Forensic Pathology Monograph - Puttoff

Question 1

proximal cause of death

Answer 1

actual true cause of death
* found from the “due to” question
EX: Atherosclerotic Cardiovascular Disease

Question 2

mechanism of death

Answer 2

also called immediate COD
= final pathologic event
EX: cardiopulmonary arrest (heart and lung stopped), MI, CHF, Vfib

Question 3

what determines the proximal COD

Answer 3

the history of pt, circumstance around death, autopsy = manner or death

Question 4

manner of death acronym

Answer 4

NASHU
N : natural (due to disease or disorder)
A : accident
S : suicide
H: Homicide
U : undetermined (SIDS)

Question 5

Homicide vs suicide

Answer 5

Homicide is murder

Question 6

reason death certificate is important

Answer 6

so see most prevalent diseases causing death in US for guiding research

Question 7

who can certify a death certificate in natural

Answer 7

physician

Question 8

who can certify a death certificate if not natural

Answer 8

legally appointed medical examiner physicians, coroners, justice of peace
= needs jurisdictions of ME

Question 9

Rigor Mortis

Answer 9

muscles stiffen after death (hrs) however time depends on temp

Question 10

Algor mortis

Answer 10

body cooling after death, need steady ambient temp to calculate

Question 11

Livor Mortis

Answer 11

blood circulating to dependent areas after death, becomes fixed after a time, (useful when looking at death scene)

Question 12

3 types of body decomposition

Answer 12

Putrefactive
Mummification
Adipocere formation

Question 13

Putrefactive

Answer 13

most temps, discoloration, tissue softening, liquefaction, gas production, body bloating

Question 14

Mummification

Answer 14

very dry and arid climate

Question 15

Adipocere formation

Answer 15

death and immersion of body into water, saponification of epidermal surface

Question 16

how to get true time of death

Answer 16

at beginning of crime scene forensic experts don’t have any definitive conclusion (as seen on TV)
TOD is usually an approximation

Question 17

forensic autopsy

Answer 17

find proximal COD, by medicolegal investigation by justice inservice of the public,
= usually death by foul play or trauma
(highly consider outside appearnece of dead person and things around them)

Question 18

hospital autopsy

Answer 18

usually deal with natural cause death evaluation,

= look for disease of extent of natural death that was undiagnosed before

Question 19

how many pt that die in hospital are autopsied

Answer 19

it continuous to decline

Question 20

misconception of forensic specialists

Answer 20

they are physicians and pathologists, not detectives or police officers

Question 21

ME

Answer 21

medical examiners

Question 22

training for ME

Answer 22

1. 4yrs (medical school)
2. 4yr (AP/CP pathology)
3. 1yr (Forensic Pathology Fellowship)

Question 23

common problem in US jurisdiction

Answer 23

staffed by unqualified due to no ME system

should be an ME signing the death certificate

Question 24

forensic specialists can be

Answer 24

a wide range or credentials and degrees depending on forensic subspecialty and size of ME offices

Question 25

ME cant be part of what case

Answer 25

when it involves a family member or next-to-kin person

Question 26

forensic features of mechanical force

Answer 26

1. Abrasion = damage to skin (epidermis) 2. Laceration = splitting of skin with hemorrhagic 3. Contusions = intact skin, hemorrhage of dermis and below 4. Incise wounds 5. Gunshot wounds

Question 27

Lacerations are caused by

Answer 27

blunt force, usually leasions are more wide then deep + hemorrhagic bridges

Question 28

Contusions are caused by

Answer 28

``` blunt force (bruise) *if yellow it has been over 18hrs ```

Question 29

bruises that are not contusions

Answer 29

Battle's Sign (Raccoon eyes) due to skull fractures and periorbital injury

Question 30

Abrasion causes by

Answer 30

scrapes, disrupted epidermis, | due to blunt force

Question 31

what are incise wounds

Answer 31

due to eged instrument (like in ER) , razor, knife | = more deep then wide +NO bridging in depths

Question 32

what can cause more then normal bleeding for a patient

Answer 32

1. chronic renal failure (from DM or HTN) 2. liver failure (usually from alcohol) 3. coagulative disorder, autoimmune, hematologic neoplastic disorders

Question 33

which organs are more susceptible to bleeding

Answer 33

1. intracranial and intracerebral from blunt force trauma (esp in elderly)

Question 34

use of drugs and finding cause of death

Answer 34

makes the whole process more complicated

Question 35

mass and velocity of handguns

Answer 35

revolvers and semiautoomatics = low V, small caliber bullets = have hollow point, muchroom over base, round thing making it not go through tissue, however causes more damage

Question 36

modern handguns have

Answer 36

rifling (grooves that make for more accurate shooting) | marginal abrasions

Question 37

machine pistols

Answer 37

civilian use is semiautomatic, fire handgun ammunition

Question 38

``` Long guns (rifles) mass and velocity of ```

Answer 38

HIGH V, fully jacked bullets, marginal abrasions, EXIT is larger then the entry also have rifling grooves

Question 39

shotguns

Answer 39

shells with pellets or varying size, gunpowder, plastic or felt = sprays the pellets (controlled by chock structure for dispersal)

Question 40

short shotgun barrel means

Answer 40

no chock so pellets disperse all over

Question 41

what is the classification of a Handgun

Answer 41

Revolver (rotating cylinder bullets) | Semiautomatic (must be inserted) = Magazine type

Question 42

what is the classification of Long Gun

Answer 42

Rifles: 1. Bolt action 2. Magazine type

Question 43

smoothbore weapons

Answer 43

shotguns with slugs (large projectiles)

Question 44

Range

Answer 44

distance from end of barrel to external skin

Question 45

close or contact range

Answer 45

1. marginal abrasion 2. gunpowder in wound 3. muzzle or slight burn on skin if contact

Question 46

Intermediate range

Answer 46

1. gunpowder around the entry (embedded in skin) = powder tattooing, stippling 2. distance determined by accuracy

Question 47

Distant range

Answer 47

1. Marginal Abrasion | 2. no gunpowder in skin, wound, or surrounding area

Question 48

entry and exit of gunshot to head

Answer 48

head has outer and inner table separated by spongy, cancellous bone = dipole ENTRY WOUND : outer table sharply circumscribed, inner beveled EXIT WOUND: Outer table beveled, inner table sharply circumscribed

Question 49

as a bullet hits the tissue or skull

Answer 49

V slows and energy is transferred