Asphyxial deaths, thermal and electrical injuries

28 NEET-PG practice questions on Asphyxial deaths, thermal and electrical injuries, part of Forensic Medicine. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   A 30-year-old electrician in Coimbatore collapses and dies after touching a live 230 V household wire. On his right palm is a small, round, greyish-white, crater-like lesion with raised edges and a pale halo around it. What is this lesion called?

   1. ACrocodile-skin burn
   2. BJoule burn (electric mark)
   3. CContact flame burn
   4. DLichtenberg figure

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   Answer: B · Joule burn (electric mark)

   The electric mark, or Joule burn, forms at the point where current enters through firm contact. Heat from the current at the high-resistance skin produces a small, round, grey-white crater with raised margins and a pale areola from local vessel spasm. It is the most important external sign of low-voltage electrocution, so the hands and points of contact must be searched carefully. Crocodile-skin burns follow high-voltage arcing, and Lichtenberg figures follow lightning.

   • A: Crocodile-skin burns come from high-voltage arcing over a wide area.
   • C: A flame burn causes blistering and singeing, not a pale crater with raised edges.
   • D: Lichtenberg figures are fern-like marks seen after lightning.

2. Question 2 · Medium

   A 10-year-old girl slips into a freshwater irrigation canal in Punjab and is pulled out dead within a few minutes. The autopsy surgeon explains the classically taught mechanism of death in freshwater drowning to the police. What is it?

   1. ALaryngeal spasm without water entering the lungs
   2. BHypertonic water drawing plasma into the alveoli
   3. CHaemodilution, haemolysis and hyperkalaemia causing VF
   4. DCold water causing reflex vagal arrest

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   Answer: C · Haemodilution, haemolysis and hyperkalaemia causing VF

   Fresh water is hypotonic, so large volumes are absorbed from the alveoli into the circulation, causing hypervolaemia and haemodilution. Red cells swell and lyse, releasing potassium, and the hyperkalaemia with hypoxia leads to ventricular fibrillation, which explains the rapid death classically described in freshwater drowning. In seawater drowning, hypertonic water draws plasma into the alveoli, causing pulmonary oedema and haemoconcentration, and death is slower. Modern studies show that hypoxia is the main cause in both, but the classical contrast is still taught.

   • A: Laryngeal spasm without aspiration describes so-called dry drowning, not the classic freshwater mechanism.
   • B: Hypertonic water drawing plasma into the lungs describes seawater drowning.
   • D: Reflex vagal arrest (immersion syndrome) causes death without features of drowning.

3. Question 3 · Easy

   A 19-year-old student is found hanging from a ceiling fan in her hostel room in Kota, suspended by a dupatta tied with a knot behind the left ear. Which ligature mark is typical of hanging?

   1. AHorizontal, complete, at the thyroid cartilage
   2. BHorizontal, complete, below the thyroid cartilage
   3. COblique, incomplete, above the thyroid cartilage
   4. DOblique, complete, below the thyroid cartilage

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   Answer: C · Oblique, incomplete, above the thyroid cartilage

   In hanging, the body weight pulls the ligature up under the jaw, so the mark runs obliquely upwards towards the knot, lies above the thyroid cartilage and is incomplete, with a gap at the knot. In ligature strangulation, the ligature is pulled tight around the neck, giving a horizontal, complete mark usually at or below the thyroid cartilage. A soft, broad ligature such as a dupatta may leave only a faint mark. The ligature should be preserved with its knot, cut away from the knot, for the police.

   • A: A horizontal complete mark points to strangulation, not hanging.
   • B: A horizontal complete mark below the thyroid cartilage is typical of ligature strangulation.
   • D: A hanging mark is incomplete at the knot and lies above the thyroid cartilage.

4. Question 4 · Medium

   A 32-year-old man is found hanging from a roof beam in his house in Meerut; the police ask the autopsy surgeon whether he was alive when he was hanged. Which finding is the most reliable sign of hanging during life?

   1. AHypostasis in the legs and hands
   2. BA tongue protruding between the teeth
   3. CA grooved ligature mark on the neck
   4. DDried saliva dribbling from the mouth

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   Answer: D · Dried saliva dribbling from the mouth

   Dribbling of saliva from the angle of the mouth on the side opposite the knot, running down the chin and onto the chest, is regarded as one of the most reliable signs of antemortem hanging. Pressure of the ligature stimulates the salivary glands, which can happen only while the person is alive. A ligature mark, protrusion of the tongue and hypostasis in the lower limbs can all occur when a dead body is suspended. Its presence should be recorded and photographed before the body is handled.

   • A: Hypostasis in the legs only shows that the body hung for some hours after death.
   • B: The tongue may protrude in post-mortem suspension and in other asphyxial deaths.
   • C: A ligature mark can be produced by suspending a dead body.

5. Question 5 · Easy

   A 40-year-old farmer working in a paddy field in Palakkad during a thunderstorm is found dead. Over his chest and shoulders is a reddish, branching, fern-like pattern on the skin, and the zip of his trousers is partly fused. What is the skin pattern called?

   1. ATache noire
   2. BJoule burns
   3. CMarbling of decomposition
   4. DArborescent (Lichtenberg) marks

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   Answer: D · Arborescent (Lichtenberg) marks

   Arborescent or Lichtenberg marks are red, branching, fern-like patterns on the skin after a lightning strike. They are thought to arise from the passage of current along the skin and are transient, fading within hours to a day or so in survivors. Other signs of lightning include fusion or magnetisation of metal objects, singeing of hair and torn clothing. The scene and weather history are as important as the body findings in deciding the cause of death.

   • A: Tache noire is drying of the sclera in open eyes after death.
   • B: Joule burns are small crater-like marks of low-voltage contact.
   • C: Marbling is a post-mortem branching of discoloured veins, seen days after death.

6. Question 6 · Medium

   Several people die in a crowd crush at the gate of a temple festival in Andhra Pradesh. The bodies show deep purple-blue congestion of the face, neck and upper chest with numerous petechiae, subconjunctival haemorrhages and a sharp line of demarcation at the upper chest; the neck has no marks. What is the cause of death?

   1. ALigature strangulation
   2. BChoking on a foreign body
   3. CTraumatic asphyxia
   4. DSmothering

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   A 23-year-old woman is brought to a district hospital in Uttar Pradesh with kerosene stove burns. The burns cover the whole of both lower limbs and the front of the trunk, while the back, perineum, arms and head are spared. Using the rule of nines, what is the burnt body surface area?

   1. A54%
   2. B63%
   3. C36%
   4. D45%

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8. Question 8 · Medium

   The body of a 27-year-old woman is found on her bed in Rohtak; her husband says she hanged herself and that he cut her down. There is a horizontal, continuous mark of uniform depth encircling the neck below the thyroid cartilage, with bruising of the strap muscles, a fractured thyroid cartilage, and a congested face with petechiae. What is the most likely cause of death?

   1. AThrottling
   2. BHanging
   3. CSmothering
   4. DLigature strangulation

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9. Question 9 · Medium

   A decomposing body of a 40-year-old man is recovered from the Brahmaputra four days after he went missing. His relatives suspect he was killed and thrown into the river. Which investigation best helps establish that he drowned while alive?

   1. ADiatoms in the femoral bone marrow
   2. BDiatoms in the stomach contents
   3. CWater in the stomach and duodenum
   4. DGettler's chloride test of heart blood

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10. Question 10 · Medium

    An 8-year-old boy is pulled out of a village pond in West Bengal within an hour of falling in, and is declared dead. Fine, white, lathery froth is coming from his mouth and nostrils; it reappears when wiped away and when the chest is pressed. What does this finding indicate?

    1. AThe body was placed in water after death
    2. BHe was alive when he entered the water
    3. CDecomposition has already started
    4. DHe died of an epileptic fit on land

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11. Question 11 · Medium

    A 24-year-old woman is found dead in a rented room in Bengaluru. The front of her neck shows several small crescent-shaped abrasions and round bruises on either side of the larynx, with more bruises on the left side than the right. There is no ligature mark. The face is congested with petechial haemorrhages in the conjunctivae. What is the most likely cause of death?

    1. AHanging
    2. BLigature strangulation
    3. CThrottling (manual strangulation)
    4. DSmothering

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12. Question 12 · Medium

    A 24-year-old woman married three years ago dies of 90% burns in her husband's house in Patna; the husband says her saree caught fire while cooking, but her parents allege harassment for dowry. Who should hold the inquest into her death?

    1. AThe Chief Medical Officer
    2. BA coroner
    3. CAn Executive Magistrate
    4. DThe police officer in charge

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13. Question 13 · Hard

    The body of a 30-year-old woman is recovered from a burnt hut in a village near Nashik. Her husband says the hut caught fire while she slept. At autopsy: 1. Soot is present in the trachea and bronchi below the vocal cords. 2. Carboxyhaemoglobin in heart blood is 40% saturation. 3. The limbs are flexed in a pugilistic attitude. 4. The hypostasis is cherry pink. Which findings indicate that she was alive when the fire started?

    1. AFindings 1, 2 and 4 only
    2. BFindings 1, 2 and 3 only
    3. CFindings 1, 2, 3 and 4
    4. DFindings 1 and 2 only

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14. Question 14 · Hard

    A 35-year-old woman is found dead, wet, beside a plastic bucket in her bathroom in Thrissur. An electric immersion water-heater rod lies in the bucket and the switch is on. At autopsy there is no electric mark anywhere on the body, and the internal findings are non-specific. The defence argues that the absence of an electric mark rules out electrocution. What is the best explanation for the absence of a mark?

    1. ALow-voltage current leaves a mark only at exit
    2. BAn electric mark appears only after a day
    3. CNo mark means she died before the contact
    4. DWet skin has low resistance, so no mark may form

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15. Question 15 · Hard

    The body of a 30-year-old man is recovered from a temple tank in Kumbakonam about 18 hours after he was last seen. The autopsy surgeon weighs four findings: 1. The wrinkled, bleached skin of the palms and soles proves he was alive when he entered the water. 2. Diatoms in the femoral bone marrow matching the tank water support antemortem drowning. 3. Weeds firmly clutched in his hand in cadaveric spasm support antemortem drowning. 4. Voluminous, waterlogged lungs that overlap the heart and pit on pressure support drowning. Which statements are correct?

    1. A1, 2 and 3 only
    2. B2 and 3 only
    3. C1, 3 and 4 only
    4. D2, 3 and 4 only

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16. Question 16 · Medium

    A 25-year-old electrician in Surat touches a live 230 V alternating current wire with his right hand while standing barefoot on a wet floor. He collapses instantly and cannot be revived. What is the most likely mechanism of death?

    1. ABurn shock from extensive burns
    2. BVentricular fibrillation
    3. CRespiratory centre paralysis
    4. DMyoglobinuric acute kidney injury

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17. Question 17 · Easy

    A fresh body recovered from a temple pond within a few hours of drowning has fine, white, lathery froth at the mouth and nostrils that reforms after it is wiped away. How is this froth formed?

    1. ABreathing mixes air, water and mucus in the airways
    2. BWater passively enters the airways after death
    3. CSaliva is churned by terminal convulsions
    4. DPutrefaction gas is escaping from the lungs and airways

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18. Question 18 · Hard

    During a pre-monsoon thunderstorm in Palakkad, lightning strikes a tree under which farm workers are sheltering. The PHC medical officer reaches the field within minutes with one helper and finds five victims: three are awake and groaning, with feathery burns and confusion; one is breathing but has cold, mottled, weak legs that he cannot move; and one is unresponsive, not breathing and pulseless. Bystanders say the last man is dead and should be left. The storm has passed and the field is now safe to enter. Whom should the medical officer attend first?

    1. AThe awake victims; leave the pulseless man
    2. BThe pulseless man: start CPR at once
    3. CThe three confused men with burns
    4. DThe man with cold, weak legs

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19. Question 19 · Medium

    A charred body is recovered from a burnt thatched hut in a village in Wayanad. The skull vault shows heat fissures, and between the bone and the dura over the parietal region lies a brick-red, crumbly, honeycombed collection of blood, with no scalp bruise or fracture line passing beneath it. The police suspect a blow to the head before the fire. What is the most likely nature of this collection?

    1. AExtradural haematoma from a blow
    2. BSubdural haematoma from shaking
    3. CHeat haematoma, an effect of the fire
    4. DPutrefactive collection of blood

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20. Question 20 · Medium

    At a wedding feast in Kannur, a guest who has drunk heavily is eating large pieces of mutton when he suddenly stops talking, clutches his throat with both hands and turns blue. He is standing, cannot speak or cough, and is making no sound. Which event is this, and what should the doctor among the guests do at once?

    1. AAlcohol seizure; turn him to the recovery position
    2. BChoking (cafe coronary); give abdominal thrusts
    3. CAcute MI; give aspirin to chew
    4. DAnaphylaxis; give IM adrenaline

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21. Question 21 · Medium

    A patient burnt in a kitchen fire has four areas of skin marked A to D, as in the table. Which area is a full-thickness burn?

    

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    1. AArea B
    2. BArea C
    3. CArea A
    4. DArea D

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22. Question 22 · Medium

    A farm labourer cannot release a live wire in a pump house, with sweating and a sustained, painful spasm of his forearm muscles. He is conscious, breathing and has a regular pulse. The table gives four levels of 50 Hz alternating current. Which level most probably flowed through him?

    

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    1. ABand C
    2. BBand D
    3. CBand A
    4. DBand B

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23. Question 23 · Medium

    A man is found suspended from a banister by an electrical cord. At autopsy the grooved mark on his neck rises obliquely behind the ear and is interrupted at the back of the neck, as in the photographs. Which conclusion is justified from the neck findings?

    

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    1. AThe oblique groove proves suicide, since homicides always leave complete horizontal marks
    2. BParallel superficial cuts beside the groove are enough to prove homicide
    3. CAbsence of a groove behind the neck is enough to exclude hanging as the mechanism
    4. DThe pattern is typical of hanging, but the manner must be decided from the scene and other findings

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24. Question 24 · Easy

    Walking home across a paddy field in Kerala during a thunderstorm, a man is knocked down by a sudden flash. Half an hour later in casualty, thin red feathery lines run from his foot up the leg, as in the photograph. What is this skin mark called?

    

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    1. ALichtenberg figure
    2. BJoule burn from contact with the ground
    3. CHypostasis
    4. DLivedo reticularis

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25. Question 25 · Medium

    Blood from the left and right sides of the heart of four bodies recovered from water is analysed for chloride (mg/100 mL as NaCl) by the classical Gettler test, as tabulated. Which body's values best fit drowning in sea water?

    

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    1. ABody C
    2. BBody B
    3. CBody D
    4. DBody A

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