SBOM - Death and Autopsy

Question 1

Which of the following are important in relation to priorities when a patient is dying?

1 - Recognise that the patient is dying
2 - Communicate with the patient and support system
3 - Involve the dying person & those important to them in decision making and care
4 - Support psychological, spiritual and social needs
5 - Plan & Do a personalised care plan
6 - all of the above

Answer 1

6 - all of the above

Question 2

There are a number of changes that can occur following the death of an individual. How many stages are their typically?

1 - 5
2 - 4
3 - 3
4 - 2

Answer 2

3 - 3

• immediate changes
• early changes
• late changes.

Question 3

Somatic death occurs immediately. What is somatic death?

1 - irreversible cessation in brain function, specifically somatic functions (voluntary)
2 - irreversible cessation in heart function
3 - irreversible cessation in lung function
4 - all of the above

Answer 3

4 - all of the above
- brain, heart and lungs
- these are basic signs and indications of death
- muscles would become flaccid at this point

Question 4

There are changes that occur following the death of an individual:

• immediate changes
• early changes
• late changes

At which stage do the following occur:
- post-mortem cooling (algor mortis)
- post-mortem rigidity (rigor mortis)
- post-mortem staining (livor mortis)

Answer 4

• early changes (hours to days)
• algor mortis = no warm due to lack of blood flow
• rigor mortis = stiffening of muscles due to myofibril changes
• livor mortis = blood pools in blood vessels (gravity dependent) and can alter skin colour

Question 5

In the late changes that occur following the death of an individual, autolysis occurs, what is this?

1 - body begins leaking fluids from orifices
2 - skin colour changes at cells die
3 - cells lack O2 and die releasing enzymes that degrade other tissues throughout the body
4 - all of the above

Answer 5

3 - cells lack O2 and die releasing enzymes that degrade other tissues throughout the body

Question 6

In the late changes that occur following the death of an individual, putrefaction occurs, what is this?

1 - body begins leaking fluids from orifices
2 - skin colour changes at cells die
3 - cells lack O2 and die releasing enzymes that degrade other tissues throughout the body
4 - degradation of tissues by microorganisms leading to gases and bloating

Answer 6

4 - degradation of tissues by microorganisms leading to gases and bloating
- can result in nasty smells

Question 7

A post-mortem is the examination of a body following death to identify the cause of death and is the GOLD STANDARD for evaluating diagnostic accuracy. Who can order a post-mortem?

1 - any consultant doctor
2 - nurse or doctor
3 - solicitor
4 - coroner

Answer 7

4 - coroner

Question 8

A post-mortem is the examination of a body following death to identify the cause of death and is the GOLD STANDARD for evaluating diagnostic accuracy and can only be requested by a coroner. Which of the following is a reason why we do post mortems?

1 - diagnostic purposes
2 - family to have closure
3 - important for epidemiology to track communicable (spreadable) diseases
4 - medical education
5 - medical research
6 - all of the above

Answer 8

6 - all of the above

• importance is likely to be in the order it is presented here

Question 9

Which of the following is classed as a conventional autopsy / post-mortem examination?

1 - death is suspicious
2 - imaging/biopsies used to identify the cause of death
3 - GP/hospital doctor unable to effectively complete a certificate of death as cause unknown
4 - all of the above

Answer 9

3 - GP/hospital doctor unable to effectively complete a certificate of death as cause unknown

Question 10

A conventional autopsy / post-mortem examination can be:

• hospital autopsy = hospital clinicians request this to identify cause of death
• coroner autopsy = GP requesting information to complete death certificate

Which of these requires consent from family?

Answer 10

• hospital autopsy
• typically occurs when the attending doctor cannot provide a cause of death to the “best of their knowledge and belief”

Question 11

Which of the following is classed as a Forensic autopsy?

1 - death is suspicious
2 - imaging/biopsies used to identify the cause of death
3 - GP/hospital doctor unable to effectively complete a certificate of death as cause unknown
4 - all of the above

Answer 11

1 - death is suspicious
- home office forensic pathologists

Question 12

Which of the following is classed as a Minimally invasive autopsy?

1 - death is suspicious
2 - imaging/partial less invasive biopsies used to identify the cause of death
3 - GP/hospital doctor unable to effectively complete a certificate of death as cause unknown
4 - all of the above

Answer 12

2 - imaging/partial less invasive biopsies used to identify the cause of death

• better for patients family

Question 13

Following a death, it is important to know when a death should be reported to the coroner. Which of the following should NOT be reported to a coroner?

1 - death due to poisoning or exposure to toxic substance, including use of medicinal product
2 - death due to violence, trauma, injury, self- harm, neglect including self- neglect
3 - death due to an RTA
4 - death following medical or surgical treatment
5 - death causing Injury or disease that is attributable to employment

Answer 13

3 - death due to an RTA
- could still request but very unlikely

Question 14

Following a death, it is important to know when a death should be reported to the coroner. One of the reasons is when a patient has not been seen by a doctor for what time period?

1 ->7 days
2 - >14 days
3 - >28 days
4 - >52 days

Answer 14

3 - >28 days
- or a doctor is not able to see the patient in a reasonable time

Question 15

A coroner is an independent judicial office holder, appointed by a council within the coroner area. They are usually lawyers but sometimes doctors. They will perform initial enquiries in order to decide whether to investigate the death. Which if the following is NOT one of 4 questions they are required to answer?

1 - Who the deceased was
2 - Those present when the patient died
3 - Where they died
4 - When they died
5 - How they died

Answer 15

2 - Those present when the patient died

Question 16

A coroner is an independent judicial office holder, appointed by a council within the coroner area. They are usually lawyers but sometimes doctors. They will perform initial enquiries in order to decide whether to investigate the death.

If death is from a known and natural disease or condition and there are no unusual circumstances, does the coroner need to investigate further?

Answer 16

• no
• the coroner will be asked to sign a Medical Certificate of the Cause of Death (MCCD)

Question 17

A coroner is the individual who will investigate and decide the cause of death. But if they are suspicious or feel that the cause of death requires further attention they can request for which individual to perform the post mortem?

1 - nurse practitioner
2 - technician
3 - pathologist
4 - all of the above

Answer 17

3 - pathologist
- can involve opening the body and biopsy tissue or imaging
- coroner decides on the best approach
- coroner releases the body to the family for the funeral

Question 18

In some cases a coroner may decide that further investigation is needed into the death. By law a coroner must continue an investigation and hold an inquest if all of the following occur, EXCEPT which one?

1 - the cause of death remains unknown after the post-mortem examination and any subsequent tests
2 - there is cause for the coroner to suspect that the deceased died a violent or unnatural death
3 - family have requested further investigation
4 - death occurred in custody or state detention

Answer 18

3 - family have requested further investigation
- this could happen but is a long process

Question 19

A male aged 65, whose GP had treated him for severe hypertension over the last 20 years, had a clinical and ECG diagnosis of angina 5 years prior to dropping dead at home after experiencing chest pain lasting for more than half an hour. The working diagnosis was of a coronary artery thrombosis due to ischaemic heart disease due to hypertension. Using the information here we need to complete the Medical Certificate of the Cause of Death (MCCD). Match the following aspects of the MCCD below with the medical apsects:

(a) Disease or condition leading directly to death
(b) Other disease or condition, if any, leading to I(a)
(c) Other disease or condition, if any, leading to I(b)

1 - hypertension
2 - coronary artery thrombosis
3 - ischemic heart disease

Answer 19

(a) Disease or condition leading directly to death = 2 - coronary artery thrombosis
(b) Other disease or condition, if any, leading to I(a) = 3 - ischemic heart disease
(c) Other disease or condition, if any, leading to I(b) = 1 - hypertension

Question 20

Is mode of dying the same as the cause of dying?

Answer 20

• no
• mode is HOW the patient died, BUT is not the cause of the patient dying

Question 21

Mode of dying tells us HOW a patient died, but not the cause of death. Which of the following are examples of MODE of death?

1 - cardiac arrest
2 - coma
3 - exhaustion
4 - renal/kidney failure
5 - respiratory arrest
6 - syncope
7 - all of the above

Answer 21

7 - all of the above
- i.e., patient can have a cardiac arrest, but what caused the cardiac arrest
- the cause of the cardiac arrest is the cause of death

Question 22

Mode of dying tells us HOW a patient died, but not the cause of death. Is it ever ok to use a mode when completing section 1 of the Medical Certificate of the Cause of Death (MCCD) form (below)?

Part I
(a) Disease or condition leading directly to death
(b) Other disease or condition, if any, leading to I(a)
(c) Other disease or condition, if any, leading to I(b)

Answer 22

• yes
• ONLY if it is supported by acceptable disease or condition beneath it