Forensic OSPE

                                       




                                            FORENSIC OSPE 2009


                      FORENSIC OSPE 2011


                      FORENSIC OSPE IMAGES



   

Slides

DOWNLOAD FIRST THREE LINK FOR GUIDE TO HOW TO IDENTIFY SLIDE THEN BELOW ARE GIVEN PICS OF SLIDES

EXAMINATION OF BLOOD
EXAMINATION OF HAIR

SEMINAL STAIN

SPERM

ANIMAL HAIR

ANIMAL HAIR1

CAMEL RBC

CHICKEN RBCS

COTTON FIBRE

HUMAN HAIR

HUMAN HAIR

HUMAN RBC

SHEEP RBCS

SPERM

Forensic ospe 2011

FORENSIC OSPE

• Exit wound characteristics
• Cadaveric spasm M/L
• Capsicum M/L Uses
• Chicken;s RBCs Characteristic
• X ray of fracture.....,jurh
• human hair slide
• Muskit,firearm
• characteristic of incised wound
• Male orbit characteristic
• Methods of abortion,abortion sticks
• Emmenoagues.......
• finger prints

Forensic Ospe:

• Absorbtion spectrum,diff b/w oxy hb nd carboxy hb,caboxyhb test,animal hair specimen,
• incised wound chracteristic,firearm,crotton oil fatal doz,period,active priciple
• charas active priciple,Runamoke,Finger prints
• Cadavaric spasm its M/L imp,wound of exit chracteristc
• arsenic ka anyidote,fatal period,capsicum k 2 active principle nd uses,chicken RBCs
• condition in whch human rbc r nucleated,skull,x.ray
• slide prep of human hair......

• mercury .. fatal perod AND MEDICOLEGAL SIGNIFICENCE
•  firearm or musket.
•  jurh jaifa  complicatns,
• difference bw hanging and and strangulation, 
• sex determnaton of saccrum,& medicolegal imp
• tests for organic poisons, 
• puterfactive changes in tatoo marks, 
• obsrvd mein finger printing or
•  specimen sending to chemical examiner

KEY"

Emmenagogues are herbs which stimulate blood flow in the pelvic area and uterus; some stimulate menstruation.

A musket is a muzzle-loaded, smooth bore long gun, fired from the shoulder.

The appearance of nucleated red blood cells (NRBC) in the circulation is associated with a variety of severe diseases, a malfunction of the bone marrow leads to this phenomenon is as unknown as the possible role that cytokines could play in this process. In critically ill patients.

Forensic Ospe 2009

Here is link of forensic ospe paper(pdf) 2009..Click on the link to download the file


Guide to ospe paper(model paper)

 Paper1


Paper 2


Paper 3


Paper 4


Paper 5

INGUINAL HERNIA EXAMINATION SCEHEME

Hernia Examination

Always start with the patient STANDING

Inspect standing

- Exposure is very important – ensure you can see from umbilicus to knees at
least!
- Look in the groin for evidence of a swelling – if you cant see one, then ask the
patient which side they have noticed a lump
- Look for evidence of previous hernia surgery – oblique scar often well hidden
in pubic hair line
- Any other obvious skin changes, swellings, lumps that may be relevant
- Ask the patient to look over their shoulder and cough (so they don’t cough into
your face!)
- As they cough, look at the lump to see if there is a cough impulse

Palpate standing

- Palpate the swelling
- Can you get above it (suggesting originates in scrotum/spermatic cord e.g.
hydrocoele)
- Does it feel soft, fluctuant, Pulsatile etc.
- Ask the patient again to cough, palpating for a cough impulse
- Ensure that you feel the opposite side, as bilateral hernias are very common,
often one being much more prominent

Auscultate

- Take this opportunity to auscultate the lump, as if it is readily reducible, there
will be nothing to listen too when the patient lies down.

Lie the patient down

Inspection

- Again, inspect the groin to ensure there is nothing missed from standing
inspection.
- Offer to palpate the abdomen for any cause of raised intra-abdominal pressure
such as ascites or mass, which can predispose to herniation

Palpation

- Having identified a hernia, the next task is to assess if it is indirect or direct.
- Ask the patient if they can reduce the hernia, if it has not done so by being
supine – NEVER do this standing as it is painful.
- Palpate the groin to assess if the hernia has completely reduced
- Warn the patient that you will palpate some bony points
- Feel for the anterior superior iliac spine and the pubic tubercle (delineating the
inguinal ligament – as opposed to the ASIS to pubic symphysis, to identify the
mid-inguinal point, the landmark for the femoral artery)
- Palpate the midpoint of the inguinal ligament (the surface landmark for the
deep inguinal ring) and ask the patient to cough
- If the hernia is CONTROLLED by pressure over the deep inguinal ring, it
suggests that the hernia is indirect.
- In order to confirm that you were in fact controlling the hernia, ask the patient
to cough without pressure to ensure that the hernia now appears.
- Offer to examine the scrotum, where you should palpate the testis and
epididymis (my finals hernia case had epididymal cysts which were expected
to be found)
That completes the examination of the hernia, but offer to examine the abdomen for
masses etc.
People often find hernias difficult as there is not much opportunity to practice –
however, as finals loom ensure you seek out hernia lists in day surgery as these cases
often come up.


Some theory

Hernia = protrusion of viscus through the confines of the cavity within which the
viscus normally lies

There are many types of hernia – ensure you are aware of the following types
- Inguinal – see below
- Femoral
o 1/3 hernias in women – i.e. more common in women but inguinal still
commoner
o Rare in males
o Arise inferiorly and laterally to the pubic tubercle
o More rigid boundary - inguinal ligament, pectineal ligament, lacunar
ligament and femoral vein being the boundaries
o More likely to strangulate
o Can be ‘richter hernia’ where a knuckle of bowel wall is trapped rather
than the entire circumference
o Can present as obstruction with no localising signs
- Sphigelian
- Umbilical
- Para-umbilical
- Epigastric
- Lumbar
- Obturator
- Hiatus

Inguinal hernias

These are the commonest type of hernia in both males and females.
Indirect – hernial sac passes through the deep inguinal ring, through the inguinal canal
and can pass into the scrotum. These tend to be found in younger men
Direct – hernial sac passes directly through the transversalis fascia and rarely pass
into the scrotum. These tend to be more prevalent in the older man. More precisely,
direct hernias pass through Hasselbachs triangle, delineated by the inferior epigastric
artery laterally, the rectus abdominus muscle medially and inguinal ligament
inferiorly.
In the exam, it would be prudent to comment that although your clinical findings
suggest that this is an indirect/direct hernia, this can only be confirmed at operation.
The precise definition of direct vs indirect is in relation to the inferior epigastric
vessels. Direct hernias arise medially to these vessels and indirect laterally.
It would be worth revising the anatomy of the inguinal canal and the contents of the
spermatic cord:
- 3 arteries – testicular artery, artery to vas, artery to cremaster
- 3 nerves – genital branch of genitofemoral, sympathetics and ilioinguinal (this
nerve actually travels WITH the spermatic cord rather than within
- 3 others – vas deferens, lymphatics, pampiniform venous plexus
- Some also include the 3 layers of fascia.

Common exam questions

1. What is the difference between indirect and direct? – see above
2. Discuss anatomy of inguinal canal
3. What investigation could be performed if unsure if hernia? – ultrasound is
often used if it is unclear if there is a hernia or not
4. What is the management?
- The answer should be repair of the hernia, as there is a risk of the hernia
becoming strangulated – unless there are contraindications to surgery –
however the repair can even be done under local anaesthesia
5. What are the operative options?
- There is the option of performing the repair open (Lichenstein procedure)
or using a pre-peritoneal laparoscopic approach which has the advantage in
bilateral hernias to do both with the same incision, and in redo operations.
The ‘pre-peritoneal’ means that the peritoneum is not breached.
Laparoscopic surgery is becoming more popular and is associated with
sooner return to work. Both types can be done as day surgery. The
principal of both types is the use of ‘tension free mesh repair’, whereby a
mesh is used to incite a fibrous reaction to create a strong barrier to
herniation that doesn’t rely upon the tension of sutures closing the defect
6. What is the differential diagnosis of a lump in the groin?
- Approach this systematically:
o Skin – sebaceous cyst
o Subcutaneous – lipoma, fibroma
o Arterial – femoral pseudo/aneurysm
o Venous – saphena varix
o Lymphatic – lymphadenopathy
o Psoas abscess
o Hernia – inguinal, femoral
o Ectopic testis

Study urges three-year gap in cervical cancer test

WASHINGTON: Healthy women over 30 who test negative for human papilloma viruses (HPV) may be able to safely extend the period between gynecological exams from every year to three years, said a US study Wednesday. "Our results are a formal confirmation that the three-year follow-up is appropriate and safe for women who have a negative HPV and normal test result," said lead study author Hormuzd Katki. The study followed 331,818 women who enrolled in a northern California testing program by Kaiser Permanente between 2003 and 2005, and followed them for five years. Among women who had a normal Pap smear and tested negative for HPV, which can cause cervical cancer, the five-year cancer risk was "very low: 2.3 per 100,000 women per year," it said. During a Pap smear, which all women should get annually, a doctor collects a sample of tissue from the woman's cervix and sends it to a lab for examination and to check for any abnormal cells. A separate test for HPV is also done during a woman's annual gynecological appointment. It often uses the same cell sample but looks specifically for signs of the virus. HPV is sexually transmitted and most of the time the body can clear it on its own. However, in some cases the infection remains and can eventually lead to cervical cancer. Women over 30 who test positive for HPV are usually retested in six months to see if the infection has cleared. The researchers said that when comparing the two tests, the HPV test alone "identified more women at high risk for cervical cancer than Pap tests." "These results also suggest that an HPV-negative test result alone could be enough to give a high level of security for extending the testing interval to every three years," said Katki. More study is needed however to determine whether such recommendations should extend to the general population, the researchers noted. "But we'll need additional evidence from routine clinical practice, and formal recommendations from guideline panels before that can be routinely recommended." The Pap smear, invented in 1943, has reduced the number of cervical cancer cases but has not eliminated them -- some 11,000 women in the United States are diagnosed with cervical cancer each year. (AFP)

Pepsi-cola and Coca-Cola are found to contain carcinogens 2-methylimidazole and 4-methylimidazole

An ingredient used in Coca-Cola and Pepsi is a cancer risk and should be banned, an influential lobby group has claimed. The concerns relate to an artificial brown colouring agent that the researchers say could be causing thousands of cancers.
‘The caramel colouring used in Coca-Cola, Pepsi, and other foods is contaminated with two cancer-causing chemicals and should be banned,’ said the Center for Science in the Public Interest (CSPI), a health lobby group based in Washington, DC.

‘In contrast to the caramel one might make at home by melting sugar in a saucepan, the artificial brown colouring in colas and some other products is made by reacting sugars with ammonia and sulphites under high pressure and temperatures.

‘Chemical reactions result in the formation of two substances known as 2-MI and 4-MI which in government-conducted studies caused lung, liver, or thyroid cancer or leukaemia in laboratory mice or rats.’ America’s National Toxicology Program says that there is ‘clear evidence’ that both 2-MI and 4-MI are animal carcinogens, and therefore likely to pose a risk to humans.

The executive director of the CSPI, Michael F Jacobson, has petitioned America’s food regulator, the Food & Drug Administration, to take action.He said: ‘Carcinogenic colourings have no place in the food supply, especially considering that their only function is a cosmetic one.’

Mr Jacobson said the name ‘caramel colouring’ does not accurately describe the additives, explaining: ‘It’s a concentrated dark brown mixture of chemicals that simply does not occur in nature.

He added that while regular caramel could not be described as healthy, ‘at least it is not tainted with carcinogens’.

U.S. regulations distinguish between four types of caramel colouring, two of which are produced with ammonia and two without it. The CSPI wants the two made with ammonia to be banned and has received backing from five prominent cancer experts, including several who have worked at the National Toxicology Program.

The type used in colas and other dark soft drinks is known as Caramel IV, or ammonia sulphite process caramel. Caramel III, which is produced with ammonia but not sulphites, is sometimes used in beer, soy sauce, and other foods.

The CSPI admitted that any risk associated with consumption of the chemicals would be extremely small. It said the ten teaspoons of sugar found in a can of regular cola would be more of a health problem.

However, it argued the levels of 4-MI in the tested colas still may be causing thousands of cancers in the U.S. population alone.

Rare Heart surgery performed at Sharif Medical City Hospital

LAHORE – Head of Sharif Medical City Hospital’s Heart Surgery Department, Prof Mazhar-ur-Rehman conducted a successful operation of a complex and rare heart disease “Hypertrophic Obstructive Cardiomyopathy” (HOCM) of a 31-year-old patient Asif Ali, a second operation of its nature in Pakistan.
Project director Sharif Medical City Hospital Prof Dr Naseeb Awan told that Prof Mazhar also performed the same surgery of a patient in the Sharif Medical City Hospital in early 2006.
On this occasion, Prof Mazhar told that in this disease, a muscle inside the heart becomes thick and large causing obstruction to the flow of blood to human body. He said that this disease was the main cause of sudden death in youngsters. He said that his team done this operation free of cost. He said that the extra muscle was removed to release the obstruction and the patient was recovering fast now.
He said that this was the second case of HOCM conducted here and Sharif Medical City Hospital had become a HOCM heart surgery centre now. The younger brother of the patient Muhammad Amjad told that he contacted the doctors in Lahore and Karachi for the surgery of his brother but most of the doctors refused to perform the surgery due to risk factor.