Forensic Medicine & Toxicology

Marks distribution of Assessment of Forensic Medicine: Total marks – 300
• Written =100 (MCQ+ SEQ+ SAQ+ FA)
• MCQ-20 (50% SBA+50% MTF),
• SEQ (Structured Essay Question)-20

• SAQ-50 (Short Answer Question) +
• FA (formative assessment) marks 10
• Structured Oral Examination= 100
• Practical=50, OSPE= 40 & Others (PM report, Injury certificate & Practical assignment) =10

 

Forensic Medicine & Toxicology
Section -01: Introduction to Forensic Medicine and Recent advances in Forensic Medicine
Contents

Core:
• Introduction to Forensic Medicine& its subdivision; medical jurisprudence
• Recent advances in Forensic Medicine
– Emerging issues in sex verification and disorder of sex development (DSD)
– Medico-legal issues in consent;
– Euthanasia: legal, social, and humanitarian aspects
– Legal and ethical issues in medical records.
– Legal issues in End life care & Palliative care
– Age of child: the legal perspective
– Analytic and Clinical toxicology
• Mass disaster: Introduction, effect, management strategies, disaster victim identification (DVI).
• Sports medicine (type, mechanism, management, and prevention of sports injuries.
• Forensic science:
– Trace evidence (blood stain, blood group, hair, semen);
– DNA Profiling.

 

Optional:
• Forensic science:
– criminalistics,
– crime scene investigation,
– forensic lab.
• Cybercrime, Basics of ICT.
• History and landmarks of Forensic medicine
• HLA typing and Bioinformatics

 

Section 3: Medical Jurisprudence (Medical ethics)
Contents

Core:
Medical ethics:
– WMA declaration Geneva declaration, international code of medical ethics
– BMDC: Bangladesh Medical &Dental Council (BMDC), its constituents, functions, and disciplinary control. the professional death sentence.
– Right & privilege, Duties.
> Rights and privileges of a doctor.
> Rights of patients.
> Duties of a medical practitioner toward patients & society, Professional secrecy & privileged communication.
– Doctor-patient relationship; Component; Skills
– Fairness and Equity; Specific Health Issues; Jargons in the field of medical ethics.
– Code of Medical ethic of BMDC
– Malpractice
> Ethical malpractice: Professional Infamous conduct
> Professional (Medical) Malpractice: civil and criminal Negligence
> Precautions, prevention & defenses against professional negligence
> Vicarious liability, Contributory negligence, corporate negligence; Res ipsa loquitor. Novus actus internet
– Medical maloccurance; Product liability.
– Applied ethics and research ethics
– Soft skill and humanities; End life care; palliative care

 

Additional:
• Code and law of medical ethics, its history
• Tokyo declaration1975, Helsinki declaration. Other important WMA declaration
• Ethical review board. The procedure of ethical review in a research proposal. Dealing with ethical dilemmas and conflicts.
• Organ transplant Act. MTP Act. Consumers Protection Act
• Legal provision related to medical practice.

 

Section 4: Forensic Pathology
Contents

Core:
01. Autopsy:
• Definition; Type; prerequisite; objective;
• Procedure: external, internal (opening body cavity, 3rd incision, removal of viscera, internal exam) and laboratory procedure; Report writing; opinion.
• Collection and dispatch of specimens.
• Inquest report: definition, type, content, magistrate inquest.
• Modern morgue.
• Exhumation: definition, procedure; importance; 2 nd autopsy.
• Forensic anthropology: Post Mortem exam of mutilated and skeletal remains.

 

Additional:
• Virtual autopsy procedure, Academic autopsy;
• Special Autopsy & disposal of a radioactive corpse.
• Recommendation of autopsy as per human rights commission.
• Clinical autopsy: Legal formalities, Procedure; Precaution; Importance
• Methods of preserving the dead body.

 

Core:
02. Death
• Mood and manner of death (natural/ unnatural)
> Asphyxia; syncope; coma
• PM changes after death:
> Immediate
> Early change: skin change, eye change, cooling of the body, hypostasis, rigor mortis
> Late change: putrefaction, adipocere formation, and mummification
• Post mortem artifacts: Resuscitative artifact, agonal artifact, and postmortem artifact.
• Sudden death.
• Custodial death.
• Anesthetic and operative deaths.

 

Additional:
• Radioactive carbon(C14) estimation
• Forensic entomology
• Death due to occupational and environmental hazards
• Dead body management & handling in disaster

 

Core:
03. Infanticide:
definition, legal bearing, cause of death, and mode of death.
a. Dead born (def, Spalding sign, maceration)
b. Live born
c. Stillborn

 

Additional:
• Precipitated labor
• Cot death, SIDS, feticide
• Death due to neglect

 

Core:
04. Violent asphyxia death:
• Hanging: def, types, cause of death, mechanism of death, PM finding, ML imp.
• Strangulation: definition, type, throat ling, ligature strangulation, cause of death, PM finding, ML imp.
• Drowning: Definition, types, pathophysiology, PM findings, cause of death, ML imp.
• Suffocation: smothering, choking, and gagging.

 

Core:
05. Wound: (L-6hrs; T-3hrs)
• Transportation wound:
– Trauma in RTA; cause, preventive device (helmet, seat belt syndrome);
– Injuries sustained by pedestrian; driver, motorcyclist; passenger; Crush syndrome.
– Objectives of autopsy in traffic wounds.

• Firearm and explosives:
– Fire arms, cartridge composition, fire arm injuries (entry and exit) according to range, medico-legal aspect.
– Bomb blast and explosion
• Electrocution and lightning.
• Autopsy (mass disaster) protocol

 

Additional:
• Transportation: Trauma in Railway disaster; River traffic, Air crush.

 

Section 5: Clinical Forensic Medicine
Contents

01. Death:
• Basic of death: definition, type, ML imp of somatic death; signs of death; cause, manner, mechanism of death; Brain death: types, signs, diagnostic criteria.
• Declaration of death.
• Suspended animation; presumption of death

 

02. Wound:
• Medico-legal aspect: injurywound, hurt, battery; grievous hurt;cause of death due to wound; homicide; defense wound;fabricated wound.
• Mechanical wound: abrasion, bruise, laceration, incised wound, and the puncture wound
• Regional injury:
– Head injury: Scalp, skull fracture, Intra cranial hemorrhage, brain injuries.
– whiplash injury.Crush syndrome.
• Domestic Violence: Battered Baby syndrom(BBS); Manchausen syndrome; violence against women.
• Thermal injury: Heat (Burn scald) and cold.
• Torture
• Neglect and starvation

 

Additional:
Chest injury, abdominal injury, genital injury, and extremity injury.

 

Core:
03. Forensic aspect of sex:
• Medico-legal aspects related to marriage.
• Impotency, sterility; Medico-legal aspect.
• Legitimacy; Paternity and maternity.
• Hymen: Type, cause of rupture; medico-legal aspect.
• Virginity and defloration.

Sexual offenses:
• Natural: Rape, Adultery, Incest.
• Unnatural: sodomy, Lesbianism, Buccal coitus, Bestiality
• Investigations: Collection & dispatch of the specimen (HVS, stain, hair, blood); radiology

Medico-legal report preparation: Impotency, fixation of paternity & maternity, report on sexual violence; rape.

Sexual perversions: sadism, masochism, voyeurism, necrophilia, necrophage.

 

Additional:
• Psychosexual instinct;
• legal provisions related.

 

Section 6: Identification
Contents

CORE:
Identification:
• Definition, types, objectives, and method of identification.
• Identification traits; Identity of living persons & dead bodies.
• Race, religion, sex.
• Age: medico-legal importance; estimation of age.
• Tattoo, scar, stature, mole, birthmark
• Stature, occupational marks.
• Trace Evidence.
• Forensic Dactylography.
• Forensic Radiology: introduction, scope, and medicolegal issues.
• Forensic Odontology: introduction, scope, and forensic issues.
• Bite marks; Modern technologies used in the identification
• Identification of mass death & examination of human remains.

 

Additional:
• X-ray identification.
• Superimposition. Lip print
• Brain fingerprinting;
• Lie detector.
• Biometrics; retina scan, Iris scan.
• Forensic Voice analysis
• Questioned document examination
• Forensic ballistic

 

Contents

Forensic aspect reproduction:
• Artificial insemination and other artificial methods of conception with medico-legal implications (Inflowing).
• Surrogated mother & baby.
• Pregnancy: Medico-legal importance; Signs of pregnancy& duration. PM finding of pregnancy
• Delivery: signs of recent & remote delivery in living & dead.
• Abortion: types, methods, complications, management duties of the medical practitioner.
• Indication of therapeutic abortion. Spontaneous, Artificial (justifiable and criminal abortion).

 

Additional:
• Feticide and viability; IUF death.
• MTP act;
• Infertility & its medico-legal issues; Invitro Fertilization

 

Section-08
CORE:
• Definition of forensic psychiatry. Classification of mental disorder, lucid interval, testamentary capacity.
• Important terms of forensic psychiatry. Elements of forensic psychiatry (psychosis, neurosis, delirium, delusion, illusion, hallucination, confabulation, phobia, impulse, etc.)
• Issues of incompetency to stand trial/event.
• Criminal responsibility of an insane person.
• Personality disorder related to crime.
• Aggressive behavior and medicolegal issues
• Diminished responsibility.
• Civil and Social responsibilities.
• Substance abuse affects the mental state
• True insanity and feigned insanity:
• Rules in relation to forensic psychiatry.

 

Additional:
• Mental health act
• Advances in forensic Psychiatry
• Psychosexual instinct

 

Section-09: Forensic Toxicology
Contents
Toxicology

CORE:
General aspects of poisoning:
• Forensic Toxicology. Legal provisions related to Poisons & poisoning.
• General aspect of toxicology.
• Poisons. Classification of poisons.
• Factors modifying the action of the poison.
• Antidote. • Principles of Management of acute & chronic poisoning.
• Prevention of domestic poison & therapeutic poison.

 

Specific Poisoning:
• Corrosive poisons: strong acids and alkalis.
• Acetaminophen (paracetamol) poisoning.
• Metallic poisons: Lead, Arsenic, Copper, and Mercury.
• Deliriants: Datura, Cannabis.
• Somniferous agents: Opium and its derivatives; Hypnotics- Barbiturate.
• Inebriates: Alcohol, methyl alcohol.
• Petroleum product: Kerosene oil.
• Gaseous poisons: Carbon monoxide, Chlorine, CO2, Cooking gas (methane).
• Insecticides: Organo-phosphorus comp (OPC) and chloro-compound.
• Snake Bite.
• Drug dependence and drug abuse. Doping.
• Food poisoning.
• Potka fish (Pufferfish)

 

Additional:
• Spinal poison; Cardiac poison; cocaine;
• Organic irritant: ricinuscommunis; ergot; arbusprecatorius; calatropis; cantharides; scorpion.
• Clinical toxicology; Environmental toxicology; Occupational toxicology; Analytic toxicology.

 

Section-10: PRACTICAL
Contents

A. Demonstration: (18hrs)
• Demonstration & observation of ten medico-legal autopsies.
• Observation/examination of intoxicated persons in the ward (Indoor).
• Flip chart
• Weapons: Blunt weapons; Sharp Cutting weapons; sharp pointed
• Dangerous weapon: firearms
• Forensic photograph:
– Identity: Tattoo; fingerprint; Barr body & Davidsons body
– Thanatology: Marbling, degloving, demonstration rigor mortis
– Asphyxia death: Ligature marks; FB in trachea (Choking) Hanging; Strangulation; Partial hanging; smothering; sexual asphyxia; traumatic asphyxia; diatoms; drowning.
– Trauma: Hesitation cut; fabricated injury; incised wound; cut throat wound with hesitation mark; defense wound; shotgun injury; pattern abrasion; graze abrasion; contact rifle entry wound; chop wound; pugilistic attitude; soot particle in the trachea; Lacerated wound;
• Toxicology specimen(poison)
• Corrosives: Hcl,H2SO4, HNO3, carbolic acid;Oxalic acid; Salicylic acid; corrosive alkali.
• Inorganic: lead; copper; Arsenic; Mercury; Phosphorus.
• Organic: chili seeds; Snake.
• Systemic:
– CNS: inebriants (Alcohol; methyl alcohol); deliriants (Dhatura, Cannabis Indica); Poppy (Opium); Nux vomica
– Insecticides: OPC; Chloro-compound
• Domestic: kerosene; naphthalene; harpic; savlon; Dettol.

B. Exercise: (22yrs)
• Preparation of certificates on the following Medico-legal situations:
– Prepare 5-10 Injury report
– Prepare 10 Postmortem reports
– Prepare the death certificate according to ICD-10 with the recording of the death note.
– Prepare medical (fitness & sickness) certificate; discharge certificate; Birth certificate.
– Prepare a report on Insanity.
– Prepare age estimation report.
– Prepare a report of sexual assault.
• Recoding Dying declaration.
• Examine for estimation of the age of a person.
• Examine victims of physical assault.
• Examine victims of sexual assault.
• Examine a drunkenness case
• Management of poisoning case
• Age estimation from bones by X-rays.
• Assignment.

C. Observation
D. Experiment:
E. Role play: Drunkenness Infamous conduct
F. Presentation
G. Problem-solving:

 

Section-11: Observation of ten Medico-legal Autopsies
Contents

– College authority will contact and fix the schedule with a suitable time & date to attend.
– Transport will be provided by the college authority

 

Section-12: Day visit-06
Contents
Visit to court.
Visit the police station
One-stop Crisis Center (OCC)
DNA lab. Forensic lab