Monday, 20 October 2014

FM points

Imp point's:  FMT

1.Mercury poisoning

Black TEA P Le
Black - black blue line on gums
T - tremors- danberry/hatter/glass bowler
E - Erethism
A- acrodynia
P - PCT mainly involved,pink disease
Le- lentis/mercuria lentis

2.LEAD poisoning

New- neuropathy & nephropathy
A - anemia with punctate basophilia
B - burtonian or blue stippled lead line
C - colic & constipation
D - dry belly ache
E- encephalopathy
F - facial pallor

Tache noir- dessicated discolouration on sclera
on either side of iris.
Changes in eye- rise in K+ in vitreous humor.
Algor mortis- cooling of the body after death.
Post mortem caloricity- temp of body remains
for 2 hours after death.
Post mortem lividity/ livor mortis- bluish purple
discoloration of skin due to accumulation of
blood in small vessels by gravity.
Rigor mortis/ cadaveric rigidity- stiffening of muscles due to fall in ATP
Cataleptic rigidity/cadaveric spasm/
instantaneous rigor- direct stiffening widout ny relaxation
Mummification- drying of body due to evaporation.
Embalming= treatment of dead body wid antiseptics and preservatives to prevent
putrefaction leading to permanent rigidity.
Dactylohraphy- study of ridge pattern of skin and fingers
Poroscopy- pores of finger prints
Ridgeology- friction ridges
Edgeoscopy- edges of friction ridges.
Hara- kiri= unsual type of suicide whr victims falls on a short sword leading to evisceration of
intestines.
Arborescent/ filigree burns- seen in lightning
Cutis anserine- granular, puckered appearance of skin after drowning
Lynching- homicidal hanging where suspect is hanged by mob
La facie sympathiqie- when ligature knot presses on cervical sympathetic, the eye on the same
side may remain open wid pupils dilated, tongue forced against teeth, dribbling of saliva.
Bansdola- 2 bamboo sticks each placed in front and back and tied with rope
Garrotting- ligature thrown over neck and tightened by twisting over a liver or rod.
Burking- homicidal smothering and traumatic asphyxia
Cafe coronary- high alcohol content anesthetises gag reflex leading to food piece choking the larynx.
Gerontophilia- passive agent is an adult
Paedeeasty- passive agent is a child( catamite)
Algolagnia= sadism+masochism
Trolism- threesome
Mixoscopia- watching others engaged in sex
Oedipus- sexual desire of son towards mother
Electra- daughter towards father
Pharoan- brother towards sister
Maceration(aseptic autolysis)- not seen if child is
born within 24 hours of death
Spalding sign- overlapping of cranial bones
Benzidine test- best initial test for blood stain detection
Kastle Mayer test- phenolphtalein test
Haemin crystal test(Teichmann's)- not useful for old stains
Haemochromogen test(Takayama) - more specific for old stains

Seminal fluid exam
Florence test- brown crystals of choline iodide
Barberio test- yellow needle shaped rhombic crystals of spermine picrate
Acid phosphatase test- conclusive test in absence of sperms or aspermia

Arsenic poisoning
Arsenic poisoning mimics cholera
Aldrich mees lines- white lines on finger nails
seen in arsenic poisoning
Fatal dose= 0.1- 0.2 gm
Tx- ferric oxide
Post mortem app- red velvety mucosa of stomach,renal tubular necrosis

Cyanide poisoning
Sources- oil seeds, beans, bamboo shoots,almonds
Causes histotoxic hypoxia
Inhibits cytochrome oxidase
Dx- Lee Jones test
Fatal dose- 200-300 mg Na cyanide
Fatal period- 2 to 10 mins
Tx- hydroxycobalamine, na thiosulphate, amylnitrite
Post mortem app- odour of bitter almond and cherry red post mortem staining

Cannabis poisoning
Active substance- delta-9-Tetrahydrocannabinol(THC)
Run amok- impulse to murder
Fatal dose- 30 mg/kg (THC)
Tx- naloxone + glucose + thiamine, diazepam, gastric lavage , psychotherapy

H2SO4 poisning
Sx- chalky white teeth, black vomit and tongue
Fatal dose- 5 to 10 ml
Fatal period- 12 to 24 hours
Tx- avoid gastric lavage, NPO, Ca/Mg oxide, olive oil, prednisolone
Post mortem app- soft, spongy, black stomach wid perforation
Dx- barium nitrate/chloride test

Vitriolage- throwing sulphuric acid on other person

Nitric acid poisoning
Xanthoproteic reaction- yellow discoloration of tissues(picric acid)
Fatal dose- 5 to 10 ml
Fatal period- 12 to 24 hours
Tx- same as sulphuric acid
Post mortem- yellow discoloration of tissues, brown black stomach(hematin)
Dx- ferrous sulphate test

HCl poisoning
Sx- grey white mucous membrane
Fatal dose- 15 to 20 ml
Fatal period-18 to 24 hours
Tx- same as above
Post mortem- brownish folds of stomach mucosa
Dx- silver nitrate test

Carbolic acid poisoning
Sx- green urine, cns depression, pulmonary edema
Fatal dose- 1 to 2 gm
Fatal period- 3 to 4 hours
Tx- gastric lavage wid 10% glycerine, MgSO4,castor oil, activated charcoal, demulcents, saline
Post mortem- corrosion of skin,leathery mucus membrane of stomach

Oxalic acid poisoning
Sx- shock, hypocalcemia, renal tubular necrosis,
coffee colored vomitus, uraemia
Fatal dose- 15 to 20 gm
Fatal period- 1 to 2 hours
Tx- gastric lavage wid calcium gluconate
Antidote- any calcium preparation, Parathyroid extracts
Post mortem- bleached scalded app of tongue and git mucosa, renal tubular necrosis
Dx- barium nitrate test

Organophosphate poisoning
MOA- ach esterase inhibition
C/f- salivation, lacrimation, urination, defecation,
git distress, emesis( SLUDGE), muscle weakness,
tachycardia, headache, tremor, ataxia
Chromolachyrrhoea- red tears d/t pophyrin accumulation
Fatal dose- 1 gm orally
Fatal period- 24 hours
Tx- atropine sulphate 2 to 4 mg i.v.,
pralidoxime, activated charcoal
Post mortem- signs of ataxia

Carbamate poisons
Eg. Carbaryl, apocarb(baygon)
MOA- carboxylic esterase inhibition
Sx- same as organophosphates wid limited CNS toxicity
Tx- atropine

Aluminium phosphate
MOA- cytochrome oxidase & respiratory chain enzyme inhibitor
Sx- respiratory distress, arryhmias, cardiogenic shock
Fatal dose- 0.1- 0.5 gm
Fatal period- 1 to 100 hours
Tx- gastric lavage wid potassium permengnate, MgSO4, liquid paraffin
Post mortem-garlic like odour, blood stained froth, congestion of git/ liver

Alcohol poisoning
Tx- glucose, thiamine, caffeine, strychinine
Post mortem- alcoholic odour, acute
inflammation of stomach, congestion and edema of brain meningis
Chronic poisoning- deep red brown gastric mucosa, fatty liver and heart
Widmark formula- calculation of blood alcohol
based on age, sex and type of liquor
Delirium tremens- most severe alcohol withdrawal syndrome
Wernicke's- Korsakoff psychosis- thiamine def in chronic alcoholics
Marchafava- Bignami disease- degeneration of corpus callosum in chronic alcoholics
Mallory Weiss disease- esophageal tears wid mediastinitis

Salicylate poisoning
Aspirin
Fatal dose- 15 to 20 gm
Reye's syndrome- hepatic failure wid
encephalopathy
Dx- ferric chloride test
Tx- emetics, NaHCO3, vit C
Post mortem- dilated pupils, congested and eroded gastric mucosa, subpleural, subendocardial hemmorhage

Lead poisoning
Fatal dose- lead acetate 20 gm, lead carbonate
40 gm
Lead compounds- vermillion( lead tetraoxide)
Sx- basophilic stippling of erythrocytes(punctate
basophilia), burtonian lines on gums, lead palsy leading to wrist and foot drop
Dx- coproporphyrin in urine, amino levulinic acid in urine, lead in blood and urine
Tx- MgSO4 lavage, EDTA penicillamine.

Opiod poisoning
Derived from papaver somniferum(poppy plant)
Fatal dose- opium 2 gm, morphine 0.2 gm,
codeine- 0.5 gm
Tx- gastric lavage wid K permenganate, naloxone
Dx- Marqui's test

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