What are signs of fetal alcohol syndrome?
Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
Deformities of joints, limbs and fingers
Slow physical growth before and after birth
Vision difficulties or hearing problems
Small head circumference and brain size
Heart defects and problems with kidneys and bones
How do you convert mm to caliber?
Multiply by 4 for example, a 9mm is equal to a 36 caliber
What is the mechanism of death with low voltage electrocution? High voltage?
Low voltage requires direct contact with charge, death by V Fib
High voltage does not require direct contact, death due to electrothermal injury or respiratory failure
What is the mechanism of death in methanol poisoning?
ACIDOSIS, not respiratory depression
What are some signs of arsenic poisoning?
Small intestines can have pseudomembranes
FATTY DEPOSITS IN HEART, LIVER, AND KIDNEYS!
Peripheral neuropathy of both sensory and motor in both acute and chronic poisoning!
How stable are the following in vitreous? 1) HCG 2) Cortisol 3) Thyroxin 4) TSH
1) stable 2) stable 3) decreases postmortem but can be used to diagnose hyperthyroid 4) can be used to detect hypothyroid
What percent of all deaths show agonal aspiration?
What is the significant of petechiae in the epiglottis?
Reduction of what amount of oxygen by displacement of oxygen by intert gases produces unconsciousness in seconds and death in minutes?
Reduction to less than 25% of normal (5-6% by volume of oxygen)
Toxins such as cobalt and adriamycin have been associated with what heart issue?
Dilated (constrictive) cardiomyopathy
Why is bridging of LAD usually benign?
The vessel is compressed during systole and nearly all coronary blood flow to the left ventricle occurs during diastole
Most common family of drugs used in suicides?
Thin film of SAH and SDH localized to the occipital lobes due to?
Decomp/lividity Rest of the brain will not have hemorrhage!
What is the most information that can be deduced about a stab wound?
maximum width of the blade, an approximation of the length of the blade, and whether it is single edged
What speed is a rifle considered high velocity?
Most deaths due to anaphylactic shock with therapeutic agents is due to?
What is amount of pressure needed to compress: 1) jugular vein 2) carotid artery 3) trachea 4) vertebral artery
1) 4.4 lbs of pressure 2) 11 lbs of pressure 3) 33 lb of pressure 4) 66 lbs of pressure
In a shotgun wound, how far before the wad does not enter the body anymore yet there may be a mark on the skin adjacent to entrance?
In venous air embolism, how much air delivered rapidly is necessary to cause death?
between 75 and 250 cm3
Fat emboli are associated with:
1) Long bone or pelvic fractures
2) acute pancreatitis
3) extensive burns
5) decompression sickness
6) parenteral infusion of lipids
7) reaming and nailing procedures of long bone fractures
What is the most common scenario of venous air embolism during therapeutic or surgical procedure?
Craniotomy in the sitting position
Here, air emboli occur in 21 to 29% of all craniotomies and 40% of all occipital craniotomies
What is the most common coronary artery anomaly?
Anomalous origin of the left coronary artery from the right sinus of Valsalva
What are the two most common suffocating gases?
Methane and carbon dioxide
With guns, what speed is considered low velocity? High velocity?
Low velocity 650-1400 ft/sec
High velocity 2400 - 4000 ft/sec
What type of necrosis is caused by acid burns? Alkaline burns?
Alkaline burns are worse and cause liquefactive necrosis with edema
Acid burns cause coagulative necrosis and the wounds are usually hard and dry
Hydrofluoric acid causes the worst injury of the acids
What is the most popular and most commonly fired cartridge in the US?
What procedure should be performed in all cases of meningitis?
Dissection of the middle ear to see if this is the source
Can carbon monoxide pass from materal to fetal blood?
Yes, the final concentration of CO Hb is 10 percent higher than the maternal concentration
With shotguns, what are the distances to get: 1) scalloped hole 2) pellets start to separate 3) individual pellets
1) 3 ft 2) 4 ft 3) 9-10 ft
What is the most common abdominal organ injured in blunt force injury cases?
What is the most commonly abused inhalant?
What is responsible for the bright pink color of blood seen in cyanide poisoning?
Oxyhemoglobin, not cyanohemoglobin (which is not made in any significant quantity)
Adhesion between cortex and dura can cause?
When is livor present, fixed, and absent?
Usually evident in 30 min to 2 hours, fixed at 8 to 12 hours, disappears when decomp takes over
Which artery has higher incidence of thrombosis?
Left compared to right Only 13% show gross thorombosis
First statewide system involving a physician as a coroner who would later be known as a medical examiner?
Massachusetts in 1877
Medical examiner system first in New York City in 1918
Medical examiner state system first is Maryland in 1939
Why is petechiae present in most strangulation cases and not in hangings?
Because blood continues to pump to the head via the vertebral arteries and cannot escape via the venous system in strangulation whereas in a lot of cases of hangings there is the 66 lb of pressure needed for occlusion
What are risk factors for venous air embolism?
1) Therapeutic or diagnostic procedures (particularly with prone, supine, lithotomy, and lateral knee chest position)
3) During childbirth or abortion
4) During oral-genital sex in a pregnant woman when her partner blows air into the vagina
What is force to produce single linear fracture?
33.3 to 75 ft lb
What is a complication of phenothiazine therapy in schizophrenics?
What color is the blood in hydrogen sulfide poisoning?
Dark colored because oxyhemoglobin is reduced and methemoglobin is formed. Sulfhemoglobin is not formed during acute exposure.
When are petal wad marks seen?
What is the most popular buckshot load in this country?
12 gauge 2-3/4 shell loaded with NINE 00 buck pellets
Fractures of which part of the clavicle is more associated with child abuse? Accidental trauma?
Fx of midportion of clavicle seen in accidental trauma
Fx of distal ends more associated with child abuse
What is mechanism of death in electrocution?
Low voltage = v fib High voltage = electrothermal injury or respiratory arrest from paralysis due to central damage to respiratory center by hyperthermic effects of current
What voltage is considered low? High?
Low voltage < 600 V
High voltage > 600 V
Residential voltage = 110-120 V
High voltage lines in suburbs and urban areas = 7500 - 8000 V
Transcontinental high tension lines = >100,000 V
What findings are associated with: phenol? phosphorous?
Phenol associated with ATN
Phosphorous associated with liver and kidney necrosis
When is rigor present and absent?
Usually appears 2-4 hours after death and fully develops in 6 to 12 hours. Usually gone by 36 hours but HUGE variation!! If someone has violent muscular exertion prior to death, can be instantaneous (cadeveric spasm)
How long does it take maggots to reach larva stage?
6 to 10 days under normal circumstances Adults emerge in 12 to 18 days
What is the most common form of arsenic used for poisoning?
What is the classic hangman's fracture?
fracture of the pedicles of C2 with the posterior arch remaining fixed to C3 C1, the odontoid process, and the anterior arch of C2 remain in articulation with the base of the skull
Sudden death due to valvular disease is usually due to what two conditions?
Mitral valve prolapse and aortic stenosis