Anatomical Findings Internal Examination 5 1

Question 1

Hydrogen Sulfide

Answer 1

Greenish tint

Question 2

Methylene blue treatment

Answer 2

Blue brain
Methylthioninium Chloride, commonly called methylene blue
Medication used to treat methemoglobinemia converting ferric iron (Fe 3+) in hemoglobin to ferrous ion (Fe 2+)
Common side effects include headache, vomiting, confusion, shortness of breath, and high blood pressure
Other side effects include serotonin syndrome, red blood cells breakdown, and allergic reactions
Often turns the urine, sweat, and stool blue to green in color

Question 3

Anatomical findings colors

Answer 3

Discoloration of intestinal tissue
Dye from capsules
A Large amount of partially digested tablets in the GI tract

Question 4

Flunitrazepam Rohypnol OD Japan

Answer 4

37 yr old female Flunitrazepam OD, when aspirated the gastric fluid was brillant blue
found open packages in room
Many drugs can turn fluids blue :Drugs such as triazolam, digoxin elixir, levodopa carbidopa hydrate, and aripiprazole, as well as some detergents, are blue substances and may color gastric fluid blue

Question 5

Body packers internal

Answer 5

Body packer may carry up to 1 kg of drug
50-200 packages at 8 to 10 g each
Each will carry a potentially lethal dose

Question 6

Pharmacobezors

Answer 6

Pharmacobezoars are uncommon but potentially problematic manifestations of drug overdose
Mass of any form of unabsorbed material within the GI tract
Dx radiographically, endoscopically, intraoperatively, or postmortem
Tend to form at anatomic strictures – between esophagus and rectum
Commonly occur in patients with prior abd surgery or altered GI motility
Besides obstructive and ischemic complications when impacted, also cause prolonged toxicological effects due to the retained drug mass

septic

Question 7

Gastro-esophageal Pharmacobezoars

Answer 7

62g lime green pharmacobezoar present w/in esophagus w/ additional 130 gm mass of similar material w/ in stomach both conatnted propranolol
Rest of GO tract was unremarkable
Mouth,parynx, glottis, laryn, trachea

Question 8

what is often the only clue and most important for drug overdose IMPORTANT

Answer 8

pulmonary congestion and edema

Question 9

Lung weight and meaning
IMPORTANT

Answer 9

lung weight greater than 1000 g suggestive of prolong CNS depressant which will be associated with CNS depressant drug
Mean adult male 825 g

Question 10

left ventricle heart failure

Answer 10

fluid backup which impedes gas exchange
fluid in lung
cant breathe

Question 11

bronchopneumonia

Answer 11

Individuals take drugs, pass out, and become comatose
Vomit and aspirate, or have mucus accumulation in their lungs for hours, and this might trigger an episode of pneumonia
“wet heavy lungs”

Question 12

Other causes of pulmonary congestion and edema

Answer 12

CPR
Drowning
Infection
Head injury
Neurogenic

Question 13

Distention of bladder

Answer 13

May be a sign of drug intox
other causes
Neurogenic bladder, diabetes mellitus, MS patients, stroke patients, spinal cord compression patients

Question 14

Rohner and pelletier/Thomas reseach studies pick one

Answer 14

Rohner found mean vol sig higher than normal bladder vol
Threshold of 330 mL
Pelletier and Thomas drug intox to control group
34% opioid intox [excluding fentanyl]
16% fentanyl intox
Control group none

Question 15

Bladder full of urine study

Answer 15

White and cina
154 autopsy cases
97 lethal drug intoc
57 control
83.7m: in control
182.5mL in OD
189.7 in multi drug intox
Prolong CNS depression w/ kidneys still producing urine and decreased biofeed back signaling need to micturate
Cocaine cases 35.6mL authors opine sudden death

Question 16

Histology may suggest drug or toxin

Answer 16

Constriction band necrosis
Polarized light microscopy: Birefringent particles
Lung
Talc or filler material in illicit powers [e.g., heroin]
Binders/diluents [e.g., microcrystalline cellulose] injected tablets
Kidney
Calcium oxalate crystals

Question 17

Cocaine users have elevated levels of

Answer 17

Catecholamines

Question 18

Catecholamines cause histologic changes within

Answer 18

Myocardium
Morphologic changes seen in hearts of cocaine and amphetamine users are similar

Question 19

Contraction Band Necrosis

Answer 19

introduced by Caulfield and Klonsky in 1959
Lesion described in heart of a cocaine user in 1922 by Bravetta and Invernizzi
a type of uncontrolled cell death (necrosis) unique to cardiac myocytes and thought to arise in reperfusion from hypercontraction, which results in sarcolemmal rupture.

Question 20

is contraction band necrosis found more common in sedatives-hypnotics or cocaine

Answer 20

93% cocaine group
Less than 10% control group

Question 21

presumptive indicator of contraction band necrosis other conditions

Answer 21

drowning
starvation
pheochromocytoma

Question 22

Pheochromocytoma

Answer 22

Tumor made up of special adrenal gland cell known as the chromaffin cells which secrete epinephrine, norepinephrine, and dopamine
Hormones active in the regulation of heart rate and blood pressure
Pheochromocytoma cells periodically secrete excessive amounts of the hormones epinephrine and norepinephrine, resulting in period of very high blood pressure, rapid heart beats, excessive sweating, and severe headaches

Question 23

Ethylene Glycol Histological findings

Answer 23

Ingestion of oxalic acids
Rust remover
Rhubarb plants
Methoxyflurane anesthetic gas