U1 LEC: POSTMORTEM EXAMINATION Flashcards
(136 cards)
1
Q
“We must turn to nature itself to the observations of the body in health and disease, to learn the truth”
A
Hippocrates
2
Q
Autopsy can be categorized by five different rulings for manner of death:
A
- natural
- accident
- homicide
- suicide
- undetermined
3
Q
T/F: A medical examiner can order an autopsy without consent from next of kin.
A
True
4
Q
First recorded autopsy
A
Antistius examines Julius Caesar’s body
5
Q
T/F: One wound to the chest led to rutpure of Caesar’s aorta.
A
True
6
Q
1806 painting by Vincenzo Camuccini
A
La mort de Cesar / The Death of Julius Caesar
7
Q
This is an instruction manual on how to conduct medico-legal investigations, examine corpses, and determine the time and cause of death.
A
Hsi Yuan Lu / The Washing Away of Wrongs
8
Q
Hsi Yuan Lu (The Washing Away of Wrongs) was written by?
A
1247 Song Ci
9
Q
Forensic issues mentioned in Hsi Yuan Lu
A
- poisoning
- decomposition
- wounds from various weapons
- strangulation
- fake wounds
10
Q
Who conducted the first known legal autopsy with the use of human eye, in which was requested by the magistrate in Bologna?
A
Bartolomeo de Varignana (1302)
11
Q
During the renaissance period, autopsies were watched in an operating theater and cadaver is opened by a?
A
lay dissector
12
Q
They performed a number of autopsies and observing anatomy unseen by the naked eye.
A
Leonardo da Vinci and Michelangelo
13
Q
Father of Modern Pathology
A
Rudolf Ludwig Karl Virchow
14
Q
Virchow characterized a case of?
A
leukemia
15
Q
PME is performed
wherever __________ is practiced
A
scientific medicine of high quality
16
Q
PME is performed
when a _________ knows why he lost a patient
A
conscientious physician
17
Q
PME is performed
when ______ is enforced
A
criminal law
18
Q
PME is performed
when a ___________ shows accurately the causes of death and confirmed medical diagnosis for the assembling of vital statistics
A
death certificate
19
Q
PME is performed
whenever there is _______ on causes and nature of diseases, and transplantation medicine
A
medical research
20
Q
PME is performed
A _______ requires PME in human death for the good of medical science, for the public’s health and for the future care of living patient
A
informed society
21
Q
Preparations before the Postmortem Examination
A
- Administrative preparations
- Preparation of the autopsy room
- Confirmation of the decedent identity
22
Q
Preparations before PME
under Administrative preparations
A
- Obtain and confirm consent
- Obtain and review clinical records
- Contact clinical team and staff pathologist
23
Q
Preparations before PME
under Preparation of the autopsy room
A
- Set up dissection instruments and tools
- Lay out swabs, media, etc. for any ancillary studies to be performed
- Prepare photographic equipment
- Assemble PPE
24
Q
Preparations before PME
under Conformation of decedent identity
A
- most important step
- Identifiers on the body must be confirmed and matched with autopsy consent form
- Confirm any limitations or restrictions to the autopsy at this time
25
Documents for autopsy
- Written consent from the next of kin (abide by restrictions or extent allowed)
- Death certificate
- Medical abstract / clinical data
- Medicolegal clearance
26
Order of consent for autopsy
1. Spouse
2. Adult children
3. Adult grandchildren
4. Parent
5. Siblings
27
T/F: If autopsy is not required by law, it cannot be done until the next of kin gives permission.
True
28
PME in which all body cavities are examined, including the head/brain.
Complete
29
PME in which may exclude examination of the head/brain.
Limited (Partial)
30
PME in which specific organs only are examined.
Selective
31
Autopsy without consent can be done under the following conditions:
- ordered by police or coroner
- necessary to complete death certificate
- deceased gave consent before he died (Advance directive)
- deceased military service who dies in active duty/training in military service
32
Autopsies are usually carried out within?
48 hours after death
33
Autopsies can be?
hospital-based or coronial
34
These are autopsies ordered by the state coroner.
Coronial autopsies
35
These are autopsies to be performed at the request of the family of the deceased.
Hospital based autopsies
36
Criteria for Autopsy (College of American Pathologists)
1. Help explain unknown and unanticipated medical complications
2. Cause of death/major diagnosis is not known with reasonable certainty
3. Help to allay concerns of family or to the public regarding death, provide reassurance to them
4. Unexpected deaths occuring during any dental, medical, or surgical diagnostic procedures
5. Death of those who participated in clinical trials
6. Natural unexplained deaths and not subject to forensic medical jurisdication
7. Natural deaths, waived by forensic medical jurisdiction
8. Deaths resulting from contagious diseases
9. All obstetric deaths
10. All perinatal, and pediatric deaths
11. Deaths at any age for suspected illness or bearing on recipients of transplant organs
12. Deaths from environmental hazard
37
CAP Criteria
1. Deaths in which autopsy may help to explain _____________ to the attending physician
unknown and unanticipated medical complications
38
CAP Criteria
2. All deaths in which the cause of death or major diagnosis is ___________ on clinical grounds
not known with reasonable certainty
39
CAP Criteria
3. Cases in which autopsy may help to _________ and or to the public regarding the death, and to provide reassurance to them regarding the same.
to allay concerns of the family
40
CAP Criteria
5. Deaths of patients who have participated in _________ approved by institutional review boards.
clinical trials
41
CAP Criteria
6. Unexpected or unexplained deaths which are apparently ______ and not subject to a _______.
natural, forensic medical jurisdiction
42
CAP Criteria
7. Natural deaths but waived by a forensic medical jurisdiction, such as:
a. persons dead on arrival
b. deaths in hospitals within 24 hours of admission
c. patient sustained injury while hospitalized
43
CAP Criteria
8. Deaths resulting from ________ diseases
high-risk infectious and contagious
44
CAP Criteria
9. and 10. All ____ deaths
obstetric, perinatal, pediatric
45
CAP Criteria
11. Deaths at any age in which is believed that autopsy would disclose a _______ which also have a bearing on survivors or recipients of _________.
known or suspected illness, transplant organs
46
CAP Criteria
12. Deaths known to have resulted from __________ hazards
environmental or occupational
47
This refers to a person who has jurisdiction in medicolegal cases.
Medicolegal examiner or coroner
48
T/F: The coroner may authorize the pathologist to proceed with an autopsy.
True
49
Jurisidiction for Medicolegal cases
1. All deaths within 24 hours of admission
2. Newborns in the first 24 hrs of life
3. All injury cases
4. All deaths due to unknown cases
5. All deaths due to suspicious cases
6. All abortion cases
7. All violent deaths
8. All accidental deaths
9. All sudden deaths
10. All cases without medical attendance within 36 hours prior to death
11. All deaths due to drowning, hanging, or strangulation
12. All deaths due to shooting, stab wounds, burns, electricity, lightning, tetanus, etc.
13. All homicides
14. All suicides
15. All cases in which there is suspicion of poisoning
16. Stillborns
17. Prematures
50
This refers to death of an organism or bodily death (brain dead).
Somatic death
51
This is the earliest definition of death of an organism.
Cessation of circulation and respiration (1960s)
52
Criteria for pronouncement of death
1. Advanced in resuscitation techniques
2. Advanced life-sustaining equipment
3. Redefinition from cessation to irreversible cessation
4. Brain death
53
Criteria for pronouncement of death
1. Advances in _____ techniques that are capable of reviving effectively cases of clinical death.
resuscitation techniques
54
Criteria for pronouncement of death
2. Advanced ___________ capable of maintaining cardiovascular and respiratory functions despite severe brain injury.
life-sustaining equipment
55
Criteria for pronouncement of death
Redefinition from _________ of cardiorespiratory functions after resuscitation attempts
cessation to irreversible cessation
56
Criteria for brain death
- Coma and cerebral unresponsiveness
- Apnea
- Absent cephalic (brainstem) reflexes)
- Electrocerebral silence
57
This refers to slow breathing.
Apnea
58
Criteria for brain death should be present for how many minutes, at least 6 hours after onset of coma and apnea?
30 minutes
59
the American Bar Association and the National Conference of Commissioners of Uniform State Laws legislative definition of death:
- Irreversible cessation of circulatory and respiratory functions
- Irreversible cessation of all functions of the entire brain (brainstem is dead)
60
American Academy of Neurology
- Coma
- Absence of multiple brain functions
61
American Academy of Neurology
Absence of the ff includes:
- Motor response
- Pupillary response to light and pupils at mid- position
- Corneal reflexes
- Caloric response
- Gag reflex
- Coughing in response to tracheal suctioning
- Sucking and rooting reflexes
62
RA 7170
Organ Donation Act of 1991
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Amendment of RA 7170
RA 7885
64
Medical Certification of Death
- Immediate cause of death
- Antecedent cause of death
- Underlying cause of death
65
This is the final disease, injury or complication directly causing death.
Immediate cause of death
66
This precedes death as consequence of an underlying cause.
Immediate cause of death
67
The violent act or accident is the ______ to an injury entered
antecedent
68
This is the condition that led or precipitate the immediate cause of death.
Antecedent cause of Death
69
These are other intervening causes of death occuring between underlying and immediate causes.
Antecedent cause of death
70
This is defined for public health and legal purposes as "the disease or injury that initiated the train of events leading to death"
Underlying cause of death
71
Other term for underlying cause of death
Promixate cause of death
72
This is the circumstances of accident which produced the fatal injury
Underlying cause of death
73
T/F: Without an underlying cause, the death would still have happened.
False
74
This is the most important entry in the certificate since mortality statistics is based on this.
Underlying causes
75
3 copies of the death certificate should be made for:
- Relative
- City Health Office
- Funeral home
76
This is death resulting from a disease.
Natural
77
This is death resulting from environmental influence.
Accidental
78
This is death intentionally self-inflicted.
Suicide
79
This is death resulting from the deliberate action of another person.
Homicide
80
This is death resulting from an unknown cause.
Indeterminate or Undetermined
81
This refers to a continuum of changes that occur in a dead body, following death.
Postmortem changes
82
Postmortem changes include:
- Livor mortis
- Rigor mortis
- Decomposition
- Taphonomy
83
This is the first demonstrable change after death.
Algor Mortis
84
This refers to the cooling of the body,
Algor Mortis
85
1st hour
2 to 2.5 deg F/hr
86
next 12 hrs
1.5 to 2 deg F/hr
87
next 12-18 hrs
1 deg F/hr
88
50% of cases, body cools at?
1.5 deg F/hr
89
T/F: Algor mortis is not a reliable indicator as to time of death.
True
90
This is the rigidity of the body due to hardening of skeletal muscles, caused by a series of physiochemical events after death.
Rigor mortis
91
Rigor Mortis
lack of ATP regeneration and increased acidity result in the?
formation of locking-chemical bridges between actin & myosin
92
Rigor Mortis
Glycogen stores are rapidly deleted, preventing energy dependent breakage of sarcomere contraction
Depletion of ATP and accumulation of lactic acid
93
T/F: In rigor mortis, interlocking is fixed without shortening of muscle
True
94
Rigor Mortis
Sets within?
2 hours after death, small muscles > larger muscle groups
95
Rigor Mortis
Complete and fully fixed after approx?
6-12 hrs
96
Rigor Mortis
Dissipates after?
36-48 hrs
97
This is fixed rigor mortis of the upper extremities wherein the arms are suspended against gravity indicating they were previously held in that position while rigor was fixing.
Antigravitational rigor mortis
98
This is characterized by a deep purple-red discoloration in skin and organs.
Livor Mortis
99
Other name for Livor Mortis
Postmortem (Lividity) Hypostasis
100
T/F: Blood supply gravitates to the skin vessels which becomes toneless and dilate after circulation ceases.
True
101
This occurs in gravity dependent areas that come into contact with firm surfaces.
Blanching
102
Livor mortis is spared in blanched areas due to?
localized pressure preventing blood from entering the skin
103
Livor Mortis
Evident as early as?
20 mins after death
104
Livor Mortis
Fully evident within?
4 hrs
105
Livor Mortis
Fixed within?
8-12 hrs
106
Tardien spots are also known as?
Tardieu petechiae, Tardieu spots
107
First described tardieu
Auguste Ambroise Tardieu
108
Evident in the death of a newborn child by strangulation or suffocation
Tardieu's ecchymoses (subpleural spots of ecchymosis)
109
Lividity is _____ discoloration of skin from blood pooling in dependent areas of the body.
pink to purple
110
Tardieu spots are what colors?
purple to black spots
111
Other Postmortem changes
- Postmortem clotting of blood
- Discoloration of tissues
- Autolysis and putrefaction
- Dessication (Tache noir)
112
This is a horizontal linear scleral blackening along the equator of the glove of eye.
Tache noir de la sclerotique
113
Tache noir is often initially what color in appearance, and over time becomes what color?
red, black
114
These darken with postmortem drying.
Lips, tip of tongue, scrotum
115
Primary Autopsy Incisions
For scalp
Mastoid-to-Mastoid incision
116
Primary Autopsy Incisions
For trunk
- I shaped
- Y shaped
- Modified Y shaped
117
Primary Autopsy Incisions
What is commonly used for females?
Y shaped, Modified Y shaped
118
Secondary Autopsy Incisions
Cutting of bones to expose cavities
- Sawing of skull
- Cutting of the sternal plate
119
This incision is a straight line incision extending from the chin to the symphysis pubis.
I shaped incision
120
This type of incision starts near the acromian process and progresses downwards towards the xiphoid process, then extended til the symphysis pubis.
Y shaped
121
This incision is made from the suprasternal notch over the clavicle, to symphysis pubis.
Modified Y shaped
122
Goal of performing the Incisions
- expose chambers of heart, lungs, liver, GIT lumen
- open urinary bladder cavity
123
This technique removes and dissects organs individually.
Technique of Virchow
124
Order of Virchow's Technique
Head > Thoracic (Cervical) > Abdominal
125
This technique is in-situ dissection in part with en bloc- technique.
Technique of Rokitansky
126
This technique utilizes en bloc- technique.
Technique of Ghon
127
This technique utilizes en masse technique.
Technique of Letulle
128
Minimally invasive technique
Needle autopsy
129
This refers to multiple percutaneous needle biopsies after death.
Blind biopsies
130
This refers to extensive organ sampling or removal via a limited incision.
Mini-autopsy
131
Non Forensic Autopsy Record Retention
Wet Tissue
3 months
132
Non Forensic Autopsy Record Retention
Paraffin blocks, Slides, Reports
10 years
133
Forensic Autopsy Record Retention
Wet tissue
3 years
134
Forensic Autopsy Record Retention
Body Fluids and Tissues for Toxicology
1 year
135
Forensic Autopsy Record Retention
Paraffin blocks, Slides, Reports, Gross Photographs/Negatives, Dried Blood stain or frozen tissue for DNA
Indefinitely
136
Hic locus et urbi mors gaudet, succarrere vitae
This is the place where the dead delights teaching the living
