. Negative view of self
b. Negative views about environment
c. Feeling of guilt
d. Negative view about future
Ans; C
• Cognitive theory of depression: Given by Aoron
Beck
Cognitive triad of Beck
• Negative view of self – ideas of worthlessness
• Negative views about environment - ideas of
helplessness (a tendency to experience world as
hostile
• Negative view about future - ideas of
hopelessness
• 37. The typical presentation as shown in
photo will be seen in which psychiatric
illness?
a. OCD
b. Phobia
c. Dissociative disorders
d. Depression
Ans: D
Physical Signs seen in DEPRESSION:
• Omega sign: it is the omega shaped fold on
the forehead above the root of the nose.
• Veraguth fold: it is triangular shape fold in the
nasal corner of upper eyelid.
• 38. A child increases cleaning his room to
avoid scolding by her mother. Which type of
operant conditioning is this?
a. Positive reinforcement
b. Negative reinforcement
c. Punishment
d. Extinction
Ans: B
• Operant conditioning/Instrumental
conditioning: Given by BF Skinner
• Types: frequency of a behavior is increased by
positive or negative reinforcement and
decreased by punishment or extinction.
TYPES EFFECT EXAMPLE
Positive reinforcement behavior is increased by a child studies more with
reward a chocolate
Negative reinforcement behavior is increased to a child cleans his room
avoid a negative more time to avoid
consequence scolding by her mother
Category IQ
Normal 90-109
Borderline 70-89
Mild MR 50-69
Moderate MR 35-49
Severe MR 20-34
Profound MR <20
• 40. A 19 year old girl enjoys wearing male clothes.
She enjoys while doing this. Wearing male clothes
gives her a feeling of more confidence and after these
episodes, she is an absolutely normal girl. What is the
most likely diagnosis?
a. Fetishism
b. Fetishistic transvestism
c. Trans-sexualism
d. Dual role transvestism
Ans: D
• In given case, she only enjoys wearing the
dress of opposite sex, and there is no any
sexual pleasure and no discomfort with her
own sex and there is no desire to be of
opposite sex.
• It is a case of dual role transvestism.
• 41. A 55% burn patient is admitted and getting
treatment in the burns department for last ten days.
He suddenly ceases to recognize the doctor and staff.
He thinks that he is in jail and complains of scorpion
attacking him. What is the probable diagnosis?
a. Acute dementia
b. Acute paranoia
c. Acute delirium
d. Acute schizophrenia
Ans: C
• History of a medical disorder (burns), followed
by disturbances in consciousness and
disorientation to time, place and person, is
suggestive of DELIRIUM.
• 42. A person has psychosis and flashback
phenomenon after abusing which of the
following substance?
• a. Cocaine
• b. Cannabis
• c. Alcohol
• d. Heroine
Ans: B
• Formication + Psychosis = seen in Cocaine
abuse
• Flashback + psychosis = seen in Cannabis
abuse
• 43. A 17 year old boy came to psychiatric OPD with a
complaint of feelings as, if he is changed from inside.
He reports feeling strange as, if he is different from
his normal self. He was very tense and anxious yet
could not point the precise change in him. This
phenomenon is best called as;
• a. Delusional mood
• b. Depersonalization
• c. Overvalued idea
• d. Autochtonous delusion
Ans: B
• Depersonalization/derealization disorder:
patient has a feeling of unreality of self
• 44. Which of the following is not a feature of
atypical depression?
• a. Insomnia
• b. Obesity
• c. Leaden paralysis
• d. Interpersonal sensitivity
Ans: A
ATYPICAL DEPRESSION: With atypical features
• These patients present with reverse biological
symptoms such as
• hypersomnia,
• overeating/hyperphagia
• weight gain/Obesity
• interpersonal sensitivity
• Leaden paralysis
• ICD-11 UPDATE: Psychotic features can be seen in
severe and moderate depression.
• 45. Find out the psychiatric illness which has
associated feature as shown by the photo;
a. Paranoid schizophrenia
b. Von Gogh syndrome
c. Pfropf szhizophrenia
d. Narcissistic personality disorder
Ans: B
• Von Gogh syndrome = self mutilation
occurring in Schizophrenia
• Pfropf schizophrenia = Schizophrenia in a
patient with mental retardation
• 46. Indications for the given procedure are all
except;
a. Depression with stupor
b. Catatonic schizophrenia
c. Chronic schizophrenia
d. Severe depression with suicidal tendency
Ans: C
ECT is the first line treatment in catatonic schizophrenia.
• ECT is not effective in chronic schizophrenia.
INDICATIONS OF ECT:
• Depression with suicidal tendency
• Depression with stupor
• Depression with psychotic symptoms
• In case of failed medication trials or intolerance to medications.
• Acute mania
• Schizophrenia (not effective in chronic cases)
• Intractable seizures
• Neuroleptic malignant syndrome
• Delirium
• On & off parkinson’s
• Note: Pregnancy is not a contraindication of ECT
• 47. Analyze the picture and find out the
disorder;
a. Cotard syndrome
b. Nihilistic delusion
c. Capgrass syndrome
d. Xenophobia
Ans: C
• Capgrass syndrome – delusion of double
• Patient beliefs that a familiar person has been
replaced by an imposter.
• 48. In which psychiatric illness, Patients keep on
accumulating useless item & the house gets
cluttered, to the point, that it becomes unsafe to
live?
• a. Aimless picking disorder
• b. Hoarding disorder
• c. Impulsive disorder
• d. Kleptomania
Ans: B
• HOARDING DISORDER: (DSM-5 & ICD-11 UPDATE)
• Earlier it was considered as a subtype of OCD, but now
it has been made a separate diagnostic entity.
• Patients keep on accumulating useless item & the
house gets cluttered, to the point, that it becomes
unsafe to live.
• This disorder is characterized by acquiring & not being
able to discard the things that are considered to have
little or no use.
• This disorder is driven by fear of losing something
important.
• Treatment: CBT + SSRI + Exposure & prevention
• 49. A boy is having diarrhea, rhinorrhea,
sweating and lacrimation. What is the most
probable diagnosis?
• a. Cocaine withdrawal
• b. LSD withdrawal
• c. Heroine withdrawal
• d. Alcohol withdrawal
Ans: C
OPIOD (Heroine) WITHDRAWAL:
• Symptoms produces a flu like syndrome with the
symptoms like;
• Rhinorrhea, lacrimation, sweating and
diarrhea.*
• Yawning and piloerection.
• Pupillary dilatation
• Muscle cramps and generalized bodyache
• Insomnia, anxiety, HTN & tachycardia
• Nausea, vomiting and anorexia.
• 50. Fear of public speaking is known as;
a. Social phobia
b. Social anxiety disorder
c. Glossophobia
d. Xenophobia
Ans: C
• Specific phobias:
• It is a strong, persistent and irrational fear of an object or a
situation.
• Eg.
• Arachnophobia – fear of spiders
• Ophidiophobia – fear of snakes
• Aerophobia – fear of flying
• Glossophobia – fear of public speaking
• Ornithophobia - fear of birds
• Trypanophobia – fear of needles.
• Hoemophobia – fear of blood.
• Vehophobia – fear of driving
• Iatrophobia – fear of doctors
• Nosocomphobia – fear of hospitals
• Phasmophobia/spectrophobia – fear of ghosts
• Astraphobia – fear of thunders/lightening. a/k/a
brontophobia, tonitrophobia.
• Cynophobia – fear of dogs
• Claustrophobia – fear of closed spaces( elevators,
small rooms)
• Agoraphobia – fear of open or crowded spaces.
Patient won’t leave home.
• Xenophobia – fear of strangers
• Zoophobia – fear of animals
• Thanatophobia – fear of death
• Acrophobia- fear of heights
• Ailurophobia – fear of cats
• Hydrophobia – fear of water
• Mysophobia – fear of dirt and germs
• Pyrophobia – fear of fire
FoRensic Medicine
And toXicoLoGY
• 1. Which type of euthanasia is legally
permitted in India?
• A. Active
• B. Passive
• C. Voluntary
• D. Involuntary
Ans: B
• Euthanasia (Mercy Killing) : pentobarbital 2-10 g, death within 15-
30 min
Types:
• Active or Positive: when a doctor administer lethal dose of
medication to a patient.
• Passive or Negative: withdrawing life supporting devices from a
serious patient.
• Voluntary: with expressed desire and consent of the patient
• Involuntary: when euthanasia is done against the will of the patient
who oppose euthanasia; and would clearly amount to murder.
• Non-Voluntary: ending of life of a person who is non mentally
competent to make an informed request to die, such a s a comatose
patient. In Non-Voluntary euthanasia, the patient has left no such
living will or given any advance directives.
2. According to transplantation of human organ
Act, which of the following doctors is not
authorized for pronouncing brain death?
a. Registered Medical practitioner, in charge of the
hospital
b. Clinician attending the patient
c. A urosurgeon of the same hospital, who has a
patient for kidney transplantation
d. A neurosurgeon
Ans: C
• A medical board (BRAIN DEATH COMMITTEE)
consists of;
• RMP, in charge of same hospital of patient
• RMP treating the patient
• A neurosurgeon/neurologist nominated by panel
• An independent RMP – a specialist
• Note: in case of non-availability of neurologist or
neurosurgeon, any surgeon, physician,
anaesthetist or intensivist, nominated by medical
in-charge of the hospital may certify brain death
3. Suspended animation is most commonly
seen in which of the following scenario?
a. Electrocution
b. Yoga practitioners
c. Insanity
d. Newborn
Ans: D
• Suspended Animation/Apparent Death is seen in:
• Insanity/Iatrogenic as in cardiopulmonary surgeries
and anaesthesia
• Morphine overdose, Mesmeric trance
• Yoga practitioners
• Newborn (Most Common)
• Electrocution
• Cholera (wasting diseases)
• Heat stroke/Hanging/Hypothermia
• Drugs like barbiturate/Drowning
• Typhoid
4. Which of the following is not an early sign of
post-mortem changes?
a. Algor mortis
b. Autolysis
c. Livor mortis
d. Rigor mortis
Ans: B Post mortem changes:
a. Kevorkian sign
b. Tache Noir Sclerotica
c. Flaccid eye ball
d. Railway trucking sign
Ans: B
• Tache Noire Sclerotica:
• Due to drying/dessication, deposition of cellular
debris and dust.
• Located at: SCLERA and CONJUNCTIVA
• Appearance: two triangles at each side of the iris
(base on the limbus, apex at the outer canthus)
• Color change: First yellow, then brown and finally
black
• Time since death: 3-4 hours
• 7. Rate of fall of temperature in a dead body
is faster in;
a. Air > water > soil
b. Soil > water > air
c. Soil > air > water
d. Water > air > soil
Ans:D
• Water > air > soil
• In algor Mortis: Fall in temperature starts in
15 minutes to ½ hour Water : air : soil = 4:2:1
• Thus, rate is maximum in water, moderate in
air and minimum in soil.
• Extra points:
Casper’s Dictum -
• It is related to putrefaction/decomposition of body.
• A body decomposes in air twice as in water and 8
times rapidly as in earth.
• At a given temperature one week of putrefaction in
air is equivalent to two weeks in water and eight
weeks buried in soil.
• Rate of decomposition in soil, water and air is 1:2:8
• 8. Find out the wrong match related to
poisoning and color of lividity;
a. Carbon monoxide – Cherry red
b. Cyanide – Bright red
c. Hypothermia – Deep blue
d. Hydrogen sulphide – Bluish green
Ans: C
a. Marbling – 36- 48 hours
b. Mummification - > 6 months
c. Rigor mortis - complete in 1 – 2 hours
d. Livor mortis - complete in 6-12 hours
Ans: C
• Marbling – 36- 48 hours
• Mummification - 6 months – 1 year
• Livor mortis - starts in 30 min to 2 hour
progress in 4 hours and complete in 6-12
hours
• Rigor mortis - begins in 1-2 hours, progress
in 3-4 hours and complete in 6 - 12 hours
10. Which of the following is not related to
mummification of a dead body?
a. Hot dry climate
b. >70% weight is lost
c. Odourless
d. Moisture environment
Ans: D
• MUMMIFICATION: drying and shrivelling of the
dead body from evaporation of water.
• Features:
• Entire body loses weight, becomes thin, stiff,
brittle and ODOURLESS. More than 70% weight is
lost
• Requirements: Absence of moisture, HOT DRY
CLIMATE, Free circulation of air
• Duration: 6 months – 1 year
•
• ADIPOCERE: commonly seen in bodies immersed in water
or in damp warm environment. Fatty tissues of the body
change into a substance known as adipocere. It is also
called GRAVE WAX.
• Sweetish smell or Rancid butter smell
• Requirements: warm moist anaerobic climate, Lecithinase
enzyme, Intrinsic Lipases
• Duration: shortest 3 weeks in summer. Complete
conversion in an adult limb requires at least 3-6 months.
• Foetuses <7 months do not show adipocere formation
• In running water, adipocere formation is not seen as the
electrolytes are washed away from the surface of the body.
• 11. Which of the following is not a
constituent of embalming fluid?
a. Ethanol
b. Formaldehyde
c. Glycerine
d. Sodium citrate
Ans: A
• CONSTITUENTS OF A TYPICAL EMBALMING FLUID:
• Preservative – commonly a mixture of FORMALDEHYDE, gluteraldehyde.
METHANOL is used to hold the formaldehyde in solution.
• Humectant (to preserve the moisture) – GLYCERINE
• Germicide – PHENOL
• Buffer ( to maintain the pH) – Sodium bicarbonate/sodium borate
• Anticoagulants – SODIUM CITRATE/SODIUM OXALATE
• Dyes (to restore the body’s natural colouration) – EOSIN
• + perfume – wintergreen
• Vehicle – water upto 10L
• Note: ETHANOL is not a constituent of embalming fluid
• Extra points:
• Best method of injection: Discontinuous injection and drainage
• Autopsy must be done before embalming
• 12. Which of the following is most common
method of skin incision to perform autopsy?
a. X-shaped incision
b. Modified Y- shaped incision
c. T-shaped incision
d. I-shaped incision
Ans: D
• Types of skin incision:
• I-shaped incision: from chin straight down to the
symphysis pubis.
• Most common method followed.
• Y shaped incision
• Modified Y shaped incision – for detailed study
of neck organs, like in hanging or strangulation.
• T shaped incision or bucket handle incision
• X shaped incision: to demonstrate the deep
bruises in custodial death cases.
• 13. What is the method of autopsy in which
individual organs are removed one by one?
a. Lettule’s technique
b. Virchow’s technique
c. Rokitansky’s technique
d. Ghon’s technique
Ans: B
Virchow’s technique:
• Individual organs removed one by one
• Anatomical relations are not preserved
Lettule’s technique:
• various system organs are removed as en-masse
(all together) – cervical, thoracic, abdominal and
pelvic organs and organ dissection.
• Anatomical relations are preserved
• Rapid technique
Ghon’s technique:
• Organ blocks and organ dissection
• cervical, thoracic, abdominal and urogenital system
are removed as organ block (separate blocks)
Rokitansky’s technique:
• In-situ dissection of organs
• Fetal brain dissection
• Infectious disease like HIV, Hep B
• Radiation hazards
• 14. Shown prints of newborn infants are
mainly used in maternity hospitals to prevent
exchange of infants. This is known as;
a. Dactylography
b. Cheiloscopy
c. Rugoscopy
d. Podography
Ans: D
• PODOGRAPHY: footprints
• Skin patterns of toes and heals are distinct and permanent.
• Footprints of newborn infants are mainly used in maternity hospitals to
prevent exchange of infants
• CHEILOSCOPY: study of lip prints
• RUGOSCOPY: Study of palatal rugae in the hard palate. It is also called as
Palatoscopy/palate-print
• DACTYLOGRAPHY: study of finger prints
• POROSCOPY: system of identification of an individual based on
arrangement of sweat pores in finger prints
• AMELOGLYPHICS: study of pattern of enamel rods.
• 15. Cephalic index helps in determination of;
a. Sex
b. Race
c. Age
d. Stature
Ans: B
• RACE: RA (Race) CE (Cephalic Index)
• Cephalic index: percentage of breadth to length in any skull.
• CE = Max breadth of skull/Max length of skull x 100
• Indian skull is Caucasian
• CE of Indian skull: 75-79.9
• Various indices for Race determination are:
• Cephalic index = Max breadth of skull/Max length of skull x 100
• Crural index = Length of tibia/length of femur x 100
• Brachial index = Length of radius/length of humerus x 100
• Humero-femoral index = length of humerus/length of femur x 100
• 16. In which of the following conditions,
permanent alteration in fingerprints will be
seen?
a. Leprosy
b. Scabies
c. Superficial Scald burn
d. Albinism
Ans: A
Permanent alteration in fingerprint pattern is seen in;
• Leprosy
• Electrocution
• Radiation exposure
• Skin Graft
Intentional alteration – Criminals
• Corrosives
• Burns
• CO2 snow
• Rubbing against hard surface
• 17. Prints of eight fingers are recorded in
finger print reader (FINDER), excluding;
a. Index finger
b. Thumb
c. Ring finger
d. Little finger
Ans: D
• FINDER (Fingerprint reader) is a computerised
automatic fingerprint reading system which
can record each fingerprint data in half
second.
• Prints of eight fingers are recorded excluding
little fingers.
• 18. Patient’s relative gives a history of tattoo,
however it was not found during autopsy. Which
of the following should be dissected to find it?
a. Skin
b. Kidney
c. Lymph node
d. Spleen
Ans: C
TATTOO MARKS;
• Faint or disappeared tattoo marks can be made out on
histological study of the regional lymph nodes.
• In decomposed bodies, they are made visible by treating
the area with 3% hydrogen peroxide (H2O2).
METHODS TO DEMONSTRATE OLD OR FAINT TATTOOS
VISIBLE;
• Infra red photography
• UV lamp
• Magnifying glass
• High contrast photography
• 19. Which of the following is a pattern of
typical hanging?
a. a
b. b
c. c
d. b and c
Ans: A
• a shows Typical hanging. Knot at occiput.
• b and c show Atypical hanging. Knot at side of neck and
front of neck.
HANGING:
• Based on position of knot: Typical and atypical
TYPICAL HANGING
• Knot is at occiput
• Point of suspension is placed centrally
ATYPICAL HANGING
• Knot of ligature is anywhere other than on the occiput
• Based on degree of suspension:
COMPLETE HANGING
• Body is fully suspended
• No body part touches the ground
• Constricting force is weight of the body
PARTIAL HANGING
• Any part of the body is touching the ground
• Eg; lying, kneeling, sitting position etc.
• Weight of the head is the constricting force.
Extra points:
• In judicial hanging: knot is placed near the side of neck (in india)
• But the knot below the chin is highly effective.
• 20. Compression of neck by a rope thrown
from behind, is called as;
• a. Mugging
• b. Throttling
• c. Garroting
• d. Bansdola
Ans: C
• Garroting: rope from behind
• SPANISH WINDGLASS: official mode of
execution in spain. Iron collar around the neck
was tightened by a screw of strangulation.
• MUGGING: compression of neck by forearm
• THROTTLING: compression of neck by one or
both palms
• Bansdola: compression of neck with two
bamboo sticks
• 21. Cutis anserina is seen in which of the
following condition?
a. Hanging
b. Drowning
c. Burns
d. Snake bite
Ans: B
• POSTMORTEM APPEARANCES: In DROWNING
External findings;
• Livor mortis-in stagnant water
• Washer woman’s hand
• CUTIS ANSERINA/Goose skin/horripilation
• Froth in nostrils
• Cadaveric spasm
Internal findings;
• Emphysema aquosum
• Presence of sand particles in the airway
• Presence of water in stomach & small intestine
• Paltauf’s hemorhhage
• 22. Which of the following is a wrong match?
a. Gustufson’s method – age estimation from
teeth
b. Galton’s method – dactylography
c. Gettler’s test – Drowning
d. Diatom’s test – Hanging
Ans: D
DIATOMS TEST:
• Diatoms are microscopic unicellular algae, which secrete silica skeletons called
frustules.
• Diatoms of size 60 µ enters the circulation.
• Presence of diatoms in the distant tissues like bone marrow of femur (best site
for analysis) is the proof of antemortem drowning..
GETTLER TEST:
• Based on chloride content of blood in heart chambers.
• Normally the chloride content of right and left side of heart is nearly same, about
600mg/100 mL.
• If difference is 25 mg% or more, it is suggestive of antemortem drowning.
• In freshwater drowning, chlorides reduces by 50% in left ventricle.
• In seawater drowning, chloride increases by 30-40% in left ventricle.
GUSTAFSON’S METHOD: age estimation from teeth
Criteria:
• Attrition
• Paradentosis
• Secondary dentin
• Root resorption
• Transparency of root
• Cementum deposition
• Most reliable criteria: transparency of root
• 2nd MC reliable criteria: secondary dentin
GALTON’S METHOD – Dactylography was first sytemized by sir francis
Galton.
• 23. What is the type of injury shown in the
case of hanging?
a. Patterned abrasion
b. Pressure abrasion
c. Graze anrasion
d. Friction burn
Ans: B
• Picture shows ligature mark, which is an
example of pressure abrasion.
• Since pattern of ligature is not reflected in this
mark, it is not a patterned abrasion.
• 24. Multiple, superficial and parallel cuts as
shown in image, are suggestive of;
a. Chop wound
b. Homicide
c. Suicide
d. Lacerations
Ans: C
• Image shows HESITATIONAL CUTS/TENTATIVE
CUTS.
• Indicates suicidal nature of the wound
• Multiple, small, superficial and parallel cuts
over the accessible body parts.
• Sites: wrist, elbow, throat, front of chest and
abdomen.
• 25. Crocodile burn is seen due to;
a. High tension current
b. Lightening
c. Scald
d. Blast injury
Ans: A
ELCTROCUTION INJURIES:
• JOULE BURN – also known as electric burn. Firm
contact with low voltage current
• SPARK BURN/FLASH BURN – loose contact with air gap
• CROCODILE BURN - Loose contact with high voltage
current.
• Multiple punched out spark lesions over the exposed
parts of the body due to arcing of high tension current.
• Scald Burn: Due to hot liquid
• 26. Which is the most common organ
involved in underwater blast with head
under water?
a. GIT
b. Lungs
c. Ear
d. Genital organs
Ans: C
Order of organ involvement is primary blast
injuries:
• In air – Tympanic membrane, Lung and GIT
• Under water (head above water level) – GIT, Lung
and ear
• Under water (head under water level) – Ear, GIT
and Lung
• 27. Which of the following is a constituent of
smokeless gunpowder?
a. Charcoal
b. Nitrocellulose
c. Sulphur
d. Potassium
Ans: B
• Constituents of;
• BLACK GUNPOWDER: Potassium nitrate (75%) + Charcoal
(15%) + Sulfur (10%)
•
• SMOKELESS GUNPOWDER;
• Single base: Nitrocellulose
• Double base: Nitrocellulose + Nitroglyecerine
• Triple base: Nitrocellulose + Nitroglyecerine +
Nitroguanidine
• SEMISMOKELESS GUNPOWDER: 80% black + 20%
smokeless gunpowder
• 28. Find out the correct match among the
following;
a. Puppe’s rule - Burns
b. Tandem bullet – Souvenir bullet
c. Near Shot gun injuries – 1 – 2 meter
d. Bevelling of skull – Entry point of bullet
Ans: C
Bevelling of skull is seen at exit point of bullet.
Gunshot wounds on skull:
• Tumbling bullet: rotates end to end during its motion
• Tandem bullet/Piggyback bullet: two bullets come out of the muzzle end
• Souvenir bullet: Retained bullet inside the body for a longer time
SHOT GUN INJURIES: there is dispersion of lead shots. The more the distance, more
the dispersion
• Contact
• Close = <1m
• Near = 1-2m
• Intermediate = >2m
• Distant = >4m
• 29. Antemortem and postmortem wounds
could be differentiated by all except;
• a. Everted margins
• b. Blood clots in surrounding
• c. Swollen edges
• d. Sharp edges
Ans: D
• Antemortem wound shows:
• Gaping, everted and swollen edges with vital
reactions of inflammation, infection and
healing.
• It bleeds freely and shows extensive, deep and
firmly adherent clotting (staining) of
surrounding tissue which can’t be washed
away.
• 30. Which injury is most susceptible in given
cases?
• a. Seat belt syndrome
• b. Whiplash injury
• c. Hinge fracture
• d. Steering wheel impact
type injury
Ans: B
• WHIPLASH INJURY: Acute hyperflexion
followed by hyperextension of neck due to
violent acceleration or deceleration force
applied to front seat passenger in a car.
HINGE FRACTURE: with heavy blows or side impacts to head.
• Linear fracture separating the skull into two halves, creating a hinge
(nodding face sign)
• It is also called as MOTORCYCLISTS FRACTURE
STEERING WHEEL IMPACT INJURY:
• It occurs due to sudden stop of car, throwing forward the driver,
and throat may be crushed across top of steering wheel or horn
ring
SEAT BELT SYNDROME: includes all injury profiles associated with the
use of seat belts. It is defined classically as a seat belt sign (seat belt
marks on the body) plus an intra-abdominal organ injury (e.g. bowel
perforations) and/or thoraco-lumbar vertebral fractures.
• 31. Sexual gratification by watching the act of
sexual intercourse or witnessing undressing
by a women or any person.
• a. Masochism
• b. Sadism
• c. Scotophilia
• d. Fetishism
Ans: C
• PARAPHILIAS:
• SADISM: sexual gratification is obtained by
infliction of pain on one’s partner
• MASOCHISM: sexual gratification is obtained or
increased by the suffering of pain.
• BONDAGE/ALGOLANIA: sadism + Masochism
• VOYEURISM/SCOTOPHILIA/PEEPING TOM:
sexual gratification by watching the act of sexual
intercourse or witnessing undressing by a women
or any person.
• NECROPHILIA: desire of sexual intercourse with
dead bodies
• FETISHISM: Perversion associated with the
compulsive usage of an inanimate objects in
order to attain the sexual gratification.
• Common fetish objects are: hand kerchief,
undergarments like panities, bras, stockings.
• TRANSVESTISM/EONISM: sexual gratification is
obtained by wearing the dress of opposite sex.
• FROTTEURISM: Sexual satisfaction is obtained by
rubbing against persons in crowd.
• SODOMY: sexual intercourse through anus
• If passive agent is adult, the act is called as
GERONTOPHILIA
• If passive agent is a child, the act is called as
PAEDERASTY (Passive agent is labeled as
CATAMITE and the active agent is PAEDOPHILE.
• BESTIALITY: sex with animal
• TRIBADISM/LESBIANISM: sexual gratification of a
female by a female. Active partner is called as
DYKE or BUTCH and passive agent is FEMME.
• BOBBIT SYNDROME: female amputates the
genitalia of male partner with a knife due to
sexual jealousy of infidelity.
• TROILISM: inducing his wife to have sexual
intercourse with another man and by
observing the same.
• TELEPHONE SCATOLOGIA: Sexual arousal by
using Obscene language over phone.
• 32. A man follows a woman repeatedly
despite a clear disinterest by the women, will
be punishable under which section?
a. Sec 354 A IPC
b. Sec 354 B IPC
c. Sec 354 C IPC
d. Sec 354 D IPC
Ans: D
• Offences against woman:
• Sec 354 A IPC: Punishment for sexual harassment (1-3 years)
• Sec 354 B IPC: Use of criminal force on woman to disrobe (3-7
years)
• Sec 354 C IPC: Voyeurism
• Sec 354 D IPC: Stalking (1st offence: Cognizable and Bailable; 2nd
offence: cognizable and non-bailable
• Sec 359 IPC: Kidnapping definition
• Sec 362 IPC: Abduction definition
• Sec 363 IPC: kidnapping punishment
• Sec 364-369 IPC: Kidnapping under various circumstances
• 33. A 15 year old girl visits a clinician with
fractured forearm. She is reporting that she
tripped and fell but cigarette burns were
observed on her forearm. What is the next step
in management?
a. Inform social worker
b. Inform higher authorities
c. Do a complete physical examination
d. Shift her to operation theatre
Ans: C
• Forearm fracture + cigarette burns on forearm.
• Can be the case of abuse/domestic violence.
• Need to do complete physical examination.
• 34. Death of a patient due to unintentional
act by a doctor, staff or hospital is called as;
a. Therapeutic privilege
b. Therapeutic misadventure
c. Vicarious liability
d. Diminished liability
Ans: B
Therapeutic misadventure: Mischance or
disaster.
• A person dies due to some unintentional act of
doctor or hospital
Vicarious Liability: Let the master answer.
• An employer is responsible not only for his
own negligent act, but also for the negligent
act of his employees.
• 35. According to MCI protocol, medical
records of patients must be maintained by a
practitioner for a minimum period of;
a. 1 year
b. 2 years
c. 3 years
d. 5 years
Ans: C
• MLC reports shall be preserved minimum for 3
years.
• 36. A doctor gets referral money from the
labs for sending the patient for unnecessary
investigations, amounts to;
a. Criminal negligence
b. Therapeutic privilege
c. Contributory negligence
d. Infamous conduct
Ans: D
Professional misconduct/Infamous conduct:
• Disgraceful & dishonourable act by doctors
Eg;
• Adultery
• Abortion
• Treating patient under alcoholic influence
• Advertisement
• Covering
• Dichotomy or fee splitting
• Practicing euthanasia
• 37. A 25 year old female was found dead in her
bedroom. Room was not locked from inside. Blood
value of alcohol was 350 mg/dL with image of face,
open neck and viscera. Picture was given of bruises
on neck (likely 6 penny bruises), cyanosed lip.
Dissected neck was showing soft tissue ecchymosis.
What is the cause of death?
• A. Cafe coronary
• B. Suicide
• C. Throttling
• D. Suicide
Ans: C
• Presences of bruises in the neck (likely 6
penny bruises), cyanosed lips and dissected
neck showing soft tissue ecchymosis is higly
suggestive of throttling.
• 38. Which of the following is related to Sec
174 CrPC?
a. Magistrate inquest
b. Police inquest
c. Coroner inquest
d. Summons
Ans: B
• Sec 174 CrPC – Police inquest
• Sec 176 CrPC – Magistrate inquest
• 39. A witness who after taking oath, willfully
makes a statement which he knows or believes
to be false, will be punished under which section
of IPC?
a. IPC 191
b. IPC 192
c. IPC 193
d. IPC 197
Ans: C
• Perjury: giving willful false evidence by a
witness while under oath (IPC 191)
• Witness is liable to be persecuted for perjury,
and the imprisonment may extend to seven
years (IPC 193)
• IPC 197: Punishment for issuing false medical
certificates
• 40. A female patient was supposed to be
operated for a lump in right breast. Surgeon
operated and removed her left breast due to
confusion. The negligent act of the surgeon
amounts to;
a. Civil negligence
b. Vicariuos Liability
c. Res judicata
d. Res ipsa loquitor
Ans: D
Res ipsa loquitor – the thing speaks for itself
• Doctrine that infers negligence from the very nature of an accident
or injury itself proves the negligent action of the physician in the
absence of direct evidence.
Res Judicata: the things have been decided
• Medical negligence case adjudicated by a court and therefore may
not be pursued further by the same partied in another court.
Vicariuos Liability: Let the master answer
• An employer is responsible not only for his own negligent act, but
also for the negligent act of his employees.
• 41. Emblem shown in photo can be used by;
1. Medical professionals
2. Armed forces medical personnel and equipment
3. Members of international Red Cross Organization
a. Only 1
b. Only 2 and 3
c. Only 3
d. 1,2 and 3
Ans: B
• RED CROSS EMBLEM;
• It should not be used by medical professionals.
• Should be used only by;
• Armed forces medical personnel and equipment
• Members of international Red Cross Organization
• 42. Staggers alkali disease in livestock can be
caused due poisoning by which of the
following elements?
a. Magnesium
b. Manganese
c. Selenium
d. Arsenic
Ans: C
• Selenium poisoning: prolonged oral exposure
of cattle to elevated dietary selenium is
associated historically with 2 clinical
syndromes:
• Alkali disease
• Blind staggers
• 43. A 24 year old man came to emergency
department with complaints of rapid heart rate. O/E
everything was normal except for episodic
tachycardia and occasional extra systole and
amblyopia. Which of the following can cause this?
a. Atropine
b. Nicotine
c. Cocaine
d. Cannabis
Ans: B
• Nicotiana Tabacum (Tobacco)
• All parts of the plant are poisonous, except the ripe seeds.
• Leaves contain toxic alkaloids, like Nicotine, Anabasine,
Nornicotine.
• An average cigarette delivers 1-3mg of nicotine.
• It stimulates the autonomic ganglia, but depresses it later
stages.
• CVS: tachycardia followed by bradycardia, hypotension,
arrhythmia, tachypne followed by respiratory depression
and collapse.
• It causes amblyopia
• 44. Which of the following is an arrow
poison?
a. Cyanide
b. Aconite
c. Opium
d. Nicotine
Ans: B
Arrow poisons are:
• Rati, calotropis, aconite, strychnine, croton,
curare.
• 45. Which of the following is a characteristic
postmortem finding of arsenic poisoning?
a. Brown leathery stomach
b. Bluish green stomach
c. Black charred stomach
d. Pink velvety stomach
Ans: D
• Stomach mucosa:
• Arsenic – pink velvety mucosa/strawberry
• Carbolic acid – white/grey leathery stomach
• HCN – Pink
• KCN – Brick red to brown
• Copper sulphate – bluish green
• Sulphuric acid – charred/black/blotting paper
stomach
• Ferrous sulphate – Green
• 46. The chemical which is used in forgery for
removing ink;
a. Formic acid
b. Oxalic acid
c. Ammonia
d. Acetic acid
Ans: B
• Oxalic acid is used in cleaning iron rust,
bleaching and dyeing.
• In remover solution in cases of forgery.
• 47. Presentation of a metallic poisoning is
shown in photo. Which of the following
elements is responsible for this?
a. Lead
b. Copper
c. Mercury
d. Arsenic
Ans: C
• ACRODYNIA: PINK DISEASE/SWIFT FEER
DISEASE
• Toxicity: idiosyncratic hypersensitivity reaction
• Due to mercurous chloride (calomel)
• Age group: CHILDREN
• Features:
• Pink discoloration in the hands and feet.
• Pink, puffy, painful, paraesthetic peripheries
• 48. Which of the following is a wrong match
of diseases and poisoning?
a. Arsenic poisoning - Black foot disease
b. Mercury poisoning - Minimata disease
c. Lead poisoning – Plumbism
d. Phenol poisoning – Acrodynia
Ans: D
• Acrodynia is caused by mercury poisoning.
• 49. A poisoning case brought to the hospital and
urine sample was collected as shown in picture.
What is the most probable poisoning?
a. Oxalic acid
b. Copper
c. Phenol
d. Sulphuric acid
Ans: C
• Green urine: Phenol
• Golden hair: Copper
• Black tongue: Sulphuric acid
• Chalky white teeth: sulphuric acid
• Yellow teeth: Picric acid
50. A 10 year old child brought to casualty with snake
bite since six hours. On examination, no systemic
signs are found and lab investigations are normal
except localized leg swelling <4cm. what is the next
step in management?
a. Intravenous anti-snake serum
b. Incision and suction of local swelling
c. Anti-snake serum subcutaneously at local sweling
d. Observe the patient for progression of symptoms,
wait for antivenom therapy.
Ans: D
• Anti-Snake Venom administration criteria:
• ASV should only be administered when there are definie
signs of envenomation.
• In addition, ASV carries risks of anaphylactic reactions and
should not therefore be used unnecessarily.
•
• Polyvalent anti-snake venom is effective in:
• Cobra
• Krait
• Russel viper
• Saw scaled viper
•
• General management of snake bite:
• Psychiatric reassurance
• Pressure immobilization
• Torniquet application
• Antisnake venom (ASV)
• Supportive measure.
Good Luck