Forensic Medicine Basics

Forensic vs. Clinical Medicine

• Forensic medicine investigates injuries and pathological processes for legal purposes.
• Clinical medicine focuses on diagnosis and treatment.

Methods to Determine Time of Death

• Body temperature assessment, livor mortis, rigor mortis, and chemical changes in organs and tissues.

Most Accurate Method for Determining Time of Death (First 24 Hours)

• Determining potassium levels in the vitreous humor of the eye.

Factors Distorting Forensic Investigation Results

• Decomposition, microclimatic conditions at the scene, and anatomical anomalies of the deceased.

Types of Forensic Examinations in Violent Deaths

• Autopsy, biological trace analysis, forensic histological and toxicological examinations.

Forensic Medical Expert Role

• Analyzing the nature, shape, and location of injuries to establish their cause and possible weapon used.

Determining Mechanism of Injury

• The nature of injuries, their distribution, estimated force, and direction of impact are all important

Features of Forensic Medical Examination of Living Individuals

• Assessing overall health status, determining the severity of injuries, and analyzing possible signs of violence.

Factors Influencing Livor Mortis Formation

• Body position, blood pressure at the time of death, and ambient temperature.

Circumstances for Forensic Expert Exhumation Involvement

• When a second examination of the cause of death is required.

Forensic Identification Methods in Mass Disasters

• Fingerprinting, DNA analysis, and anthropological examination.

Standard Procedure for Forensic Autopsy

• External examination, opening of thoracic, abdominal, and cranial cavities, and examination of internal organs.

Biological Materials for Toxicological Poisoning Detection

• Blood, urine, stomach contents, liver, kidney, and brain tissues.

Bone Changes Indicating Fracture Age

• Degree of bone remodeling, presence of a callus, and structural changes in bone tissue.

Determining Severity of Bodily Injuries

• Based on criteria established in criminal law and medical regulations.

Parameters Analyzed in Strangulation Evidence

• Presence of fractures in the hyoid bone, hemorrhages in neck muscles, and condition of blood vessels.

Characteristic Signs of Electrical Injury

• Electrical burns, coagulation of tissues, and damage to the nervous system.

Forensic Medicine Studies

• Issues arising at the intersection of medicine and law, including causes of death, mechanisms of injuries, and personal identification.

Emergence of Forensic Medicine as Independent Science

• 17th century: The state began systematically using medical knowledge for legal purposes.

Ancient Legal Document with Forensic Medicine References

• The Code of Hammurabi: established punishments for medical errors.

Founder of Forensic Medicine as a Scientific Discipline

• Fortunato Fedele: first systematized forensic medical knowledge.

First Department of Forensic Medicine in Russia

• Established in 1805, at the Medical-Surgical Academy to train medical experts.

Russian Scientist's Contribution

• V. P. Vorobyov: created the first forensic medical expertise manuals.

Legal Document Defining Forensic Medical Examination Framework

• The Criminal Procedure Code: establishes procedural norms for expert conclusions.

Who Can Appoint a Forensic Medical Examination

• An investigator, court, prosecutor, or inquiry officer within criminal and civil proceedings.

Document Prepared After Forensic Medical Examination

• The expert conclusion containing answers to the investigative questions.

Cases for Forensic Medical Examination

• In criminal investigations where the cause of death or nature of injuries needs to be determined.

Main Task of Forensic Medical Expert

• Conducting research to determine causes of death, nature of injuries, and severity of bodily harm.

Authorized to Conduct a Forensic Medical Examination

• Forensic medical experts with specialized training.

Organization Coordinating Forensic Activities

• The Ministry of Health.

Cases for Repeated Forensic Medical Examination

• Only by court order if new circumstances are discovered.

Name of Initial Examination at Crime Scene

• Preliminary body inspection followed by documentation.

Who Can Be Present During Autopsy

• Representatives of investigative authorities and interested parties with permission.

Examination of Living Individuals Includes

• Examination of the body, identification of injuries, and determination of their age.

Difference Between "Dying" and "Death"

• Dying describes the process of vital functions fading, while death is the irreversible cessation of organism activity.

Main Criterion for Biological Death

• Irreversible cessation of brain function.

Difference between Clinical and Biological Death

• Clinical death is potentially reversible with timely resuscitation, whereas biological death involves irreversible cell changes.

Not Included in Forensic Classification of Death

• Clinical death

Death Characterized by Aging or Disease

• Natural death

Primary Characteristic of Violent Death

• Caused by external factors such as mechanical trauma, chemical exposure, or electric shock.

Not Considered Violent Death

• Death from myocardial infarction.

Early Postmortem Changes

• Algor mortis and livor mortis.

Adipocere Formation

• Waxy, soap-like transformation of fatty tissues due to moisture and bacterial activity.

Rigor Mortis

• Biochemical changes in muscles causing postmortem stiffening.

Postmortem Lividity Full Development

• 10–12 hours.

Muscle Fixation in Rigor Mortis

• Muscle fixation in a specific position due to ATP depletion.

Influencing Factors of Rigor Mortis Onset

• Environmental temperature, physical condition of the deceased, cause of death.

Late Postmortem Change Classification

• Tissue decomposition due to bacterial activity.

First Visible Sign of Decomposition

• Greenish discoloration of the lower abdominal wall.

Conditions Promoting Mummification

• High temperature and dry air.

Primary Purpose of Corpse Examination at Discovery Scene

• To establish the circumstances of death, document the body's position, note any injuries, and collect forensic evidence.

First Step in Forensic Examination at Crime Scene

• Documenting the position of the body, surrounding environment, and visible injuries.

External Factors to Document During Forensic Examination

• The position of the body, location of lividity, environmental conditions.

Determining Postmortem Lividity (Fixed or Movable)

• To determine whether the body was moved after death.

Differentiating Dying from Death in Forensic Medicine

• Dying: sequence of physiological reactions; death: irreversible cessation of metabolic processes.

Definitive Criterion in Determining Biological Death

• Permanent loss of the ability to generate bioelectrical activity in the cerebral cortex.

State Sometimes Mistaken for Death

• Post-hypothermic cardiac arrest with residual brain activity.

Category Determined by Pathological Findings

• Sudden cardiac death due to arrhythmogenic right ventricular dysplasia.

Pathological Mechanism Differentiating Sudden from Natural Death

• Sudden death occurs without premonitory symptoms and is associated with acute systemic dysfunction.

Pathognomonic Finding in Homicidal Suffocation

• Bilateral conjunctival petechiae accompanied by a fracture of the greater horn of the hyoid bone.

Most Influential Factor in Algor Mortis

• The presence of insulating clothing and the ambient humidity

Determines Livor Mortis Fixation

• Breakdown of capillary endothelial integrity and hemoglobin denaturation.

Observation Suggesting Postmortem Displacement

• Presence of dual lividity patterns with varying degrees of intensity.

Biochemical Process Underlies Rigor Mortis Development

• Depletion of ATP, leading to irreversible actin-myosin cross-bridge formation.

Rigor Mortis Develops Most Rapidly Under

• Elevated ambient temperature and significant muscular exertion prior to death.

Forensic Significance of Late-Stage Decomposition

• Extensive adipocere formation suggests a postmortem interval of at least several months.

Distinguishing Feature of Mummification

• Rapid desiccation of soft tissues with preservation of structural morphology.

Primary Forensic Value of Adipocere Formation

• It significantly slows the rate of tissue decomposition, preserving forensic evidence.

Primary Goal of Forensic Body Examination at a Crime Scene

• Documenting the body's position, injuries, and environmental context before any alterations occur.

Crucial External Body Examination Observations at the Scene

• The distribution of postmortem lividity and any signs of body repositioning.

Importance of Assessing Postmortem Lividity (Fixed or Unfixed)

• To determine if the body was moved after death based on livor mortis displacement.

Scenario for Using Forensic Entomology

• When decomposition is advanced, and conventional postmortem changes provide insufficient information.

Horizontal Ligature Mark Indicates

• Manual Strangulation

The Estimated Postmortem Changes Can Determine Time of Death Interval

• 12–24 hours

Soap-Like Transformation of Fat in Corpses

• Saponification

Wnat Is The Most Reliable Method For Determining Time Of Death In A Decomposed Body

• Forensic entomology, where the life cycles of insects feeding on the body provide an accurate timeline

What is characteristic of an electrocution victim?

• Lichtenberg figures, a branching pattern of erythematous lesions on the skin caused by electrical discharge.

Which factor does NOT influence the rate of postmortem cooling (algor mortis)?

• The blood type of the deceased

What external sign suggests that a fire victim was alive at the time of the fire?

• High carboxyhemoglobin levels in the blood, indicating inhalation of smoke

If a body is found with livor mortis fixed anteriorly but discovered in supine position the following can be inferred

• The body was repositioned after livor mortis had become fixed

How does the forensic examination determine drowning as the cause of death?

• By detecting the presence of diatoms in the lungs and bone marrow, indicating water inhalation

What is the primary goal of forensic medical examination of a newborn's corpse?

• To establish whether the infant was stillborn or born alive and the cause of death

What is the most reliable method to determine whether a newborn was born alive?

• The hydrostatic test (floating lung test)

The hydrostatic (floating lung) test is based on which principle?

• The presence of air in the lungs causes them to float in water if the infant breathed after birth

In a forensic examination of a newborn, which feature is most indicative of stillbirth?

• Atelectatic lungs that sink in water

Which forensic method helps determine whether a newborn had an independent circulation before death?

• The histological examination of umbilical vessels

Which feature is NOT useful in distinguishing between antemortem and postmortem injuries in a newborn?

• Degree of rigor mortis development

What forensic finding suggests a newborn was a victim of infanticide?

• Evidence of umbilical cord strangulation with subcutaneous hemorrhages

What does the Fodere test assess in forensic neonatal examination?

• The ability of gastric contents to float in water

Which of the following indicates a prolonged intrauterine death of a fetus?

• Maceration of the skin with epidermal slippage

How can forensic experts differentiate between death due to suffocation and stillbirth?

• By performing the histological examination of lung alveoli

In cases of suspected drowning of a newborn, what forensic finding supports the diagnosis?

• Hyperinflated lungs with fluid-filled alveoli

What external feature helps estimate the gestational age of a deceased newborn?

• The presence of lanugo, vernix caseosa, and ear cartilage firmness

B) It can provide evidence of umbilical cord strangulation

• The baby was born alive; however, respiratory failure occurred due to asphyxia shortly after birth.

B) Skull fractures with underlying intracranial hemorrhage

• Which of the following findings is most prominent in a traumatic birth injury?

To confirm intrauterine respiration based on the liver's buoyancy

• What Is The Significance Of The Liver Flotation Test In Newborn Forensic Examination

C) Peeling and softening of the skin without gas formation

• Which Characteristic Distinguishes Maceration From Putrefaction In A Stillborn Fetus

The Presence Of Aerated Lungs Confirmed Hydrostatically

• How Does Forensic Pathology Confirm Live Birth When Examining a Newborn?

Compression

• The Most Accurate Reliable Marker Is The Presence Of Endothelial Damage

B) The newborn was stillborn and never took a breath

• Based on the following evidence, provide any conclusions in relation to neonates?

B) Petechial hemorrhages and abrasions on the neck

• Which of the following conclusions are accurate?

Drowning after live birth

• What forensic finding is expected in an individual that may have drowned?

To establish whiter the infant was stillborn or born alive and the cause of death

• Why is it essential to conduct a forensic examination of neonates?

B) Moderate harm to health

• A 27-year-old woman was strangled during a domestic violence incident. She lost consciousness briefly and has petechial hemorrhages on her face. Oxygen saturation is normal, and CT imaging shows no airway damage. How should the injury be classified?

Severe harm to health

• A factory worker is hurt at the workplace due to negligence on behalf of the company. What type of harm to health is this?

B) Presence of inflammatory response and active bleeding

• What is the role of inflammatory responses and wound care?

B) The location and severity of injures of the genetalia should be included

• Why is the forensic examination needed from the report of the coroner

The location and severity of injuries

• Whay is the most important part of the forensic report according to the physician

The inability to distinguish between consensual and non-consensual intercourse based on physical evidence alone

• How is consent determined

Cardiac arrhythmia due to electric current

• When electrocution occurs

Is the victim was alive and breathing when the fire started

• Fire investigation regarding a woman

B) Rapid deceleration forces during impact

• What is the cause of mortality due to a vehicle accident

Blast lung injury

• 1. What is the cause of mortality after an explosion

"B" incised wound

• What type of injury is described in the scenario

###B) The presence of tire tread marks on the body

• The type of victim in the following scenario

###To determine whether sexual contact occurred and assess for force or coercion What is rape?

"C" 1- 2 weeks

Estimated timeline of the wounds ####C) An injury resulting in a life-threatening condition, permanent disability, or loss of organ function is considered a servere injury

• What injury is this considered?

Which One Of The Following Injuries Is Most Likely To Be Classified As Moderate Harm To Health?

• A Non-Displaced Rib Fracture With No Complications

What Primary Injury is Sustained from a High Speed Collision Resulting in a Death With the Driver Not Wearing a Seatbelt?

• Severe Head Trauma From Ejection

What Key Forensic Finding Is Observed When Strangers Commit Homicide?

• Hyoid bone/ conjunctiva

What Evidence Pertains To drowning As Reason For Demise

• Water in lungs and diatoms in alveolar bone

What are the following blast trauma injuries? What are they categorized as *

• Primary, secondary, tertiary and quatarnary is blast trauma injuries

An individual that sustained wounds while in a high speed setting was alive "true or false"

• When the victim has soot inhalation and elevated carbonlyhemoglobin levels is an indicator of a victim that was still alive

What Was The Finding And Sign Suggesting That Heatstroke Was Present

• The rectal region is above the 41 degree with multiorgan failure

what is the Most Characteristic Of Head Stroke Forensic Examination

• High Temperatures with Multiple Organ Failure

When a gunshot is not close range what is the description

• Distant range gunshot wound

What can the team use to identify the source when dealing with high speed

• Distance the body was thrown