FORENSICS TEST 1 2015

SECTION B: 20 marks
1. Write short notes on the definition, aetiology, pathogenesis,
pathologic features and complications of each 1 of the following
injuries (8):
(a) Bruise(2):
– Definition: An injury that results in interstitial haemorrhage without a
break in the continuity of the surface of the tissue involved.
– Aetiology: blunt force trauma

- Pathogenesis: applied force causes crushing of the soft tissues against

a hard object e.g. bone, resulting in the tearing of the blood vessels with
bleeding into the surrounding interstitium.
- Pathologic features: redness, swelling, colour changes due to
breakdown to haemoglobin.
- Complications: Hypovolaemia, hypovolemic shock, renal failure etc.
(b) Abrasion(2):
– Definition: Traumatic injury of the skin where tissue disruption is limited
to the epidermis and upper part of dermis.
– Aetiology: blunt force trauma
- Pathogenesis: blunt force crushes skin and disrupts the layers of the
skin. If dermis affected then blood vessels involved – results in scab
formation.
- Pathologic features: redness, swelling, oozing of blood/serum
- Complications: Usually do not complicate but may become infected and
cause sepsis.
(c) Laceration(2):
– Definition: A wound that is formed when blunt force tears, splits or
crushes tissues resulting in a wound that extends beyond the
subcutaneous tissues in the skin.
– Aetiology: Caused by blunt objects, bullet, screwdriver, fist, falls, MVA
etc.
- Pathogenesis: A laceration is formed when the tissues in the area
where force is applied are stretched, crushed or split beyond their
capacity to resist.
- Pathologic features: bridging tissue, irregular margins
 - Complications: Haemorrhage especially with lacerations of liver,
laceration of vital organs may cause immediate death by interfering with
the normal functioning of these organs e.g. heart, brain.
(d) Incision(2):
– Definition: Injury that is formed when a sharp hard object strikes a body
part with some degree of force.
– Aetiology: Caused by sharp hard objects e.g. knife, broken glass, blade
etc.
- Pathogenesis: Sharp, hard objects cause injury by cutting tissues on
their sharp ends. The tissues are split apart by this cutting resulting in a
clean-cut wound were tissues in the path are cut apart.
- Pathologic features: clean cut edges, no bridging tissues.
- Complications: profuse bleeding – hypovolemic shock- death.
2. Discuss the absorption, metabolism and elimination of ethyl alcohol
in the human body(5):
Absorption: Drug enters blood circulation after ingestion, IV, IM,
intradermal, sublingual or PR.
20% in stomach
80% in small bowel
 Thinner mucosa
 Better blood supply
 Greater surface area - microvilli
Insignificant amount: other
NO absorption through intact skin
Slower rate of absorption: food in stomach, fatty meals, smoking cigarettes
Faster rate of absorption: empty stomach, gastrectomy, low blood glucose.
Metabolism: Liver: 80 – 90 %
Liver breaks down OH to water & CO2
Oxidative metabolism
 Alcohol Dehydrogenase- ethanol 1st broken down into acetaldehyde by
this coenzyme (ADH). The acetaldehyde in then broken down into
acetic acid by ADH, oxidases and lyases.
 Cytochrome P450 (CYP2E1)
Non-oxidative metabolism
Metabolised @ constant rate: 0.01 -0.02 g%/hr
Cannot be influenced under normal circumstance BUT Increased in
chronic OH , liver disease.
Excretion: Unchanged via
 Lungs (breath): 5%
 Kidneys (urine): 5%
 Perspiration: insignificant amount
 Faeces: insignificant amount
 3. Write short notes on the provisions of Section 48 of the
Medical,Dental and Supplementary Health Service Profession Act
number 56 of 1974 as it relates to the so called ‘Procedure related
death’(3):
The death of a person
• undergoing or
• as a result of therapeutic/ diagnostic/ palliative nature or
• if any part of the procedure is a contributory cause
= not deemed death from natural causes as contemplated by the
Inquest Act.
4. When (ie. under what circumstances) can a medical practitioner
disclosure the HIV status of a deceased person?(4):
Disclosing the HIV status of deceased persons is allowed :
- In death certificates.
- As a result of court order.
- In the interest of public.
- If given to endangered third parties.

SECTION C: 20 marks
1. Read article “5 cops in court over teen rape” and answer the following
questions (8).
(a) In your own words, what is rape? (1):
Rape: Unlawful and intentional act of sexual penetration without consent.
(b) What other sexual offences do you know of? (1):
Incest, forced pregnancy, forced sterilization, forced exposure to
pornography.
(c) If she had consulted you, how were you going to deal with the issue
of consent? Please explain (2)
Informed Consent is mandatory.
Important to seek written Consent from survivor, especially if minor.
Suggest reporting case to police, and request SAP 308 form.
SAP 308 completed by SAPS and survivor: Voluntary consent by survivor.
Objective of SAP 308: Gives the Med. Practitioner permission to break
confidentiality code by completing SAP J88 and submitting to SAPS and
Courts.
Complete J88 if SAP 308 has been completed and given to you.
(d) If you were given the responsibility to examine this girl for suspected
rape:
(i) What specimens were you going to take from her in order to
facilitate her medico-legal and clinical management? (2)
Bloods – for STDs, HIV, Hepatitis.
Vaginal swab.
 Semen collection if present.
Sexual Assault Evidence Collection Kit – Confirm or exclude foreign
DNA.
(ii) How were you going to clinically and medico-legally manage
her? (2)
Prophylatic treatment for HIV or STDS, refer for psychological
counselling, social support, welfare support, completion of J88,
make yourself available to testify in court, if death happens report to
police.
2. A suspected drunk driver arrested by SAPS and taken to health
professional. Body mass 70kg, normal physique (r=0.7) and BAC of
0.20g%. (9)
(a) What law is applied by police to arrest this driver? (1):
National road traffic act 93 of 1996
(b) Is consent necessary before examining the driver in this context?
Please explain. (2)
No, because he is a suspect of crime and is officially arrested and according
to the criminal procedure act, no consent if the suspects are examined for
medico legal reasons.
(c) Please write down the Widmark’s formula and explain what each
letter in the equation means (3)
A=pcr X 10
A – amount of alcohol (grams)
p- persons mass (kg)
c – bac (g%)
r- widmarks distribution factor (males= 0.7 ; females= 0.6)
10 – factor to change % to %
(d) Calculate the total alcohol in his body. (2)
A= pcr x 10
= (70kg)(0.2g%)(0.7) x 10
= 98g
(e) Approximately how many cans of beer (each can has a total volume
of 400ml and alcohol conc. of 4g. per 100ml) has this man consumed
(1)
16g per 400ml.
No of cans= total OH in body/grams in can = 98/16 = 6.125 cans
3. A victim of domestic violence with minor injuries is seen in casualty by
you the casualty officer on call. Which statutory forms are you going to
need and complete in this case. Please discuss.(3)
SAP 308 form – completed by police official and signed by patient.
J88 form – comprehensive medico-legal report by doctor.
Section 212 – affidavit completed by doctor.