Repeated Medical PG Question- 85

#FORENSIC MEDICINE (NEET-PG)

Q- A middle-aged man presented with paraesthesia of hands and feet. On examination of his hands the following was seen. The most probable diagnosis is 

A. Lead poisoning

B. Arsenic poisoning

C. Thallium poisoning

D. Mercury poisoning

 

Answer:B. Arsenic poisoning

The image shows raindrop pigmentation as characteristically seen in Arsenic Poisoning 

There is patchy brown (not black) pigmentation of the skin.

Chronic arsenic poisoning has four stages 

>The first stage (nutritional and gastrointestinal disturbances): The earliest sign is gradual emaciation. There is a loss of appetite, nausea, and intermittent vomiting and diarrhea.

>The second stage (catarrhal changes): It resembles common cold, i.e. conjunctivitis, running nose and eyes, coughing, etc.

>Third stage (skin rash): There is classical 'raindrop pigmentation', i.e. patchy brown pigmentation of the skin. At initial stages, there is a vesicular eruption that may resemble nettle rash. Hyperkeratosis of palms and soles occurs. There are white transverse bands crossing the nails, known as Mee's line, and indicate periods of arrested growth due to interference with normal metabolism. There are alopecia and exfoliative dermatitis.

>Fourth stage (nervous disturbances): There is sensory and motor (i.e. mixed) polyneuropathy, with painful paresthesia of hands and feet and muscle tenderness.

Q- In a case of a gun shot injury to skull with entry wound surrounded by abrasion collar & tattooing and a exit wound along with metal fragments of bullet inside the bullet track, what will be preserved for calculating the range of firing? 

        A. Hair

        B. Bullet pieces

        C. Blood

        D. Clothes

Answer is A. Hairs

•To calculate range, required findings are presence of burning or singeing (d’ flame), blacking (d’ smoke) & tattooing (d’ gun powder). 

•Given finding is tattooing which is seen upto intermediate range.

•To check if the gun was fired from near, then hairs should be analysed for presence of any singeing or smoke deposits

•The same can be done with clothes however the injury here is on the skull hence the hairs