Contusion/Bruise-Factors and Color changes

Contusion/Bruise-Factors and Color changes

Q. 1

Yellow color of a bruise is due to which of the following?

 A

Bilirubin

 B

Hemoglobin

 C

Hemosiderine

 D

Deoxyhemoglobin

Q. 1

Yellow color of a bruise is due to which of the following?

 A

Bilirubin

 B

Hemoglobin

 C

Hemosiderine

 D

Deoxyhemoglobin

Ans. A

Explanation:

The yellow color is due to degradation of hemoglobin to bilirubin. Deoxyhemoglobin is responsible for bluish bruise seen on the first day after the injury.

Bruises change color over time, because of the degradation of haemoglobin in the blood. However, the timescale of this degradation is not fixed, and it is therefore possible only to give a rough estimation of the age of the bruise. 
Colour changes are:

Dark blue/ purple (fresh)
Blue
Brown
Green
Yellow


Q. 2

A patient is brought to you with alleged history of assault 2 hours ago. You seen multiple well defined bruises with vesication over the flexor aspect of left hand and skin of right leg. You suspect that the bruises are artificially made. Which of the following will be more suggestive of an artificially made wound?

 A

Bright red wound

 B

The wound margins are well defined with small vesicles covering it

 C

Inflammation at the site of the wound

 D

Extravasated blood present

Q. 2

A patient is brought to you with alleged history of assault 2 hours ago. You seen multiple well defined bruises with vesication over the flexor aspect of left hand and skin of right leg. You suspect that the bruises are artificially made. Which of the following will be more suggestive of an artificially made wound?

 A

Bright red wound

 B

The wound margins are well defined with small vesicles covering it

 C

Inflammation at the site of the wound

 D

Extravasated blood present

Ans. B

Explanation:

Feature of artificial bruising is given below:
 
1) Seen on exposed easily accessible parts
2) Dark brown in colour
3) Well defined wound covered with vesicles
4) Inflammation around the surrounding site
5) Itching
6) Vesicles on the fingertip and other parts of the body due to scratching
 
Note: Artificial bruises can be caused by juice of marking nut, calotropis or plumbago rosea
 
Ref: Textbook of Forensic Medicine by Narayana Reddy, Edition 20, Page 155

Q. 3

A contusion can be differentiated from postmortem staining by doing:

 A

Diaphanous test

 B

Picard’s test

 C

Incision test

 D

Gettler’s test

Q. 3

A contusion can be differentiated from postmortem staining by doing:

 A

Diaphanous test

 B

Picard’s test

 C

Incision test

 D

Gettler’s test

Ans. C

Explanation:

While taking an incision on contusion, extravasation of blood into the surrounding tissues which is firmly clotted and cannot be washed by gentle stream of water. Subcutaneous tissues are deep reddish-black.
 
On incision in postmortem staining, blood is seen in blood vessels, which can be easily washed away. Subcutaneous tissues are pale.
 
Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 163.

Quiz In Between


Q. 4

Blue colour of the bruise is due to

 A

Hemosiderin

 B

Deoxyhemoglobin

 C

Bilirubin

 D

Hematoidin

Q. 4

Blue colour of the bruise is due to

 A

Hemosiderin

 B

Deoxyhemoglobin

 C

Bilirubin

 D

Hematoidin

Ans. B

Explanation:

B i.e. Deoxyhemoglobin


Q. 5

Which is not true regarding colour of bruise :

 A

4th day – bluish black to brown

 B

7-12 days – green

 C

1′ day – red

 D

2 weeks – normal

Q. 5

Which is not true regarding colour of bruise :

 A

4th day – bluish black to brown

 B

7-12 days – green

 C

1′ day – red

 D

2 weeks – normal

Ans. B

Explanation:

B i.e. 7-12 days = green


Q. 6

A person ‘X’ hits another person ‘Y’ with a wooden stick on provocation. This leads to formation of a bruise 3cm x 3cm on the forearm. No other injuries are noted. Which of the following is true, regarding his punishment:

 A

Imprisonment for one year and/or fine of Rs. 1000

 B

Imprisonment for two years and/or fine of Rs. 5000

 C

Imprisonment for 1 month and/or fine of Rs. 500

 D

Rigrous Imprisonment for six months

Q. 6

A person ‘X’ hits another person ‘Y’ with a wooden stick on provocation. This leads to formation of a bruise 3cm x 3cm on the forearm. No other injuries are noted. Which of the following is true, regarding his punishment:

 A

Imprisonment for one year and/or fine of Rs. 1000

 B

Imprisonment for two years and/or fine of Rs. 5000

 C

Imprisonment for 1 month and/or fine of Rs. 500

 D

Rigrous Imprisonment for six months

Ans. C

Explanation:

C i.e. Imprisonment for 1 month and/or fine of Rs. 500/-

–   Emasculation (class 1), permanent privation of sight of either eye (2), or hearing of either ear (3) privation of any part (member) or joint (4) destruction or permanent impairment of powers of any member or joint (5) permanent disfiguration of head or face (6) fracture / dislocation of bone or tooth (7) and any hurt which endangers life or which causes sufferer to be, during the period of 20 days, in severe bodily pain or unable to follow his/ her ordinary pursuits (class 8) are included in grevious hurt (section 320 IPC).

–  To be counted as grevious hurt, the loss of privation of sight or hearing may be partial and need not be complete but has to be permanent. Again permanent does not mean that it should be incurableQ. For example, when loss of sight is due to corneal opacity due to some injury, it is curable by corneoplasty. But as because corneal opacity is permanent by itself it will be considered grevious hurtQ & chances of cure by corneoplasty does not minimize its gravity-Apurba Nandy 2/e P-203.

Abrasion heals completely without leaving any disfiguration or deformity of hence its a simple injuryQ. Contusion of scalp does not produce permanent disfiguration as it reverts to normal in few weeks.

– Contrary to popular belief, a simple stay in hospital for 20 days or deliberately delaying the healing of simple hurt by patient for 20 days do not constitute grevious injury. And a stay of < 20 days (even with bodily pain) is not considered a grevious injury. Grevious hurt is a cognizable offence for which a police officer can arrest a person without a warrant from magistrateQ. Punishment for voluntarily causing simple (non grevious) hurt on provocation with simple (non dangerous) weapon is imprisonment extending upto 1 month and/or fine upto Rs. 500/- or bothQ. Stick is a non dangerous weapon and bruise on forearm is simple (not grevious) hurtQ.

Quiz In Between


Q. 7

Bruise in the following areas do NOT show typical colour changes:       

September 2003

 A

Ear lobes

 B

Tongue

 C

Conjunctiva

 D

Genitalia

Q. 7

Bruise in the following areas do NOT show typical colour changes:       

September 2003

 A

Ear lobes

 B

Tongue

 C

Conjunctiva

 D

Genitalia

Ans. C

Explanation:

Ans. C i.e. Conjunctiva


Q. 8

Bruise attains greenish discoloration by:

September 2003

 A

1 day

 B

2-3 days

 C

5-6 days

 D

7-12 days

Q. 8

Bruise attains greenish discoloration by:

September 2003

 A

1 day

 B

2-3 days

 C

5-6 days

 D

7-12 days

Ans. C

Explanation:

Ans. C i.e. 5-6 days


Q. 9

Prominent bruise with minimum force is seen in:

AIIMS 09

 A

Scalp

 B

Soles

 C

Palm

 D

Face

Q. 9

Prominent bruise with minimum force is seen in:

AIIMS 09

 A

Scalp

 B

Soles

 C

Palm

 D

Face

Ans. D

Explanation:

Ans. Face

Quiz In Between


Q. 10

Antemortem bruise is differentiated from postmortem bruise by:       

AIIMS 09

 A

Well-defined margin

 B

Capillary rupture with extravasation of blood

 C

Yellow color

 D

Gaping

Q. 10

Antemortem bruise is differentiated from postmortem bruise by:       

AIIMS 09

 A

Well-defined margin

 B

Capillary rupture with extravasation of blood

 C

Yellow color

 D

Gaping

Ans. B

Explanation:

Ans. Capillary rupture with extravasation of blood


Q. 11

All are true about antemortem contusion, except:

NEET 14

 A

Sequential color change

 B

No inflammation

 C

Raised enzyme levels

 D

Blood cells in surrounding tissue

Q. 11

All are true about antemortem contusion, except:

NEET 14

 A

Sequential color change

 B

No inflammation

 C

Raised enzyme levels

 D

Blood cells in surrounding tissue

Ans. B

Explanation:

Ans. No inflammation


Q. 12

Feature which differentiates true from artificial bruise is ‑

 A

Round shape with irregular margins

 B

Irregular shape with regular margins

 C

Swelling of surrounding area

 D

Erythema of surrounding area

Q. 12

Feature which differentiates true from artificial bruise is ‑

 A

Round shape with irregular margins

 B

Irregular shape with regular margins

 C

Swelling of surrounding area

 D

Erythema of surrounding area

Ans. A

Explanation:

Ans. is ‘a’ i.e., Round shape with irregular margins

Quiz In Between


Q. 13

Bruise discoloration as shown in the photograph below occur after ? 

 A

1 day.

 B

2 days.

 C

7 days.

 D

15 days.

Q. 13

Bruise discoloration as shown in the photograph below occur after ? 

 A

1 day.

 B

2 days.

 C

7 days.

 D

15 days.

Ans. B

Explanation:

Ans:B.)2 days.

Colour Changes of Bruise:

Time

Color change

Pigment

At first

Red

Hemoglobin

Few hrs to 3 days

Blue

Reduced Hb

4th day

Bluish black to brown,

Hemosiderin

5-6 days

Green

Hematoidin

7-12 days

Yellow

Bilirubin

2 weeks

Normal



Q. 14

The image shown is of a nut which is used to produce artificial bruise.Which among the following is an ingredient of this nut ? 

 A

Semecarpol.

 B

Croton.

 C

Abrin.

 D

Ricin.

Q. 14

The image shown is of a nut which is used to produce artificial bruise.Which among the following is an ingredient of this nut ? 

 A

Semecarpol.

 B

Croton.

 C

Abrin.

 D

Ricin.

Ans. A

Explanation:

Ans:A.)Semecarpol.

The nut shown in the picture above represents marking nut ( semicarpus anacardium ).

MARKING NUT

  • Latin name: Semecarpus anacardium
  • English name: Marking nut
  • Uses:
    • Laundry marker,Quack remedy for assorted ailments,Ink Preparation
  • The nut is black, roughly cone shaped, and has a thick pericarp.
    • The contained juice is brown, oily, and acrid.
    • Its active principles are Semecarpol and bhilawanol.
  • Medicolegal aspects:
    • The juice is used as an abortifacient by application to the os uteri by means of an abortion stick. It is applied to the genitals as a punishment for adultery.
    • It is used by malingerers to produce an artificial bruise to support a false charge; its presence, however, can be detected by chemical analysis of the blister fluid.
    • The juice may be instilled into the eyes to produce an irritant conjunctivitis.
      • This is resorted to by personnel in army, navy or air force when they wish to leave the job or by inmates of jail to avoid work.
    • Accidental poisoning may occur from internal administration by quacks.

CONTUSION (BRUISE)

  • Effusion of blood into tissues due to rupture of blood vessels caused by blunt trauma.

Artificial bruise

True bruise

Caused by Juice of marking nut, calotropis,Plumbago rosea

Trauma

Dark brown color

Color changes

Well defined margins

Merge with surrounding areas

Vesicles present

Absent

Redness seen in the surrounding skin

Redness in the site of injury

Itching present

Absent



Q. 15

All are true about antemortem contusion except‑

 A

Sequential color change

 B

No inflammation

 C

Raized enzyme levels

 D

Blood cells in surrounding tissueAccidendal

Q. 15

All are true about antemortem contusion except‑

 A

Sequential color change

 B

No inflammation

 C

Raized enzyme levels

 D

Blood cells in surrounding tissueAccidendal

Ans. B

Explanation:

Ans. is ‘b’ i.e., No inflammation

Quiz In Between


Q. 16

Brown color of contusion is due to –

 A

Haematodin

 B

Reduced hemoglobin

 C

Haemosiderin

 D

Bilirubin

Q. 16

Brown color of contusion is due to –

 A

Haematodin

 B

Reduced hemoglobin

 C

Haemosiderin

 D

Bilirubin

Ans. C

Explanation:

Ans. is ‘c’ i.e., Haemosiderin

Color change and age of bruise (Contusion)

  • After a bruise has appeared, it tends to get smaller from periphery to center and passes through a series of colour changes. These are due to disintegration of RBCs by hemolysis and breakdown of hemoglobin into the pigments haemosiderin, haematodin and bilirubin changes are : –
  1. At first : Red (oxyhemoglobin)
  2. Few hours to 3 days : blue (reduced hemoglobin)
  3. 4th day : Bluish-black to brown (haemosiderin)
  4. 5-6 days : Greenish (haematodin)
  5. 7-12 days : Yellow (Bilirubin)
  6. 2 weeks : Normal (absorption of pigment)

Q. 17

Difference between contusion and post-mortem lividity is that post-mortem lividity ‑

 A

Shows sequential color change

 B

Easily washable

 C

Shows diffuse irregular margins

 D

Has raised enzyme levels

Q. 17

Difference between contusion and post-mortem lividity is that post-mortem lividity ‑

 A

Shows sequential color change

 B

Easily washable

 C

Shows diffuse irregular margins

 D

Has raised enzyme levels

Ans. B

Explanation:

Ans. is ‘b’ i.e., Easily washable

 

Quiz In Between



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