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Forensics > Autopsy > Flashcards

Autopsy Flashcards

1
Q

Name 3 autopsy signs of immersion

A

External foam around mouth and nostrils, emphysema aquosum (hyperexpanded and waterlogged lungs), subpleural haemorrhages, (distended air spaces)

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2
Q

How does a close range entry gunshot wound present? (5)

A

•Soot/smoke soiling
• tattooing (powder burns and propellant residue ) !
• ring of abrasion!
• smudge ring
• ring of “contusion” (due to injury of small blood vessels and haemorrhage in vicinity of central defect)
( skin and hair burns, round or oval)
• singular central defect smaller than size bullet

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3
Q

How does distant range gunshot wound present? (3)

A

• Collar of abrasion
• smudge ring
• outside smoke/propellant distance! So no smoke, burn or tattoo
(round with sharp margins)

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4
Q

How does an exit gunshot wound present? (4)

A
  • Irregular (stellate usually)
  • approximable wound edges
  • MAY HAVE ring of abrasion (shored exit wound). If body part supported by firm surface only.
  • skin everted
  • generally larger than entrance wound
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5
Q

How does a stab wound present?

A

Deeper than it is long /wide

Generally perpendicular force

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6
Q

Name 7 special types of lacerations

A
  1. Splitting of skin (split laceration) - on area with bone beneath eg scalp, chin.
  2. Stretch laceration- eg ran over by car
  3. Decollement (subcut tissue lacerated but no open injury. A cavity forms between skin and muscle filled with blood and fluid
  4. Hook lacerations
  5. Patterned lacerations eg blow to head with hammer
  6. Tear laceration (most common)
  7. Cut laceration eg axe
  8. Avulsion laceration: heavy weight eg car passing over body, causing large areas skin to be avulsed and lost. Also called flaying
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7
Q

Name 5 types of burns patterns

A

1 Jet of flame - type burn pattern (spray)

  1. Explosion pattern
  2. Flame pattern from direct effects
  3. Immersion pattern eg hot water bath
  4. spilling pattern
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8
Q

How can it be determined whether or not the patient was alive at the time of the fire?

A

Soots in trachea = alive,

CO in blood

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9
Q

Name 4 autopsy findings indicating hypothermia at time of death

A
  1. Haemorrhagic gastric lesions (wischnewsky spots)
  2. Infarction small bowel (red blood sludging)
  3. Haemorrhagic pancreatitis with fat necrosis
  4. Cold injuries to extremities - dusky pink esp over large joints
  5. Bright red lividity
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10
Q

What are haemorrhagic gastric lesions caused by cold called?

A

Wischnewsky spots

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11
Q

What are haemorrhagic gastric lesions caused by heat called?

A

Curling ulcers

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12
Q

What are haemorrhagic gastric lesions caused by brain tumour/injury called?

A

Cushing ulcers

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13
Q

Name 3 types of skin lesions found in electrical injuries

A
  • Collapsed blister (low voltage) - contact (raised rim with concave centre). May be red, black, inconspicious while with depressed firm centres
  • spark burn - air gap between metal and skin (yellow/brown keratin with areola of pale skin around it)
  • Crocodile skin - high voltage
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14
Q

How are explosive injuries identified? (4)

A

Marshall’s triad:
1. Small bruises
2. Punctate abrasions and small irregular puncture lacerations
3. Dust or dirt tattooing
Triad of injuries may be so confluent as to give skin purple discolouration

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15
Q

5 classic signs of asphyxia?

A

Adelson’s Obsolete diagnostic quintet:
1 petechial haemorrhages (pinpoint on eyelids, conjunctiva, ears, face, neck, upper chest, viscera, especially subpleural and subepicardial (Tardieu spots) ) - due to raised intracapillary pressure and capillary wall anoxia.
2. Congestion (face: plumb colour- engorgement of blood ) and especially pulmonary oedema (of face, neck, tongue)
3. Cyanosis (face, neck tongue)
4. Engorgement of right heart with blood
5.fluidity of blood, stays unclotted (fibrinolysins )

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16
Q

Signs of hanging on autopsy (8)

A
  1. Ligature mark curvilinear-tapers upwards
  2. Ligature mark has suspension point (discontinuous ligature mark)
  3. Ligature mark above thyroid cartilage
    4 with or without contusions/abrasions
  4. Salivary tail
  5. Usually no internal neck injury
  6. Careful interpretation with slip knot
  7. Protrusion tongue, blue tip
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17
Q

Signs of ligature strangulation on autopsy (5)

A
  1. Horizontal ligature mark
  2. Intersecting loop (s)
  3. At level of thyroid cartilage or below
    4 May have abrasions/contusions
    5 often internal injuries eg hyoid bone, the thyroid / cricoid cartilage, strap muscles of neck
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18
Q

How does a lightning injury appear on autopsy? (5)

A
  • Lichtenberg figures: feathering, tree-fern patterns
  • Red streaks following skin creases or sweat - damped tracks
  • complete/partial stripping clothes
  • burns: esp hair
  • lacerations.
  • wavelike arrangements of myocardial cells
  • eardrum burst
  • eye injuries: retinal detachment, later cataracts
19
Q

What phenomenon is caused when a bullet enters the skull?

A

Bevelling

20
Q

Which rule states that the skull fracture from the first blunt force injury develops normally, while those caused by the subsequent injury are stopped where structure of skull has already been deployed?

A

Puppe ‘s rule

21
Q

What is Puppe’s rule?

A

-the skull fracture from the first blunt force injury develops normally, while those caused by the subsequent injury are stopped where structure of skull has already been deployed

22
Q

How does traumatic cause of primary brain stem haemorrhage present at autopsy?

A

Well circumscribed lie lat to tegmentum without distortion of midbrain. (as opposed to natural cause)

23
Q

See picture 4 and label the skull # types

A 
A. Linear (with radiating fissure fractures)
B depressed
C. Depressed a la signature
D. Depressed by sharp edged weapon
E. Depressed pond or indented
F depressed stellate ("spider web ")
G comminuted
24
Q

See picture 5 and label base of skull #

A

A type 2 hinge #
B type 3 hinge
C type 1 hinge
D ring or foramen #

25
Q

What is mottling (see p 148 and 157 autopsy atlas) of the heart a sign of?

A

Myocarditis or MI

26
Q

See picture 6. What pathology is illustrated?

A

Bacterial pericarditis- leaves “crust” or exudate (“bread and butter” pericarditis)

27
Q

What pathology is shown in picture 7?

A

Myocarditis (white. Normal = brown

28
Q

What pathology is shown in picture 8.

A

Berry aneurysm

29
Q

What pathology is shown in picture 9?

A

Extra dural haemorrhage

30
Q

Name 5 causes subendocardial haemorrhage on autopsy

A
  1. Heavy metal poisoning
  2. hypovolaemia
  3. Head injury
  4. HypertherMia
  5. hypothermia
31
Q

Name 7 PM findings that may be associated with drowning

A

1 external foam or froth and frothy fluid in airways - “ whisked egg white” texture and consistency (mixture bronchial secr/mucus, proteinaceous material, pulmonary surfactant, aspirated fluid )

  1. Emphysema aquosum/ heavy, “waterlogged” lungs (medial margins meet in midline, don’t collapse upon removal)
  2. Pleural fluid accumulation
  3. Sub-pleural haemorrhages: Paultauf ‘s spots (haemolysis within intra-alveolar haemorrhages)
  4. Miscellaneous: engorged organs, reduced weight of spleen, muscular haemorrhages in neck and back , wrinkled washerwoman hands and feet , red staining intima of aorta near heart (hemolysis ), cutis anserina (goosebumps)
  5. Microscopy lungs: alveolar distension, haemorrhage and rupture, narrowed capillaries
  6. middle ear congestion/haemorrhage, bloody/watery fluid in intracranial sinuses,
32
Q

2 differences between anatomical pathology and forensic autopsy

A

Anatomical pathology: natural causes, need consent of family, not routinely done
Forensic: unnatural, do not need consent, done for every unnatural death.

33
Q

What will pulmonary barotrauma /’blast lung “ due to blast over pressure (Bop) /blast wave show on autopsy? (6)

A
  1. Oedema
  2. Haemorrhage
  3. Laceration
  4. Contusions
  5. Acute lung injury (Ali)
  6. ARDS
34
Q

Serial rib fractures which are postero-lateral are probably caused by?

A

Non- accidental injury

35
Q

Name 3 features ante- mortem abrasion

A
  1. Shows slight haemorrhage
  2. Haemorrhage into tissues
  3. Assumes dark brown colour
36
Q

Signs of hangings vs ligature strangulation (8)

A

• Hanging ligature mark is curvilinear and tapers upwards with a point of suspension; strangulation has horizontal ligature mark with intersecting loop(s)
• hanging above level thyroid cartilage; strangulation below.
• hangings have salivary trail! Also usually tongue protrusion with blue tip
• hanging no internal neck injuries; strangulation usually injury to hyoid bone, thyroid/cricoid cartilages or strap muscles of neck.
• both may have abrasions/contusions.
• distance from ground not far in hangings; staged homicide high
. Incompletely surround neck vs completely
. Deepest segment diametrically opposite the point of suspension us wider, narrower or same width as ligature
• livor mortis at feet vs position dependent

37
Q

Name 5 pitfalls and artefacts encountered in the neck at pm exam that make it difficult to diagnose strangulation. How can this be solved?

A
  1. Developmental anatomy of hyoid bone
  2. Triticeous cartilages
  3. Prinsloo-gordon haemorrhage
  4. Postmortem hypostatic hemorrhage
  5. Resus-related neck injury
    Solve by drain blood from neck and then layered in situ dissection of anterior neck structures.
38
Q

Name 3 ways the eyes can indicate death

A
  • loss corneal and light reflexes
  • Fixed unreactive pupils - mid dilated position
  • Retina trucking of blood
39
Q

Difference between salt and fresh water drowning? (5)

A
  1. Fresh water: haemolysis vs salt water none
  2. Haemodilution vs haemoconcentration
  3. Hyper volaemia vs hypovolaemia
  4. Hyponatraemia vs hypernatraemia
  5. V Fib vs ventricular asystole
40
Q

What are wischnewsky spots?

A

Hemorrhagic gastric lesions as result of mucosal necrosis with haematin formation due to disturbance gastric microcirculation and exposure haemoglobin to gastric acid, may be seen in hypothermia (mostly) , sepsis, shock, alcohol misuse

41
Q

What are tardieu spots?

A

Petechial haemorrhages due to intense Congestion or due to pressure, often from gravity. Often found on lividity as decomposing capillaries rupture . Occur more rapidly in asphyxia and present first where capillaries are least supported eg conjunctiva, face, epiglottis, subpleural surface lungs, heart, meninges, thymus.

42
Q

Name 3 autopsy findings associated with hyperthermia

A
  • Rhabdomyolysis
  • acute pancreatitis
  • necrosis of liver, kidney, brain
43
Q

What is proper way to investigate asphyxia at autopsy?

A

BloodLess-field neck dissection. Layered dissection technique

Forensics (9 decks)

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