5 - Autopsy

Question 1

“List four types of death that must be reported to the Coroner.”

Answer 1

“The cause of death is unknown
The deceased has not been seen by the certifying doctor either after death or within the 14 days before death
The death was violent, unnatural or suspicious
“The death may be due to an accident (whenever it occurred)
The death may be due to neglect by self or others
The death may be due to an industrial disease or due to the deceased persons employment
The death may be due to an abortion
The death occurred during an operation or before recovery from the effects of an anaesthetic
The death may be a suicide
The death occurred during or shortly after detention in police or prison custody
The death may be related to poisoning

Question 2

“List two reasons for conducting hospital autopsies”

Answer 2

“Audit – Major discrepancies between stated cause of death and actual cause of death (main diagnosis missed in 15% of cases subsequently autopsied Cameron et al 1980. )
Monitoring effectiveness of new treatments e.g. complex congenital heart disease.
Teaching e.g. unrivalled clinic pathological correlation.
Research e.g. knowledge of variant CJD relies heavily on study of post mortem brain tissue.

.

Question 3

“Explain how the need for consent from the deceased’s relatives differs between a Coroners’ and a hospital autopsy.
”

Answer 3

Hospital
With the relevant consent, any material can be taken

Coroners
No consent of family needed (but their wishes should be considered)

Question 4

List natural causes of sudden unexpected death in the community

Answer 4

Cvd, hypertensive heart disease, CNS, vascular system, respiratory system, gastrointestinal.

Question 5

“Define a bruise. Give an example of a mechanism of injury that would lead to a bruise”

Answer 5

“A blunt trauma injury. Occurs alone (skin intact) or is associated with other injuries.
An extraversated collection of blood which has leaked from damaged small arteries, venules and veins but not capillaries
Occur more easily where skin is lax. Fragility of vessels, coagulation state etc all effect bruising.
May take hours or days to form. May get patterned bruises (can see better with special light sources). Deep bruising may never be seen on the surface.
You can bruise after death (but usually small and lie on dependant parts).
Not everything is a bruise: e.g. Pink areas may be due to hypothermia.
”

Question 6

“Define an abrasion. Give an example of a mechanism of injury that would lead to an abrasion.
”

Answer 6

“A graze or scratch. The most superficial of blunt trauma injuries.
Confined to the epidermis (strict definition) but may actually extend into the superficial dermis due to skin anatomy).
Can occur before and after death
Due tangential force – may have a distal skin tag eg Friction burn, or Vertical force eg Stamp – no distal skin tag.
Abrasion examples - Friction burn, Car radiator, Flooring, Whip, Stamp.
”

Question 7

Who is the coroner?

Answer 7

An independent judicial officer of the crown who has a statutory duty to investigate the circumstance of certain categories of death for the protection of the public

Question 8

Summarise cases that need to be reported to the coroner

Answer 8

Unnatural, not seen doctor,accident, neglect,employment, abortion, operations during anaesthetic, suicide, police detention, poisoning

Question 9

What are the 2 types of autopsy?

Answer 9

“Hospital
Consent must be obtained from the relatives
With the relevant consent, any material can be taken

Coroners
No consent of family needed (but their wishes should be considered)
”

Question 10

What is on a death certificate?

Answer 10

“1a Immediate cause of death (must be filled in)
1b Predisposing factor
1c Predisposing factor
2 Other factors contributing to but not directly leading to death”

Question 11

List non natural causes of sudden unexpected death in the community

Answer 11

Drugs, alcohol, trauma (self or others)

Question 12

What is a laceration?

Answer 12

“A split to the skin. The result of blunt force overstretching the skin. Usually pass through the full thickness of the skin. They are deep and will bleed.
Margins ragged with crushing and bruising. “Bridging fibres” arch across the skin defect.
Common where skin can be compressed between the force and underlying bone e.g. Scalp, elbow, shin.
Rare over soft fleshy areas e.g. Buttocks, breasts. A laceration shows poor reproduction of the object causing it.
“Flaying” – tangentially applied force leading to a horizontal laceration.
examples – Fall, Punch, Stick, Hammer, Bomb, Wheel of car (flaying”

Question 13

What are cut or stab

Answer 13

W “Cut (or slash)
The length of the injury is longer than its depth

Stab(or penetrating injury)
The depth of the wound is greater than the width
”

Excerpt From
MBBS Year 1 MCD Autumn

Question 14

What are examples of vascular SUDs?

Answer 14

Ruptured aortic aneurysm

Question 15

What are examples of GI SUDs?

Answer 15

Pancreatitis, bleeding ulcers

Question 16

Examples of cardiovascular SUDs

Answer 16

Coronary artery disease-mode of death is usually cardiac arrhythmia and severe coronary artery atherosclerosis is most common anatomical finding.
Other causes include cardiomyopathy, myocarditis, floppy mitral valve.

Question 17

Examples of cns suds

Answer 17

“Non traumatic subarachnoid haemorrhage: 
(Usually due to Berry aneurisms

Intracerebral haemorrhage

Epilepsy

”

Question 18

Examples of respiratory SUDs

Answer 18

Pulmonary embolus

Asthma