#Kathmandu University

#BIRAT MEDICAL COLLEGE

Budhiganga-02, Tankisinuwari, Morang

Level: III MBBS (Batch: 2022)
Semester: 7th
Time: 2 hrs. 30 mins.
Date: March 15, 2026

Examination: Pre-University
Subject: Forensic Medicine
Marks: 50

#INSTRUCTION TO THE CANDIDATE

• Answer each section in a separate answer book.

• Write brief, relevant and legible answers.

• Illustrate your answer with well labeled diagrams where required.

• All questions are compulsory.

#SECTION ‘B’

#Short Answer Questions [6Q × 5 = 30 marks]

1. Describe the early stages of postmortem changes in the body, mentioning at least two features for each stage. [2+4=6]

2. Define asphyxia. Describe Gordon’s classification of asphyxia with one example for each type. [2+4=6]

3. A 25-year-old woman, Emily, presents to the hospital after the discovery of her deceased newborn in her apartment. The infant was found unresponsive, wrapped in a blanket. A post-mortem examination is conducted to determine the cause of death and to ascertain whether foul play was involved.
a. What are the key aspects a forensic pathologist should examine during the post-mortem of a newborn? [2]
b. List the possible causes of death that should be considered in suspected infanticide? [2]
c. What investigations and tests can be performed to help establish infanticide? [2]

4. A 10-year-old girl is brought to the emergency department with unexplained bruises and signs of neglect. The medical team suspects child abuse and must follow the appropriate procedures and legal obligations.
a. What mandatory legal obligations do healthcare providers have when they suspect child abuse? [2]
b. How should clinical findings be recorded and documented to support potential legal proceedings? [2]
c. Describe two short-term and two long-term psychological effects that child abuse can have on a child. [2]

5. A 28-year-old man stabbed his neighbor during an argument, reportedly saying, “The voices told me to harm him,” while appearing confused and unresponsive to reasoning. Medical evaluation revealed schizophrenia in an active psychotic episode and he was sent for forensic psychiatric assessment of criminal responsibility.
a. Define criminal responsibility in the context of mental illness. [2]
b. Name the legal test used to determine insanity at the time of the offense. [2]
c. What is the role of a forensic psychiatrist in such cases? [2]

#SECTION ‘C’

#Problem Based Questions / Modified Essay Questions [2Q × 10 = 20 marks]

#Problem–I

A 28-year-old male is brought to the Emergency Department after a fight in a bar. He has a stab wound in the left lower chest. He is pale, sweating, and restless. Vital signs: Blood pressure: 90/60 mmHg; Pulse: 110/min; Respiratory rate: 28/min. On examination: A single penetrating wound with clean edges is seen below the left nipple. Chest auscultation reveals decreased breath sounds on the left side. FAST scan shows free fluid in the pericardial area and left hemothorax. The patient is rushed to surgery.

a. Explain why a stab wound in the left lower chest can be immediately life-threatening, even if the external wound appears small. [2]
b. Which internal organs are at highest risk of injury in this location, and why? [2]
c. Name two wound features that may help a forensic expert distinguish homicidal from accidental stab wounds. [2]
d. What is meant by the term “wound track” and how can it help in medico-legal reconstruction of the incident? [2]
e. If defensive injuries are present on the patient, what is their significance in determining the manner of injury? [2]

#Problem–II

A 30-year-old male is brought to the Emergency Department after being found unconscious inside a poorly ventilated storage shed. Bystanders reported a strong garlic-like odor. An open container of pesticide tablets used for grain fumigation was found nearby. On arrival, the patient developed profound hypotension that was poorly responsive to initial fluid resuscitation. On examination he is tachypneic and has altered mental status. Vital signs: Heart rate: 120 bpm; Blood pressure: 80/50 mmHg; Oxygen saturation: 85% despite supplemental oxygen. Laboratory findings: Severe metabolic acidosis; Elevated lactate levels. A family member confirms that he had recently been using a pest control product for stored grains.

a. What is the most likely diagnosis? [2]
b. What is the mechanism of toxicity of this compound? [2]
c. What are the immediate management priorities in this patient? [2]
d. What postmortem findings are expected in fatal cases? [2]
e. What preventive measures can reduce the risk of such poisoning in occupational settings? [2]