Role of the Pathologist

Question 1

What are the roles of the general pathologist?

Answer 1

Diagnostician, MDT meeting, research, teaching, management and leadership, post mortem

Question 2

What are the roles of the forensic pathologist?

Answer 2

Post mortem = full, part, CT scan, view and grant
Determine cause of death
Non-suspicious and suspicious deaths
Court
Fatal accident inquiries

Question 3

What additional testing can be done as part of a post mortem?

Answer 3

Histology, microbiology, radiology, toxicology, genetic studies, neuropathology

Question 4

What are the types of post mortem?

Answer 4

Hospital and Legally required

Question 5

What are some features of hospital post mortems?

Answer 5

Less common, family or clinician requested, consented and not a legal requirement

Question 6

Why might a patient request a hospital post mortem?

Answer 6

Donation of brain for neurodegenerative research

Question 7

What are some features of legally required post mortems?

Answer 7

Procurator fiscal requested and legally required, no consent needed

Question 8

When may a post mortem be legally required?

Answer 8

Sudden and unexpected death
Responsible clinician unable to certify death
Death due to negligence
Suspected suicide or homicide
Death at work or in custody
Death of a child

Question 9

What is sudden death?

Answer 9

Death within 24hrs of symptom onset

Some only accept death within 1hr from onset

Question 10

What are the reversible causes of cardiac arrest?

Answer 10

Hypoxia, hypovolaemia, hyperkalaemia (metabolic), hypothermia, thrombosis, tamponade, toxins, tension pneumothorax

Question 11

What are some causes of hypoxia?

Answer 11

Non-suspicious = asthma, pneumothorax, respiratory obstruction or depression, aspiration
Suspicious = respiratory obstruction, drug related, drowning

Question 12

What are some features of an autopsy of a hanging?

Answer 12

May have respiratory obstruction

Usually a space in the ligature mark

Question 13

What are some indications of strangulation?

Answer 13

Petechial haemorrhages behind the eyes

Damage to the hyoid bone

Question 14

What is the most common cause of hypovolaemia?

Answer 14

Aneurysms

Question 15

What are some causes of hypovolaemia?

Answer 15

Non-suspicious = upper or lower GI bleed, haemoperitoneum, trauma
Suspicious = trauma, stabbings, shootings

Question 16

What are some causes of hyperkalaemia and other metabolic disturbances?

Answer 16

Non-suspicious = diabetic and alcoholic ketoacidosis, toxins
Suspicious = toxins (e.g poisoning)

Question 17

What is an internal sign of hypothermia?

Answer 17

Wischnewski ulcers = look like black spots

Question 18

What are some causes of hypothermia?

Answer 18

Non-suspicious = exposure to cold, alcoholic, drugs, underlying medical disease
Suspicious = exposure to cold, neglect, forced outside

Question 19

What are some external signs of atherosclerosis due to coronary artery disease?

Answer 19

Fold in ear lobe

Corneal arcus

Question 20

What are some non-suspicious causes of thrombosis?

Answer 20

Coronary artery thrombosis (usually on atherosclerosis), pulmonary venous thromboembolism, embolism from DVT, paradoxical emboli

Question 21

What are some suspicious causes of thrombosis?

Answer 21

Contribution, deaths in custody, one punch or “scared to death” due to increased physiological stress

Question 22

What are some causes of tamponade?

Answer 22

Non-suspicious = after MI, pericarditis, TB, iatrogenic, aortic dissection, trauma, neoplasm
Suspicious = secondary to blunt or sharp force trauma

Question 23

What are some causes of toxins?

Answer 23

Non-suspicious = overdose, negligence, accidental
Suspicious = third party involvement (poisoning), negligence

Question 24

What are some causes of a tension pneumothorax?

Answer 24

Non-suspicious = chronic lung disease, spontaneous, trauma
Suspicious = secondary to trauma

Question 25

Why is a tension pneumothorax difficult to diagnose in an autopsy?

Answer 25

Any disturbance after death will cause release of pleural fluids

Question 26

What may be a sign that a patient has had CPR before death?

Answer 26

Target lesion on chest from CPR thumper, especially if elderly