Author: Renu Maurya

Summon

Summon


SUBPOENA (SUMMONS)

  • Sub- under; Poena- penalty)
  • Also known as  Duces tecum

Section

  • Section 61 – 69 CrPC deal with summons

DEFINITION

  • Subpoena is defined as a legal document compelling the attendance of a witness on a particular day and time in the court of law under penalty.
  • It can be served also to produce any official document or any paper before the court of law.
  • However, summons is a milder form of process.

PROCEDURE OF SERVING THE SUMMONS

  • Usually, it is issued by presiding officer of the court, delivered by a court official or a police constable.
  • Person receiving should sign on the original and keep the duplicate with him.
  • If person summoned to is not available, it may be served to:
  • The other major member of the family/ relatives, but not to a servant.
  •  If the person is a government servant, it may be served through the head of the office in which he or she is employed.
  • It may be even affixed on some conspicuous part of the house in which the person summoned ordinarily resides.
  •  Summons by post: It can even be sent by registered post.
  • However, on these occasions, court may not consider this as being served. If the postal authority returns the cover stating he or she is refusing to receive the same, court considers that it has been served in spite of not receiving it.

Conduct of Money

  • Conduct money refers to the travelling and daily expenses to reach the court.
  • In civil cases, it is paid by the party calling him), at the time of serving the summon. judge decides the conduct money in the civil case.
  • The summon in civil case can be ignored if conduct money is not sanctioned or if the amount is less, and the witness can bring the fact to notice of judge.
  • In criminal cases, no money is paid along with summon
  • The witness can ask for it, after giving evidence, but he should not insist if the court is not willing to sanction, since otherwise he can be charged for contempt of court.
  • To an independent doctor, it is always paid (known as bhatta), while the doctor in government service, can claim from his office.

RULES OF SUMMONS

If a medical officer is summoned to attend two courts on a particular time and day, following rules may be opted:

  • Criminal cases should be given preference over civil cases.
  • If both are criminal cases, higher courts should be given first preference. However, the medical officer should inform the other court which he or she is not attending.
  • If both cases are of the same ranking courts, summons received earlier should be attended first.

If witness fails to attend the court :

In civil cases : 

  • He will be liable to pay damages.

In criminal cases: 

  • the court may issue notice under section 350 CrPC  and may sentence him to fine or imprisonment or may issue bailable or non-bailable warrant to secure the presence of the witness
Exam Question
 

SUBPOENA (SUMMONS)

  • Sub- under; Poena- penalty)
  • Also known as  Duces tecum

Section

  • Section 61 – 69 CrPC deal with summons

DEFINITION 

  • Subpoena is defined as a legal document compelling the attendance of a witness on a particular day and time in the court of law under penalty.
  • No conduct money is paid to the doctor in criminal cases
  • Conduct money is paid to expert witness with summons from civil court
Don’t Forget to Solve all the previous Year Question asked on Summon

Module Below Start Quiz

Summon

Summon

Q. 1

Conduct money is paid to expert witness with summons from :

 A

Civil court

 B

Criminal court

 C

High court

 D

Sub magistrate

Q. 1

Conduct money is paid to expert witness with summons from :

 A

Civil court

 B

Criminal court

 C

High court

 D

Sub magistrate

Ans. A

Explanation:

A i.e. Civil court


Q. 2

Subpoena is also called:  

MAHE 06

 A

Summons

 B

Panchnama

 C

Requisition

 D

Inquest papers

Q. 2

Subpoena is also called:  

MAHE 06

 A

Summons

 B

Panchnama

 C

Requisition

 D

Inquest papers

Ans. A

Explanation:

Ans. Summons


Q. 3

Duces tecum is: 

WB 08

 A

Summon

 B

Panchnama

 C

Conduct money

 D

Hostile witness

Q. 3

Duces tecum is: 

WB 08

 A

Summon

 B

Panchnama

 C

Conduct money

 D

Hostile witness

Ans. A

Explanation:

Ans./ Summon


Q. 4

Following is not true regarding summons ‑

 A

It is a legal document

 B

No conduct money is paid to the doctor in criminal cases

 C

Section 61 – 69 CrPC deal with summons

 D

None of the above

Q. 4

Following is not true regarding summons ‑

 A

It is a legal document

 B

No conduct money is paid to the doctor in criminal cases

 C

Section 61 – 69 CrPC deal with summons

 D

None of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., None of the above

All are true.

Summon

  • Summon is a legal document compelling attendance of a witness in a court of law under penalty, on a particular day, time and place, for the purpose of giving evidence. It is issued by the Court in writting, in duplicate, signed by presiding officer of court and bears the seal of the court.
  • Conduct money refers to the travelling and daily expences to reach the court. In civil cases, it is paid by the party calling him, at the time of serving the summon. Judge decides the conduct money in civil case. The summon in civil case can be ignored if conduct money is not sanctioned or if the amount is less, and the witness can bring the fact to notice of judge. In criminal cases, no money is paid along with summon. The witness can ask for it, after giving evidence, but he should not insist if the court is not willing to sanction, since otherwise he can be charged for contempt of court. To an independent doctor it is always paid (known as bhatta), while the doctor in government service, can claim from his office.
  • In case, two or more summons are received for the same date and time, the principles for preference of summon are:
  1. Criminal case is preferred over civil case.
  2. If both cases are criminal/civil, summon from higher court is preferred.
  3. If both cases are criminal/civil and from court of same status, summon received earlier is preferred.

However, in each situation other court is informed accordingly.

Quiz In Between



Medical Evidence

Medical Evidence


It means :

  • All statements which the court permits or requires to be made before it by witnesses,  in relation to matter of fact under inquiry.

It includes:

  • All documents produced for the inspection of court.
Types of Medical Evidence

Documentary

  • Medical certificate
  • Medico-legal reports
  • Dying declaration

Oral-

  • Direct
  • Indirect or Circumstantial
  • Hearsay

Medical Certificates:

  • Documentary evidence
  • They refer to ill health, insanity, age, death etc.
  • The medical practitioner is bound to issue death certificate, stating the cause of death, without charging the fees.
  • Issuing false medical certificate is punishable under section 197IPC.

Medical reports:

  • They are the medical reports prepared by a doctor on request of the investigating officer, usually in the criminal cases.
  • The report consists of two parts:
  • Facts observed on examination
  • Opinion  drawn from the facts

Dying declaration:

  • It is a written or oral statement of a person, who is dying as a result of some unlawful act, relating to the material facts of cause of his death.
  • Magistrate should be called to record the declaration (if there is time).
  • Doctor should certify his mental state and consciousness before recording(compos mentis).
  • If there is no time to call the magistrate, the doctor should take the declaration in the presence of two witnesses.
  • It can also be recorded by village headman, police officer, but its value is less.
  • Oath is not necessary.
  • It must be signed by the declarant, doctor and the witnesses.
  • If the declarant dies, it is accepted as the evidence in court.
  • If the declarant survives, it is not valid,  but it has the corroborative value.
  • The declarant should not be influenced.
Dying Deposition
  • It is the statement of a person on oath, recorded by the magistrate in the presence of the accused or his lawyer, who is allowed to cross-examine the witness.
  • More importance in court then dying declaration
Exam Question
 
Types of Medical Evidence

Documentary

  1. Medical certificate
  2. Medico-legal reports
  3. Dying declaration

Medical Certificates:

  • Documentary evidence
  • Issuing false medical certificate is punishable under section 197IPC.

Dying declaration:

  • It is a written or oral statement of a person, who is dying as a result of some unlawful act, relating to the material facts of cause of his death.
  • Magistrate should be called to record the declaration (if there is time).
  • Doctor should certify his mental state and consciousness before recording(compos mentis).
Dying Deposition
  • It is the statement of a person on oath, recorded by the magistrate in the presence of the accused or his lawyer, who is allowed to cross-examine the witness.
  • More importance in court then dying declaration
Don’t Forget to Solve all the previous Year Question asked on Medical Evidence

Module Below Start Quiz

Medical Evidence

Medical Evidence

Q. 1

All is exempted from oral testimony EXCEPT

 A

Dying declaration

 B

Medical evidence of injury as witness

 C

Chemical examination report

 D

Evidence of medical expert in lower court

Q. 1

All is exempted from oral testimony EXCEPT

 A

Dying declaration

 B

Medical evidence of injury as witness

 C

Chemical examination report

 D

Evidence of medical expert in lower court

Ans. B

Explanation:

B i.e. Medical evidence of injury as witness


Q. 2

Dying deposition is recorded by :

 A

Doctor

 B

Magistrate

 C

Police officer

 D

Lawyer

Q. 2

Dying deposition is recorded by :

 A

Doctor

 B

Magistrate

 C

Police officer

 D

Lawyer

Ans. B

Explanation:

B i.e. Magistrate


Q. 3

Dying deposition is more important than dying declaration becase it is :

 A

Made to a magistrate

 B

Oath is taken

 C

Made in presence of accused

 D

Cross examination is permitted

Q. 3

Dying deposition is more important than dying declaration becase it is :

 A

Made to a magistrate

 B

Oath is taken

 C

Made in presence of accused

 D

Cross examination is permitted

Ans. A

Explanation:

A i.e. Made to magistrate

Quiz In Between


Q. 4

Which carries more weight in a court of law :

 A

Dying declaration

 B

Dying deposition

 C

Both carry the same weight

 D

Both are not significant

Q. 4

Which carries more weight in a court of law :

 A

Dying declaration

 B

Dying deposition

 C

Both carry the same weight

 D

Both are not significant

Ans. B

Explanation:

B i.e. Dying deposition


Q. 5

Medical certificate is :

 A

Documentary evidence

 B

Oral evidence

 C

Hearsay evidence

 D

Parole

Q. 5

Medical certificate is :

 A

Documentary evidence

 B

Oral evidence

 C

Hearsay evidence

 D

Parole

Ans. A

Explanation:

A i.e. Documentary evidence

Medical certificate is simplest form of documentary evidence. In case of death certificate doctor

Must issue certificate & cannot charge any fees for itQ

Can not delay it even if his professional charges are not paid

Must mention the exact cause of death instead of vague terms.


Q. 6

When a doctor issues a false medical certificate, then he is liable under:        

AIIMS 11; Bihar 11; NEET 15

 A

Sec. 197 IPC

 B

Sec. 87 IPC

 C

Sec. 304A IPC

 D

Sec. 338 IPC

Q. 6

When a doctor issues a false medical certificate, then he is liable under:        

AIIMS 11; Bihar 11; NEET 15

 A

Sec. 197 IPC

 B

Sec. 87 IPC

 C

Sec. 304A IPC

 D

Sec. 338 IPC

Ans. A

Explanation:

Ans. Sec. 197 IPC

Quiz In Between


Q. 7

Dying declaration can be taken by:

PGI 12; NIMHANS 14

 A

Village headman

 B

Doctor

 C

Magistrate

 D

Any one

Q. 7

Dying declaration can be taken by:

PGI 12; NIMHANS 14

 A

Village headman

 B

Doctor

 C

Magistrate

 D

Any one

Ans. D

Explanation:

Ans. Any one


Q. 8

Dying declaration is a:     

MAHE 10

 A

Circumstantial evidence

 B

Oral evidence

 C

Documentary evidence

 D

Hearsay evidence

Q. 8

Dying declaration is a:     

MAHE 10

 A

Circumstantial evidence

 B

Oral evidence

 C

Documentary evidence

 D

Hearsay evidence

Ans. C

Explanation:

Ans. Documentary evidence


Q. 9

Documentary evidence along with oral evidence is required:  

PGI 12

 A

Dying declaration

 B

Postmortem report

 C

DNA fingerprinting

 D

Chemical examiner report

Q. 9

Documentary evidence along with oral evidence is required:  

PGI 12

 A

Dying declaration

 B

Postmortem report

 C

DNA fingerprinting

 D

Chemical examiner report

Ans. B

Explanation:

Ans. Postmortem report


Q. 10

Doctors role in noting dying declaration is to ‑

 A

Ascertain compos mentis

 B

Call the magistrate

 C

Elicit information by leading questions

 D

Ask the investiating medial officer to be there

Q. 10

Doctors role in noting dying declaration is to ‑

 A

Ascertain compos mentis

 B

Call the magistrate

 C

Elicit information by leading questions

 D

Ask the investiating medial officer to be there

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ascertain compos mentis

Dying declaration

  • It is the written or verbal statement made by a person likely to die because of some unnatural act done on his body, narating the circumstances or the conditions responsible for his present state of health or the cause and manner of likely unnatural death.
  • Ideally dying declaration should be recorded by executive or honorary magistrate, but can also be recorded by doctor, village head man, police or any other person, if there is no time to call a magistrate. Doctor has to certify the patient to be compos mentis (sound mind). It is recorded in presence of two disinterested witnesses. Relatives and police officers are not allowed to be present. No oath is administered.
  • It carries less weight than dying deposition as no cross-examination is possible. If the patient does not die after the recording of declaration, the dying declaration loses its importance sice now he can be called to the court and his evidence can be recorded after cross-examination.

Quiz In Between



Witnesses and Recording Of Evidence

Witnesses and Recording Of Evidence


Witnesses
  • A person who gives evidences regarding facts.
Types
  1. Common witness
  2. Expert witness

Common witness:

  • A person who gives evidence about the facts observed or perceived by him.
  • Principle is known as “first-hand knowledge rule”

Expert witness:

  • A person who has been trained or is skilled or has knowledge in technical or scientific subject, and is capable of drawing the opinion and conclusions from the facts observed by himself or noticed by others.
  • Eg: doctor, fingerprint expert, ballistic expert.

Hostile witness:

  • One who is supposed to have some interest or motive for concealing part of the truth, or for giving completely false evidence.
  • IPC -191
Perjury
  • Willful false evidence
  • Whoever, being legally bound by an oath or by an express provision of law to state the truth , or being bound by law to make a declaration upon any subject , makes any statement which is false , and which he either knows or believe to be false ,is said to give false evidence(sections 191 ,192 IPC and 344 CrPC).
  • Punishment of up to 7 years(section 193 IPC)
Record of Evidence
  • Oath
  • Oath is declaration required by law, which is compulsory and hold the witness responsible for the consequences of his evidence.
Examination-in-chief  (Direct Examination)
  • This is the first examination of a witness.
  • Question are put to him by the lawyer for the side which has summoned him.
  • In criminal cases burden to prove is always on the prosecution, and accused is presumed to be innocent till the contrary is proved against him.
  • No leading question is allowed.
The objects are:
  • To elicit all relevant, convincing medical facts.
  • To elicit the conclusion which the doctor has drawn from the facts
Cross-Examination
  • Witness is questioned by the lawyer for the opposite party.
  • The defense witness is cross examined by the public prosecutor.
  • Leading questions are allowed.
The main objects are: 
  • To  elicit facts favourable to his case.
  • To test the accuracy of statement made by witness.
  • To modify or explain what has been said.
  • To develop new or odd facts.
  • To discredit the witness.
  • To remove any undue emphasis which may have been given to any of them.
Reexamination(Re-Direct – Examination)
  • This is conducted by the lawyer for the side which has called the witness.
The objective is:
  • To correct any mistake or to clarify or to add the details to the statement made by witness in cross-examination.
  • Leading questions are not allowed.
  • The opposing lawyer has right to re-cross-examination on the new point raised.
Conduct money
  • It is money paid in some legal systems to a person under the compulsion of a summons to witness/ subpoena to pay for their expenses to attend in court.
  • It generally incorporates a daily rate for each day the witness must attend in court (with a one-day minimum), plus a travel allowance to allow the witness to get to the place of the hearing.
  • Generally, conduct money must be delivered with the summons for it to have legal effect.
  • Witnesses are generally entitled to additional conduct money if their attendance is required on more days than anticipated.
  • Moreover, witnesses who are required to make an overnight stay to attend in court on more than one day are generally entitled to an allowance for accommodation and meals.
  • The rates for travel, daily attendance, accommodation and meals are generally set under a court tariff, and are fixed for all witnesses.
  • A witness may not refuse to appear merely because they believe the conduct money is insufficient to make up for their lost wages or actual travel expenses.
  • Witnesses may be paid more, but the additional cost cannot be claimed against the losing party – only the tariff amount can be recovered.
  • Occasionally, special witnesses, such as experts, may be entitled to receive conduct money under a higher tariff.
Exam Question
 
Witnesses
  • A person who gives evidences regarding facts.
Types
  1. Common witness
  2. Expert witness

Expert witness:

  • doctor, fingerprint expert, ballistic expert.
  • Volunteering a statement can be done by doctor

Hostile witness:

  • One who is supposed to have some interest or motive for concealing part of the truth, or for giving completely false evidence.
  • IPC -191
Perjury
  • Willful false evidence
  • Whoever, being legally bound by an oath or by an express provision of law to state the truth , or being bound by law to make a declaration upon any subject , makes any statement which is false , and which he either knows or believe to be false ,is said to give false evidence(sections 191 ,192 IPC and 344 CrPC).
  • Punishment of up to 7 years(section 193 IPC)
Record of Evidence
  • Oath is declaration required by law, which is compulsory and hold the witness responsible for the consequences of his evidence.
Cross-Examination
  • Witness is questioned by the lawyer for the opposite party.
  • The defense witness is cross examined by the public prosecutor.
  • Leading questions are allowed.
Conduct money
  • It is money paid in some legal systems to a person under the compulsion of a summons to witness/ subpoena to pay for their expenses to attend in court.
  • Conduct money is paid to expert witness with summons from civil court
  • In civil cases, conduct money is decided by judge
Don’t Forget to Solve all the previous Year Question asked on Witnesses and Recording Of Evidence

Module Below Start Quiz

Witnesses and Recording Of Evidence

Witnesses and Recording Of Evidence

Q. 1

The witness is liable to be prosecuted for perjury, and the imprisonment may extend upto seven years. This falls under which section of IPC?

 A

S.190 of Indian Penal Code

 B

S.191 of Indian Penal Code

 C

S.192 of Indian Penal Code

 D

S.193 of Indian Penal code

Q. 1

The witness is liable to be prosecuted for perjury, and the imprisonment may extend upto seven years. This falls under which section of IPC?

 A

S.190 of Indian Penal Code

 B

S.191 of Indian Penal Code

 C

S.192 of Indian Penal Code

 D

S.193 of Indian Penal code

Ans. D

Explanation:

The witness is liable to be prosecuted for perjury, and the imprisonment may extend upto seven years falls under S.193 of I.P.C.
 
Ref: The Essentials of Forensic Medicine & Toxicology Dr.K.S.Naraya Reddy, 29th Edition, Page 12

Q. 2

Cross examination of the prosecution witness is done by :

 A

Public prosecutor

 B

Defence counsel

 C

Judge

 D

None

Q. 2

Cross examination of the prosecution witness is done by :

 A

Public prosecutor

 B

Defence counsel

 C

Judge

 D

None

Ans. B

Explanation:

B i.e. Defence counsel


Q. 3

Leading questions are permitted only in

 A

Examination in chief

 B

Cross examination

 C

Dying declaration

 D

Re-examination

Q. 3

Leading questions are permitted only in

 A

Examination in chief

 B

Cross examination

 C

Dying declaration

 D

Re-examination

Ans. B

Explanation:

B i.e. Cross examination

  • Leading questions are permissible during cross examinationQ & not during examination in chief (or direct examination) and re-examination.

A leading question is one which suggests to the witness the answer desired and admits of a conclusive answer by a wwwwww• simple ‘yes’ or ‘no’. Did Mr. A attack the decreased? was the length of cut 3 cm?

Quiz In Between


Q. 4

Conduct money is paid to expert witness with summons from :

 A

Civil court

 B

Criminal court

 C

High court

 D

Sub magistrate

Q. 4

Conduct money is paid to expert witness with summons from :

 A

Civil court

 B

Criminal court

 C

High court

 D

Sub magistrate

Ans. A

Explanation:

A i.e. Civil court


Q. 5

Who can be considerd as an expert witness :

 A

Medical men

 B

Firearm expert

 C

Chemical examiner

 D

All

Q. 5

Who can be considerd as an expert witness :

 A

Medical men

 B

Firearm expert

 C

Chemical examiner

 D

All

Ans. D

Explanation:

D i.e. All


Q. 6

Perjury is :

 A

Willful utterance of falsehood

 B

An act comitted within court premises

 C

Failure to sign summons

 D

Failure to appear as a witness

Q. 6

Perjury is :

 A

Willful utterance of falsehood

 B

An act comitted within court premises

 C

Failure to sign summons

 D

Failure to appear as a witness

Ans. A

Explanation:

A i.e. Willful utterance of falsehood

Quiz In Between


Q. 7

Which of the following is true about oath :

 A

Not compulsory

 B

Compulsary and binds witness for evidence given

 C

holds witness responsible for consequence of evidence

 D

Witness is liable for prosecution if he does not take oath

Q. 7

Which of the following is true about oath :

 A

Not compulsory

 B

Compulsary and binds witness for evidence given

 C

holds witness responsible for consequence of evidence

 D

Witness is liable for prosecution if he does not take oath

Ans. B

Explanation:

B i.e. Compulsory & binds witness for evidence given


Q. 8

All is exempted from oral testimony EXCEPT

 A

Dying declaration

 B

Medical evidence of injury as witness

 C

Chemical examination report

 D

Evidence of medical expert in lower court

Q. 8

All is exempted from oral testimony EXCEPT

 A

Dying declaration

 B

Medical evidence of injury as witness

 C

Chemical examination report

 D

Evidence of medical expert in lower court

Ans. B

Explanation:

B i.e. Medical evidence of injury as witness


Q. 9

Conduct money is fee given to a:   

AP 07

 A

Witness in civil court

 B

Witness in criminal court

 C

Doctor for good behavior in court

 D

Witness for good conduct

Q. 9

Conduct money is fee given to a:   

AP 07

 A

Witness in civil court

 B

Witness in criminal court

 C

Doctor for good behavior in court

 D

Witness for good conduct

Ans. A

Explanation:

Ans. Witness in civil court

Quiz In Between


Q. 10

In civil cases, conduct money is decided by:

NEET 13

 A

Opposite party

 B

Judge

 C

Doctor

 D

Witness

Q. 10

In civil cases, conduct money is decided by:

NEET 13

 A

Opposite party

 B

Judge

 C

Doctor

 D

Witness

Ans. B

Explanation:

Ans. Judge


Q. 11

Volunteering a statement can be done by:

Punjab 07

 A

Eyewitness

 B

Medical witness

 C

Hostile witness

 D

IO

Q. 11

Volunteering a statement can be done by:

Punjab 07

 A

Eyewitness

 B

Medical witness

 C

Hostile witness

 D

IO

Ans. B

Explanation:

Ans. Medical witness


Q. 12

Hostile witness is one who:          

Maharashtra 08

 A

Threatens the Judge

 B

Threatens the prosecutor

 C

Refuses to answer

 D

Willfully gives false evidence

Q. 12

Hostile witness is one who:          

Maharashtra 08

 A

Threatens the Judge

 B

Threatens the prosecutor

 C

Refuses to answer

 D

Willfully gives false evidence

Ans. D

Explanation:

Ans. Willfully gives false evidence


Q. 13

A witness, who after taking oath, willfully makes a statement which he knows or believes to be false is guilty of offence under section: 

AIIMS 11; NEET 13, 15

 A

190 IPC

 B

191 IPC

 C

192 IPC

 D

193 IPC

Q. 13

A witness, who after taking oath, willfully makes a statement which he knows or believes to be false is guilty of offence under section: 

AIIMS 11; NEET 13, 15

 A

190 IPC

 B

191 IPC

 C

192 IPC

 D

193 IPC

Ans. D

Explanation:

Ans. 193 IPC


Q. 14

Hostile witness is covered under IPC section ‑

 A

191

 B

192

 C

193

 D

194

Q. 14

Hostile witness is covered under IPC section ‑

 A

191

 B

192

 C

193

 D

194

Ans. A

Explanation:

Ans. is ‘A’ i.e., 191.

  •  Hostility is one form of perjury.
  • A hostile witness is one who’s provided an eyewitness account of a criminal event or other information to help the prosecution build a case, but has later turned in court, giving a different version of events or contradictory information.
  • A witness is termed hostile, when he gives a certain statement on his knowledge about commission of a crime before the police but refutes it when called as witness before the court during trial. 
  • IPC 191 – Giving false evidence (Perjury)

Quiz In Between



Bechet’s Syndrome

Bechet’s Syndrome


BECHET’S SYNDROME

  • Bechet’s syndrome is a multisystem disorder with recurrent oral and genital ulcerations and ocular involvement.
  • HLA marker- HLA- B51 associated

Pathogenesis-

  • Endothelial activation
  • Hyperfunctions of neutrophils

Clinical Features-

  • Recurrent aphthous ulcerations
  • Genital ulcers
  • Skin- folliculitis, eythema nodosum, sweet syndrome, pyoderma gangrenosum, acne.
  • Eye involvement- scarring and bilateral panuveitis, Iritis/Posterior uveitis/Optic neuritis.
  • Nondeforming arthritis
  • Pseudo aneurysms

Diagnosis-

  • Pathergy Test Positive

Treatment-

  • Oral ulcers- topical glucocorticoids, thalidomide
  • Cyclosporine- eye involving
  • Cyclosphosphamide- pseudo aneurysms
  • Colchicine- mucocutaneous manifestations and arthritis
Exam Question
 
  • Bechet’s syndrome is a multisystem disorder with recurrent oral and genital ulcerations and ocular involvement.
  • HLA- B51 associated
  • Recurrent aphthous ulcerations
  • Genital ulcers
  • Skin- folliculitis, eythema nodosum, sweet syndrome, pyoderma gangrenosum, acne.
  • Eye involvement- scarring and bilateral panuveitis, Iritis/Posterior uveitis/Optic neuritis.
  • Nondeforming arthritis
  • Pseudo aneurysms
Don’t Forget to Solve all the previous Year Question asked on Bechet’s Syndrome

Module Below Start Quiz

Bechet’s Syndrome

Bechet’s Syndrome

Q. 1

Bechet’s disease is characterized by:

 A Hypopyon
 B

Hyphema

 C Subconjuctival hemmorrhage
 D

Scleritis

Q. 1

Bechet’s disease is characterized by:

 A Hypopyon
 B

Hyphema

 C Subconjuctival hemmorrhage
 D

Scleritis

Ans. A

Explanation:

Hypopyon REF: Khurana 4th ed p. 156

Uveitis in bechet’s disease

  • Bilateral
  • Recurrent iridocyclitis
  • Hypopyon
  • Viteritis
  • Periphlebitis
  • Retinitis

Q. 2

Bechet’s syndrome is characterized by all of the following eye manifestations, EXCEPT:

 A

Posterior uveitis

 B

Iritis

 C

Optic Neuritis

 D

Retinal pigmentation

Q. 2

Bechet’s syndrome is characterized by all of the following eye manifestations, EXCEPT:

 A

Posterior uveitis

 B

Iritis

 C

Optic Neuritis

 D

Retinal pigmentation

Ans. D

Explanation:

The eye disease is present in 50% of patients with Bechet’s syndrome. It is usually present at the onset but may also develop within the first few years. 

Iritis, posterior uveitis, retinal vessel occlusions and optic neuritis can be seen in some patients with the syndrome.

Note: Scarring and bilateral panuveitis is the most dreaded complication of Bechet’s, since it occasionally progresses rapidly to blindness.

Ref: Moutsopoulos H.M. (2012). Chapter 327. Behçet’s Syndrome. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.


Q. 3

HLA marker of bechet’s syndrome

 A

HLA-B27

 B

HLA-DR5

 C

HLA-B51

 D

HLA-CW6

Q. 3

HLA marker of bechet’s syndrome

 A

HLA-B27

 B

HLA-DR5

 C

HLA-B51

 D

HLA-CW6

Ans. C

Explanation:

Ans. is ‘c’ i.e., HLA-B51

Quiz In Between



Vitamin B1 & Deficiency

Vitamin B1 & Deficiency


VITAMIN B1(THIAMINE)

  • Thiamine is also called Aneurine.
  • Thiamine has a role in metabolism of carbohydrates.
  • Active form of thiamine is thiamine pyrophosphate (TTP) or Thiamine diphosphate.
  • Thiamine is a coenzyme
  • Thiamine Pyrophosphate is the coenzyme which functions for the decarboxylation reaction-
  1. Pyruvate dehydrogenase- conversion of pyruvate to acetyl CoA
  2. α-ketoglutarate dehydrogenase– conversion of α-ketoglutarate to succinyl CoA
  3. Branched chain keto acid dehydrogenase- catalyses oxidativdecarboxylation of Branched keto Chain Amino acids.
  4. Thiamine diphosphate is also the coenzyme for transketolase in pentose phosphate pathway.

Thiamine nutritional status is best assessed by erythrocyte or whole blood transketolase activity.

 Sources-

  • Aleurone layer of cereals.
  • Yeast is also good source of thiamine.
  • Meat

VITAMIN B1 DEFICIENCY

  • Deficiency of thiamine causes-
  1. Beri Beri- 2 types
  2. Wet Beri Beri
  3. Dry Beri Beri
  4. Wernicke’s encephalopathy with korsakoff psychosis
  5. Lactic acidosis
  • Recommended Daily Allowance of Vitamin B1- 1-1.5 mg/day
Exam Question
 
  • Thiamine is also called Aneurine.
  • Thiamine has a role in metabolism of carbohydrates.
  • Active form of thiamine is thiamine pyrophosphate (TTP) or Thiamine diphosphate.
  • Thiamine is a coenzyme
  • Thiamine Pyrophosphate is the coenzyme which functions for the decarboxylation reaction-
  1. Pyruvate dehydrogenase- conversion of pyruvate to acetyl CoA
  2. α-ketoglutarate dehydrogenase- conversion of α-ketoglutarate to succinyl CoA
  3. Branched chain keto acid dehydrogenase- catalyses oxidative decarboxylation of Branched keto Chain Amino acids.
  4. Thiamine diphosphate is also the coenzyme for transketolase in pentose phosphate pathway.

Thiamine nutritional status is best assessed by erythrocyte or whole blood transketolase activity.

  • Sources-
  • Aleurone layer of cereals.
  • Yeast is also good source of thiamine.
  • Meat

VITAMIN B1 DEFICIENCY

  • Deficiency of thiamine causes-
  1. Beri Beri- 2 types
  2. Wet Beri Beri
  3. Dry Beri Beri- polyneuritis, muscle wasting
  4. Wernicke’s encephalopathy with korsakoff psychosis
  5. Lactic acidosis
  • Recommended Daily Allowance of Vitamin B1- 1-1.5 mg/day
Don’t Forget to Solve all the previous Year Question asked on Vitamin B1 & Deficiency

Module Below Start Quiz

Vitamin B1 & Deficiency

Vitamin B1 & Deficiency

Q. 1

Body content of thiamine is:

 A

5 g

 B

6 g

 C

20 g

 D

30 g

Q. 1

Body content of thiamine is:

 A

5 g

 B

6 g

 C

20 g

 D

30 g

Ans. D

Explanation:

Body content of thiamine is placed at 30 mg and if more than this is ingested, it is merely lost in urine.
 
Ref: Park 22nd edition, page 572

Q. 2

A young man from a poor socio economic family presented with symmetric distal peripheral neuropathy involving both sensory and motor systems along with features of congestive heart failure. Investigations revealed thiamine deficiency. All of the following conditions are predisposing factors for thiamine deficiency, EXCEPT:

 A

Chronic diarrhoea

 B

Chronic alcoholism

 C

Homocysteinemia

 D

Food faddist

Q. 2

A young man from a poor socio economic family presented with symmetric distal peripheral neuropathy involving both sensory and motor systems along with features of congestive heart failure. Investigations revealed thiamine deficiency. All of the following conditions are predisposing factors for thiamine deficiency, EXCEPT:

 A

Chronic diarrhoea

 B

Chronic alcoholism

 C

Homocysteinemia

 D

Food faddist

Ans. C

Explanation:

Thiamine deficiency is now most often seen as a consequence of chronic alcohol abuse, recurrent vomiting, total parenteral nutrition, and bariatric surgery.
Thiamine deficiency polyneuropathy can occur in normal, healthy young adults who do not abuse alcohol but who engage in inappropriately restrictive diets.

clinical thiamine deficiency is limited primarily to alcoholics, food faddists, and patients receiving chemotherapy.
 
Predisposing factors for pediatric thiamine deficiency include unsupplemented parenteral nutrition, breastfed infants of thiamine-deficient mothers, congestive heart failure,85 and severe malnutrition.
 
Ref: Amato A.A., Barohn R.J. (2012). Chapter 384. Peripheral Neuropathy. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

 


Q. 3

A very ill infant is admitted to the hospital. Laboratory examination reveals a very high serum concentration of lactic acid. In addition to taking steps to correct the acidosis, the attending physician prescribes thiamine. The rationale for thiamine administration is that thiamine is converted to a coenzyme used by which of the following enzymes?

 A

Lactate dehydrogenase

 B

Pyruvate carboxylase

 C

Pyruvate dehydrogenase

 D

Pyruvate kinase

Q. 3

A very ill infant is admitted to the hospital. Laboratory examination reveals a very high serum concentration of lactic acid. In addition to taking steps to correct the acidosis, the attending physician prescribes thiamine. The rationale for thiamine administration is that thiamine is converted to a coenzyme used by which of the following enzymes?

 A

Lactate dehydrogenase

 B

Pyruvate carboxylase

 C

Pyruvate dehydrogenase

 D

Pyruvate kinase

Ans. C

Explanation:

Thiamine is a water-soluble vitamin that is converted to the coenzyme thiamine pyrophosphate.

This coenzyme is used by pyruvate dehydrogenase to convert pyruvate to acetyl coenzyme A.

In the absence of thiamine, pyruvate accumulates and can be converted by lactate dehydrogenase to lactate, which is spilled in the blood causing lactic acidosis.

Lactate dehydrogenase produces lactate from pyruvate but does not use thiamine pyrophosphate.

Some lactic acidosis might be produced by decreased pyruvate carboxylase activity, but the enzyme requires biotin rather than thiamine pyrophosphate.
 

Pyruvate kinase makes pyruvate from phosphoenolpyruvate, but does not use thiamine pyrophosphate.
 
Ref: Botham K.M., Mayes P.A. (2011). Chapter 23. Biosynthesis of Fatty Acids & Eicosanoids. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper’s Illustrated Biochemistry, 29e.

Quiz In Between


Q. 4

Thiamine is NOT used in which of the following biochemical  reactions?

 A

Lactate to pyruvate

 B

Alpha Ketoglutarate to succinyl CoA

 C

Glucose to pentose

 D

Oxidative decarboxylation of alpha keto amino acids

Q. 4

Thiamine is NOT used in which of the following biochemical  reactions?

 A

Lactate to pyruvate

 B

Alpha Ketoglutarate to succinyl CoA

 C

Glucose to pentose

 D

Oxidative decarboxylation of alpha keto amino acids

Ans. A

Explanation:

TPP is required for the oxidative decarboxylation of alpha ketoglutarate to succinyl CoA and CO2. Transketolase in HMP shunt pathway of glucose uses thiamine. Main role of thiamine is in the carbohydrate metabolism. It is required for the activity of enzyme pyruvate dehydrogenase which catalyses the conversion of pyruvate to acetyl CoA and CO2.

 
Deficiency manifestations of Thiamine:
  • Wet Beriberi: Patients have cardiovascular manifestations such as edema  of legs, face, and serous cavities. 
  • Dry Beriberi: Patients have CNS manifestations such as peripheral neuritis with sensory disturbance. 
  • Wernicke Korsakoff syndrome: Clinical features includes encephalopathy plus psychosis.
  • Polyneuritis
Ref: Textbook of Biochemistry for Medical Students  By Dm Vasudevan page 391. Textbook of Biochemistry for Dental Students  By Vasudevan page 157.

Q. 5

Thiamine deficiency causes decreased energy production because

 A

It is required for the process of transamination

 B

It is co-factor in oxidative reduction

 C

It is co-enzyme for transketolase in pentose phosphate pathway

 D

It is co-enzyme for pyruvate dehydrogenase

Q. 5

Thiamine deficiency causes decreased energy production because

 A

It is required for the process of transamination

 B

It is co-factor in oxidative reduction

 C

It is co-enzyme for transketolase in pentose phosphate pathway

 D

It is co-enzyme for pyruvate dehydrogenase

Ans. D

Explanation:

D i.e. It is coenzyme for pyruvate dehydrogenase

Thiamin (vit B1) has central role in energy yielding metabolism especially of carbohydrates. So thiamin requirement increases in excess intake of carbohydrates and its deficiency leads to decreased energy productionQ. Hampered or decreased function of pyruvate dehydrogenase enzyme (which forms acetyl CoA from pyruvate) and a-ketoglutarate dehydrogenase enzyme (of TCA cycle) in which thiamin acts as coenzyme is the main cause of this decreased energy production. Decreased PDH function also Vt pyruvic and lactic acidiosisQ.


Q. 6

Thiamine requirement increases in excessive intake of:

 A

Carbohydrate

 B

Amino acid

 C

Fat

 D

Lecithine

Q. 6

Thiamine requirement increases in excessive intake of:

 A

Carbohydrate

 B

Amino acid

 C

Fat

 D

Lecithine

Ans. A

Explanation:

A i.e. Carbohydrate

Quiz In Between


Q. 7

Thiamine level is best monitored by :

 A

Transketolase level in blood

 B

Thiamine level in blood

 C

G6PD activity

 D

Reticulocytosis

Q. 7

Thiamine level is best monitored by :

 A

Transketolase level in blood

 B

Thiamine level in blood

 C

G6PD activity

 D

Reticulocytosis

Ans. A

Explanation:

A i.e. Transketolase level in blood


Q. 8

Thiamine acts as a cofactor in :

 A

Conversion of pyruvate to acetyl-CoA

 B

Transa mina tion reactions

 C

Oxidation in respiratory chain

 D

Conversion of pyridoxal to pyridoxal phosphate

Q. 8

Thiamine acts as a cofactor in :

 A

Conversion of pyruvate to acetyl-CoA

 B

Transa mina tion reactions

 C

Oxidation in respiratory chain

 D

Conversion of pyridoxal to pyridoxal phosphate

Ans. A

Explanation:

A i.e. Conversion of Pyruvate to acetyl COA


Q. 9

Thiamine is essential for

 A

Isocitrate dehydrogenase

 B

Succinate dehydrogenase

 C

Pyruvate dehydrogenase

 D

Acetyl CoA synthetase

Q. 9

Thiamine is essential for

 A

Isocitrate dehydrogenase

 B

Succinate dehydrogenase

 C

Pyruvate dehydrogenase

 D

Acetyl CoA synthetase

Ans. C

Explanation:

 C i.e. Pyruvate dehydrogenase

Quiz In Between


Q. 10

Thiamine is not used in which of the following reactions

 A

Lactate to pyruvate

 B

Alphaketoglutarate to succinyl CoA

 C

Glucose to pentose

 D

Oxidative decarboxylation of a-keto amino acids

Q. 10

Thiamine is not used in which of the following reactions

 A

Lactate to pyruvate

 B

Alphaketoglutarate to succinyl CoA

 C

Glucose to pentose

 D

Oxidative decarboxylation of a-keto amino acids

Ans. A

Explanation:

A i.e. Lactate to Pyruvate


Q. 11

Thiamine deficiency may be seen in all of the following except:             

March 2009

 A

Homocystinemia

 B

Chronic alcoholism

 C

Heart failure patients on diuretics

 D

Starvation

Q. 11

Thiamine deficiency may be seen in all of the following except:             

March 2009

 A

Homocystinemia

 B

Chronic alcoholism

 C

Heart failure patients on diuretics

 D

Starvation

Ans. A

Explanation:

Ans. A: Homocystinemia

Causes of thiamine deficiency:

  • Lack of thiamine intake :

–          Diets consisting mainly of the following:

  • Food containing a high level of thiaminases, including milled rice, raw freshwater fish, raw shellfish, and ferns
  • Food high in anti-thiamine factor, such as tea, coffee, and betel nuts
  • Processed food with a content high in sulfite, which destroys thiamine

–          Alcoholic state

–          Starvation state

  • Increased consumption states

–          Diets high in carbohydrate or saturated fat intake

–          Pregnancy

–          Hyperthyroidism

–          Lactation

–          Fever – severe infection

–          Increased physical exercise

  • Increased depletion

–          Diarrhea

–          Diuretic therapies

–          Peritoneal dialysis

–          Hemodialysis

–          Hyperemesis gravidarum

Loss of thiamine through renal excretion can occur with most, if not all, diuretics.

It has been seen with the use of such diuretics as mannitol, acetazolamide, chlorothiazide, amiloride, and loop diuretics. Thiamine loss is associated with the increase in urine flow rate, but it is not related to sodium excretion.

This suggests that patients with polyuria, even if the condition is unrelated to diuretics, may benefit from thiamine supplementation.


Q. 12

Thiamine deficiency is best diagnosed by‑

 A

Thiamine level in blood

 B

Transketolase level in blood

 C

Aldolase level in blood

 D

Thiamine level in urine

Q. 12

Thiamine deficiency is best diagnosed by‑

 A

Thiamine level in blood

 B

Transketolase level in blood

 C

Aldolase level in blood

 D

Thiamine level in urine

Ans. B

Explanation:

 

THIAMINE (VITAMIN B1)

Thiamine is also called aneurine. Thiamine has a central role in energy-yielding metabolism and especially the metabolism of carbohydrates. The active form of thiamine is thiamine pyrophosphate (TTP) also called thiamine diphosphate (TDP).

Thiamine diphosphate (TDP) or TPP is the coenzyme for three multienzyme complexes that catalyze oxidative decarboxylation :

  • Pyruvate dehydrogenase in carbohydrate metabolism, which catalyzes the conversion of pyruvate to acetyl CoA.
  • α-Ketoglutarate dehydrogenase in citric acid cycle, which catalyzes the conversion of a-ketogluta rate to succinyl CoA.
  • Branched-chain keto acid dehydrogenase which catalyzes the oxidative decarboxylation of branched chain keto amino acids, i.e. leucine, isoleucine and valine.
  • Thiamine diphosphate is also the coenzume for transketolase, in the pentose phosphate pathway. There­fore, thiamine nutritional status is best assessed by erythrocyte (preferred) or whole blood transketolase activity.
  • Deficiency of thiamine causes :
  1. Beriberi
  2. Wernicke’s encephalopathy, with korsakoff psychosis
  3. Lactic acidosis

Q. 13

Thiamine deficiency – causes ‑

 A

Pellagra

 B

Ben – Beri

 C

Keshan’s disease

 D

Rickets

Q. 13

Thiamine deficiency – causes ‑

 A

Pellagra

 B

Ben – Beri

 C

Keshan’s disease

 D

Rickets

Ans. B

Explanation:

Ans. is ‘b’ i.e., Beri-Berl

Beri-beri

  • Deficiency of thiamine (Vit B])
  • Can be dry (neural involvement)

Quiz In Between



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