DaVinci medical academy

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1 The candidate should be able to :-

  • describe the common psychiatric conditions encountered in Sri Lanka
  • obtain a relevant history and conduct a mental state examination with a view to arriving at a differential diagnosis.

 

  1. The candidate should possess knowledge, skills and attitudes to manage and refer as necessary for further opinion and care, the common psychological conditions presenting to a primary care physician
  • Psychotic illnesses (schizophrenia, affective disorders, delusional disorders, brief psychotic episodes).
  • Organic psychiatric illness (delirium, dementia, epilepsy related psychiatric disorders).
  • Patients who presents after deliberate self-harm.
  • Neurotic stress related disorders (anxiety disorders, phobia, obsessive compulsive disorder and dysthymia, adjustment disorder, somatoform and dissociative disorders).
  • Substance misuse (eg. alcohol, cannabis, heroin)
  • Sexual dysfunction (eg. erectile dysfunction, premature ejaculation, vaginismus, general lack of desire)
  • Puerperal psychiatric disorders.
  • Normal and abnormal grief reaction.
  • Psychiatric ailments encountered in childhood (eg.conduct disorder, emotional disorders, learning disabilities, pervasive developmental disorders, attention deficit disorders).
  • Suicide risk assessment, brief supportive psychotherapy, motivational interview, conduct family meetings, liaison of agencies relevant to the care of the patient.
  • Screening for alcohol dependence,

 

  1. The candidate should be able to work out the differential diagnosis and management of common psychiatric emergencies such as acute dystonic reactions, neuroleptic malignant syndrome, lithium toxicity, delirium, seizures, suicidal behaviour, depressive stupor, intoxication due to alcohol and drugs,  an agitated patient, violent and homicidal behaviour

 

  1. Recommended Reading for Psychiatry :

 

  • Shorter Oxford Textbook of Psychiatry (5th ed or latest) by Michael Gelder, Richard Mayou & Philip Cowen
  • Psychiatry (3rd ed or latest) by Michael Gelder, Richard Mayou & John Geddes (Oxford Core Text Series)
  • Concise Texbook of Clinical Psychiatry (2nd ed or latest) by Benjamin J Sadock & Virginia A Sadock
  • Oxford Handbook of Psychiatry by Semple, Smyth, Burns, Darjee, McIntosh (Latest edition)
  • Lecture Notes in Psychiatry (8th ed or latest) Paul Harrison, John Geddes & Michael Sharpe

Forensic medicine

  1. Candidates should be able to describe:-
  • The medico-legal framework in the country and the duties required of a medical officer within this system while working in the roles of an intern medical officer, an officer in the out-patient department of a hospital, a house officer of a ward as a medical officer in medico-legal work, as a General practitioner as a Specialist in Forensic medicine, and as a doctor working in any other capacity.
  • Inquests – Definition, types of deaths that require an inquest, procedure of the inquest, appointment and powers of Inquirer into sudden death, doctor’s role in the inquest, judicial and pathological post mortems, dying declaration, dying deposition
  • Changes after death – Definition of death, classification of changes after death, hypostasis, rigor mortis, putrefaction, adipocere, mummification. Estimation of time since death: eye changes, cooling, hypostasis, rigor mortis and putrefaction, cessation of bodily functions, circumstantial factors, forensic entomology.
  • Injuries – Definition, characteristic features, mechanism of producing injuries of abrasions, contusions, lacerations, incised injuries, stabs, fractures, effects of injury and cause of death, circumstances of injury (accident /suicide / homicide), injury patterns, defense, self-inflicted and fabricated injuries, injuries due to falls, medico-legal importance of injuries, healing of injuries, antemortem and postmortem injuries, Interpretation of injuries and determination of the features of weapons producing injuries. Regional injuries: face, head, neck, chest, abdomen, pelvis, spine, limb.
  • Categories of hurt – non-grievous hurt, grievous hurt (section 311 penal code), endangering life, fatal in the ordinary course of nature, necessarily fatal injuries, Medico-legal Examination form and Medico-legal report
  • Autopsy examination and report writing, dissection procedures in special circumstances eg neck, face, pelvic dissection, musculoskeletal, spinal cord, suspected thromboembolism, pneumothorax, air embolism,Death certification and cause of death according to the WHO format, declaration of death
  • Road traffic and train accidents – Injuries and injury patterns seen in pedestrians such as primary impact, secondary impact, secondary and run-over injuries, vehicle occupants, motor cyclists, pedal cyclists, three wheeler injuries, protective devices in vehicles, injuries caused by a moving train
  • Firearm injuries: basic types and parts of gun, mechanism of firing, smooth bore and rifled weapons, mechanisms of causing of injury, entrance wound, exit wound, estimation of approximate range, identification of weapons, direction of firing, atypical features of gunshot wounds.
  • Death from explosives: types of explosives devices, mechanisms of injury, injury patterns, post mortem examination, investigation of mass disasters to include procedure, requirements for conducting a medico-legal investigation, the role of the Forensic pathologist in a major disaster
  • Injuries and effects of physical agents – heat, cold, electricity, lightning eg Types of burns, effects and sequelae, degree of burns and categorization, medico-legal issues in a burnt body, antemortem and postmortem burns, hypothermia and hyperthermia, features, effects, sequelae and circumstances of electrocution, mechanisms and causation of death, injuries due to lightning and medico-legal investigation
  • Sudden natural death – Definition, causes in different systems, negative autopsy and establishing the cause of death, autopsy findings in starvation and neglect
  • Identification of the living and dead – medico-legal importance, general and specific methods of identification, clothing and personal effects, scars, stigmata, tattoos, deformities, disease, primary identifiers, determination of age, sex, stature, examination of skeletal remains, forensic odontology, exhumation and excavation of mass graves
  • Criminal abortion – law of Sri Lanka and developments in other countries, types and methods of abortion, spontaneous abortion as a differential diagnosis, objectives of the medico-legal examinations, reporting on evidence of recent pregnancy and delivery, evidence of abortion and evidence of interference, cause of death.
  • Sexual offences – law of sexual offences and related offences, medico-legal investigation of a victim of sexual abuse to include history, examination, sample collection and investigation, referrals, follow up and report writing, examination of an alleged assailant, medico-legal examination in child sexual abuse, unnatural offences
  • Infanticide – Definition, objectives of medico-legal investigation, stillbirths and natural infant deaths as a differential diagnosis, viability, establishment of maturity, signs of live birth, signs of recent delivery, modes of infanticide, autopsy examination and investigation in a suspicious infant death, examination of alleged mother and referral to psychiatrist.
  • Child abuse and Sudden Infant Death Syndrome (SIDS) – Definition, laws in Sri Lanka, types of abuse, features and injuries seen in child abuse, differential diagnosis, medico-legal investigation and management of suspected child abuse, autopsy findings in child abuse, definitions, possible aetiologies and autopsy examination in SIDS
  • Torture and battering – Definition, methods of torture, identification of injuries, injury patterns and scars in torture and report writing, modes of presentation, weapons used, investigation of a death in custody, wife battery, abuse of domestic servants, cause of death.
  • Asphyxia – Definition, types and circumstances of death, general features of asphyxia, medico-legal investigation to include history, scene visit, post mortem examination and investigation in smothering, gagging, choking, overlaying, hanging, manual and ligature strangulation, traumatic asphyxia, postural asphyxia and sexual asphyxia
  • Drowning and immersion in water – Definition, features, circumstances, types of drowning, investigation of a body recovered from water.

 

  • Scene of crime, collection of samples and chain of custody – Definition, importance of scene visit, investigation, recording and collection of evidence at a scene, Locard’s principle and its use at a scene, role of the Forensic Pathologist at a scene of crime, despatch of body to the mortuary, examination of blood and other stains, use of blood in disputed paternity, DNA profiling, collection of samples and maintanence of chain of custody in medico-legal work.

 

 

  1. With regard to Forensic Toxicology the candidate should be able to describe:-
  • Definitions, routes of administration and elimination, actions, factors affecting outcome, diagnosis, principles of management, autopsy, sending specimens for analysis, classification of poisons, circumstances of poisoning (accident, suicide, homicide), sources, preparations, properties, circumstances of poisoning, basic mechanism of action, basic clinical and pathological stages and post mortem appearance.
  • List the common poisons in Sri Lanka. Agro-chemicals (insecticides, rodenticides, weedicides), organophosphorous compounds, organo-chlorate compounds, carbamates, paraquat, diquate. Corrosive poisons: acids, alkali. Alcohol:  methyl alcohol, ethyl alcohol, investigation of a death due to alcohol

Plant poisons:  Definition and classification:  atropine, strychnine, modecca palmate, Gloriosa superba, Manioc, other common plant poisons.  Metal poisons : lead, arsenic, mercury, copper, (cyanide). Anti-narcotic legislation:  heroin, opium, cannabis Barbiturates, phenothiazines, salicylates Other poisons:  carbon monoxide, ammonia and other poisonous gases, phenol. Ethical and medical issues in poisoning

  1. 3. Candidates should be able to describe the medico-legal aspects of alcohol and addictive drugs, alcoholic beverages, absorption, metabolism and actions on the body, stages and intoxication, examination, and reporting on drunkenness, criteria in diagnosing drunkenness, differential diagnosis of drunkenness, completion of medico-legal examination form and medico-legal report in drunkenness.

 

  1. 4. Candidiates should be able to give an account of the legal system in Sri Lanka: Magistrates Court, Primary Court, District Court, High Court, trial by jury, Court of Appeal, Supreme Court, Tribunals, Commissions, Attorney General’s Department. Medical evidence:  Evidence Ordinance, Oral and documentary evidence, preparation of reports, giving oral evidence in court, doctor as an expert witness.

 

  1. The candidate should be able to describe:-
  • Basic medical ethics – consent and its types and uses, professional secrecy and privileged communications, consent and its various features, professional misconduct.
  • Medical negligence – criminal and civil medical negligence, definition of negligence, causation, damages, standard of care, accepted practice, burden of proof, Res lpsa Loquitur, Defenses, malpractice litigation, common defences by the Practitioner.
  • Forensic psychiatry: Criminal responsibility, testamentary capacity, fitness to plead, fitness to stand trial, detention of mentally ill patients, guardianship of mentally ill patients.
  • Industrial accidents and compensation: Doctor’s duties, procedure in claiming compensation, assessment of disability.
  • The Sri Lanka Medical Council – Members and office bearers, powers and duties of the Council, categories of registration, procedure in obtaining registration, rights and privileges of registered persons, disciplinary proceedings, Preliminary Proceedings Committee, Professional Conduct Committee, Erasure.

 

  1. Recommended reading for Forensic Medicine:
  • Keith Simpson’s Forensic Medicine (edited by Bernard Knight),
  • Lecture Notes in Forensic Medicine (Vols I & II) – Dr. L.B.L. de Alwis,
  • Forensic Medicine and Medical Law – Dr. Hemamal Jayawardena,
  • Clinical Forensic Medicine edited by W.D.S. Mc Lay.

 

 

 

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