Forensic Medicine Prometric exam questions with answers

1. Question 1Asphyxia and Drowningmedium

   A young woman is found dead in her bedroom. There are small bruises and crescentic abrasions on both sides of the neck and petechiae in the conjunctivae. Which internal finding most supports manual strangulation?

   1. APulmonary oedema with froth in the airways
   2. BFatty streaks in the carotid arteries
   3. CHaemorrhage in the strap muscles of the neck
   4. DCongestion of the liver and spleen
   Show answer and explanation▾

   Answer: C. Haemorrhage in the strap muscles of the neck

   Manual strangulation causes focal haemorrhage in the neck muscles and soft tissues, often with fractures of the hyoid or thyroid cartilage horns in older people. A layer-by-layer neck dissection in a bloodless field is needed so artefact is not mistaken for bruising. Pulmonary oedema and organ congestion are non-specific findings.

2. Question 2Clinical Forensic Medicinehard

   A 5-month-old infant collapses at home. CT shows thin bilateral subdural haemorrhages of different densities, and there is no skull fracture. Which further finding most strengthens a diagnosis of abusive head trauma?

   1. AA single small bruise on the shin
   2. BExtensive multilayered retinal haemorrhages
   3. CMild anaemia on the full blood count
   4. DEnlarged extra-axial spaces on CT
   Show answer and explanation▾

   Answer: B. Extensive multilayered retinal haemorrhages

   Subdural haemorrhage combined with extensive, multilayered retinal haemorrhages extending to the periphery, and encephalopathy, strongly supports abusive head trauma when there is no adequate accidental explanation. Benign enlargement of the extra-axial spaces is a differential that should be considered, not a supportive finding. Anaemia is non-specific.

3. Question 3Firearm, Blast, Thermal and Electrical Injurymedium

   A gunshot entry wound over the right temple is a large star-shaped tear with soot inside the wound and a faint muzzle imprint on the surrounding skin. What range of fire is most likely?

   1. AHard contact discharge
   2. BIntermediate range of about 30 cm
   3. CDistant range beyond one metre
   4. DRicochet from a nearby wall
   Show answer and explanation▾

   Answer: A. Hard contact discharge

   In a hard contact wound over bone, gases enter the tissue and lift the skin against the muzzle, splitting it into a stellate tear and stamping a muzzle imprint, with soot deposited within the wound. Intermediate range produces powder tattooing around a round entry. Distant wounds show neither soot nor tattooing.

4. Question 4Firearm, Blast, Thermal and Electrical Injurymedium

   A charred body is recovered from a house fire. Which autopsy finding best indicates that the person was alive when the fire started?

   1. AHeat fractures of the skull vault
   2. BPugilistic posture of the limbs
   3. CSplits in the skin of the limbs
   4. DSoot in the airways below the vocal cords
   Show answer and explanation▾

   Answer: D. Soot in the airways below the vocal cords

   Soot below the vocal cords, together with raised carboxyhaemoglobin, shows the person was breathing in smoke and was alive in the fire. Heat fractures, the pugilistic posture and skin splits are heat artefacts that occur equally in bodies burnt after death. Such artefacts must not be mistaken for antemortem injury.

5. Question 5Thanatology and Time Since Deatheasy

   A forensic physician plans to estimate the time since death using the Henssge nomogram. She has measured the deep rectal temperature and the ambient temperature at the scene. Which further measurement is essential to use the nomogram?

   1. ABody weight of the deceased
   2. BVitreous potassium concentration
   3. CExtent of rigor mortis
   4. DDegree of corneal clouding
   Show answer and explanation▾

   Answer: A. Body weight of the deceased

   The Henssge nomogram uses rectal temperature, ambient temperature and body weight, with corrective factors for clothing, covering and air movement. Vitreous potassium and rigor are separate methods and are not inputs to the nomogram. Corneal clouding is a crude sign without a defined role in the calculation.

6. Question 6Forensic Pathology Practice and Sudden Deathmedium

   A 19-year-old footballer collapses and dies during a match. The heart weighs 520 g with asymmetric thickening of the interventricular septum. Which histological finding confirms the likely diagnosis?

   1. AMyocyte disarray with interstitial fibrosis
   2. BFibrofatty replacement of the right ventricle
   3. CLymphocytic infiltrate with myocyte necrosis
   4. DContraction band necrosis in the subendocardium
   Show answer and explanation▾

   Answer: A. Myocyte disarray with interstitial fibrosis

   Hypertrophic cardiomyopathy is characterised by asymmetric septal hypertrophy with myocyte disarray and interstitial fibrosis, and it is a leading cause of sudden death in young athletes. Fibrofatty replacement of the right ventricle indicates arrhythmogenic cardiomyopathy. Lymphocytic infiltrate with necrosis indicates myocarditis.

7. Question 7Thanatology and Time Since Deathhard

   Blowfly larvae are recovered from a decomposing body found outdoors in summer. An entomologist determines the age of the oldest larvae using local temperature data. What does this larval age best represent?

   1. AThe maximum possible time since death
   2. BThe exact time of death
   3. CThe minimum time since death
   4. DThe time the body was moved outdoors
   Show answer and explanation▾

   Answer: C. The minimum time since death

   Blowflies lay eggs on a body after death or around death, so the age of the oldest larvae gives a minimum postmortem interval. Delays in colonisation caused by weather, wrapping or burial mean death may have occurred earlier, so it is not a maximum or an exact time. Larval age alone cannot show when a body was moved.

8. Question 8Wounds and Mechanical Injuryeasy

   A woman is found dead with a deep incised wound on the front of the left wrist. Several shallow, parallel, superficial cuts lie beside it. What do the superficial cuts most likely represent?

   1. ADefence injuries from an attacker
   2. BPostmortem animal activity
   3. CTentative self-inflicted injuries
   4. DInjuries from emergency treatment
   Show answer and explanation▾

   Answer: C. Tentative self-inflicted injuries

   Multiple shallow parallel cuts beside a deeper wound at an accessible site such as the wrist are classic hesitation or tentative injuries, which support self-infliction. Defence injuries are usually on the palms and the back or ulnar side of the forearms. Animal activity produces irregular gnawed margins without vital reaction.

9. Question 9Forensic Toxicologymedium

   A farm worker is brought in dead after collapsing in a field. Witnesses describe vomiting, profuse sweating, drooling and muscle twitching. Pupils are pinpoint. Which laboratory result would best support the suspected poisoning?

   1. ARaised blood carboxyhaemoglobin
   2. BReduced red cell acetylcholinesterase
   3. CRaised serum paracetamol level
   4. DRaised blood ethanol level
   Show answer and explanation▾

   Answer: B. Reduced red cell acetylcholinesterase

   The muscarinic and nicotinic features with miosis point to organophosphate poisoning, which inhibits acetylcholinesterase. Low red cell acetylcholinesterase activity supports exposure, and the compound itself can be identified in blood or stomach contents. Carboxyhaemoglobin and ethanol do not cause this cholinergic picture.

10. Question 10Medical Ethics, Law and Certificationmedium

    A man with long-standing alcoholic cirrhosis dies from massive haemorrhage from oesophageal varices. How should the cause of death be recorded in Part I of the certificate?

    1. AIa Cardiac arrest, Ib Haemorrhage, Ic Cirrhosis
    2. BIa Alcoholic cirrhosis, Ib Oesophageal varices, Ic Haemorrhage
    3. CIa Haemorrhage, Ib Oesophageal varices, Ic Alcoholic cirrhosis
    4. DIa Oesophageal varices only, cirrhosis in Part II
    Show answer and explanation▾

    Answer: C. Ia Haemorrhage, Ib Oesophageal varices, Ic Alcoholic cirrhosis

    Part I records the chain of events leading to death, with the immediate cause on the top line and the underlying cause that started the sequence on the lowest line. Alcoholic cirrhosis caused the varices, which caused the haemorrhage. Modes of dying such as cardiac arrest should not be recorded as a cause.

11. Question 11Thanatology and Time Since Deathmedium

    A body is found two days after the person was last seen. Rectal temperature has equilibrated with the room. Which postmortem specimen is most useful for a biochemical estimate of the time since death?

    1. AFemoral blood glucose
    2. BCerebrospinal fluid protein
    3. CUrine creatinine
    4. DVitreous humour potassium
    Show answer and explanation▾

    Answer: D. Vitreous humour potassium

    Vitreous potassium rises in an approximately linear way after death as cells release potassium, and the vitreous is relatively protected from contamination and putrefaction. It is therefore the most widely used biochemical marker of the postmortem interval once body cooling is complete. Blood glucose falls unpredictably after death and is not a time marker.

12. Question 12Thanatology and Time Since Deathmedium

    A body recovered from a waterlogged grave several months after burial shows waxy, greyish-white, rancid-smelling tissue over the cheeks, buttocks and thighs. What process has produced this change?

    1. AHydrolysis and hydrogenation of body fat
    2. BDehydration of tissues in dry air
    3. CAutolysis of the pancreas and liver
    4. DBacterial production of hydrogen sulphide
    Show answer and explanation▾

    Answer: A. Hydrolysis and hydrogenation of body fat

    Adipocere forms when body fat is hydrolysed and hydrogenated to fatty acids in a warm, moist, anaerobic setting such as wet graves or water. It takes weeks to months and can preserve wounds and facial features. Mummification needs dry conditions, while hydrogen sulphide production causes the green discolouration of putrefaction.

13. Question 13Wounds and Mechanical Injurymedium

    A woman has died from multiple stab wounds to the chest. Which group of additional injuries most strongly suggests she tried to protect herself from a knife attack?

    1. AAbrasions over both knees and elbows
    2. BBruises on the inner upper arms
    3. CFingertip bruises on the front of the neck
    4. DIncised wounds on the palms and ulnar forearms
    Show answer and explanation▾

    Answer: D. Incised wounds on the palms and ulnar forearms

    Active defence injuries occur when the victim grasps the blade, cutting the palms and fingers, while passive defence injuries occur on the ulnar side and back of the forearms raised to shield the body. Knee and elbow abrasions are typical of falls. Fingertip neck bruises suggest manual strangulation rather than a defensive posture.

14. Question 14Wounds and Mechanical Injurymedium

    A court asks a forensic physician to state the exact age of a yellow-green bruise on a child's forearm. Which statement is most defensible in the report?

    1. ABruise colour cannot reliably give a precise age
    2. BYellow colour proves the bruise is over 7 days old
    3. CGreen colour proves the bruise is 2 to 3 days old
    4. DAll bruises in one person change colour at one rate
    Show answer and explanation▾

    Answer: A. Bruise colour cannot reliably give a precise age

    Bruise colour change depends on depth, site, size, age of the person and lighting, and studies show poor agreement between observers, so precise ageing is not possible. At most, a yellow component suggests the bruise is not fresh. Stating exact day ranges from colour overstates the science and is a recognised cause of expert error.

15. Question 15Wounds and Mechanical Injurymedium

    A man falls backwards while intoxicated and strikes the back of his head on a concrete floor. He dies the next day. Where are cerebral contusions most likely to be found at autopsy?

    1. AOccipital lobes beneath the impact site
    2. BCerebellar hemispheres only
    3. CInferior frontal and temporal lobes
    4. DParasagittal parietal cortex
    Show answer and explanation▾

    Answer: C. Inferior frontal and temporal lobes

    When the moving head strikes a fixed object, contrecoup contusions on the opposite side are typically larger than coup lesions, and the orbital frontal and temporal poles are most affected because they lie against rough bony ridges. Occipital contusions beneath the impact are usually small or absent in a fall. This pattern helps distinguish a fall from a blow to the stationary head.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.