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Fundamentals 3- Heme > Autopsy Pathology > Flashcards

Autopsy Pathology Flashcards

1
Q

What kind of autopsy requires a permit?

A

Hospital autopsy. The permit requires signatures from next of kin and a witness

A forensic autopsy just needs to meet the criteria for legal investigation by the ME. No permit is necessary

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2
Q

What are the components of a hospital autopsy?

A
  1. External examination

2. internal examination – most crucial

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3
Q

What are the components of a forensic autopsy?

A
  1. Investigation of the scene
  2. External examination
  3. Internal examination

a lot of times cause of death is established solely by scene investigation

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4
Q

What are examples of situations where the external and internal investigations would not show findings, but scene investigation can determine COD?

A

Drowning
Positional asphyxia in infants
Drug deaths (discovered with tox screens)

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5
Q

What is the purpose of the hospital autopsy?

A
  1. document natural disease processes
  2. answer clinicians questions
  3. efficacy of surgical procedures
  4. treatment efficacy
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6
Q

What is the purpose of the forensic autopsy?

A
  1. Determine cause and manner of death
  2. Document traumatic injuries
  3. Report natural disease that may have consequences for family or public health
  4. ID remain
  5. Collect evidence
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7
Q

When a patient dies at the hospital and an autopsy is ordered, who signs the death certificate?

A

The clinician NOT the pathologist

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8
Q

What is the difference in confidentiality between forensic and hospital autopsies?

A

Forensic- public record

Hospital- confidential

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9
Q

What is the difference between hospital autopsy and forensic autopsy in terms of toxicology?
How do they differ in terms of identity of the patient?

A

Forensics almost always requires a tox report. Hopsital autopsy RARELY orders a tox report.

In hospital autopsy, the identity of the patient is known while in forensic autopsy, the identity of the patient is frequently unknown.

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10
Q

Why do you need a permit for a hospital autopsy?

What are the two signatures required?

A

If you don’t have a permit it is considered battery and a criminal offense.
The permit requires signature from the legal next of kin and the signature of a witness (nurse, chaplain, hospital administrator).

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11
Q

What is the VERY first step you need to take before starting a hospital autopsy?

A

Ensure that the case does not fit the criteria of needing to be sent to the ME.

  1. death within 24 hours of hospital admission
  2. Under 6
  3. stillborn when mother is suspected of being on drugs
  4. trauma (NO TIME LIMIT)
  5. police custody
  6. during surgery/medical procedure or within 24 hours after
  7. suspicious or unexpected death
  8. death without a physician in attendance
  9. death occurring at the workplace
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12
Q

What are the 9 criteria that make an autopsy a medical examiner’s case?

A
  1. death within 24 hours of hospital admission
  2. Under 6
  3. stillborn when mother is suspected of being on drugs
  4. trauma (NO TIME LIMIT)
  5. police custody
  6. during surgery/medical procedure or within 24 hours after
  7. suspicious or unexpected death
  8. death without a physician in attendance
  9. death occurring at the workplace
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13
Q

What is the order of “next of kin”?

A
  1. spouse
  2. adult child
  3. legal guardian of minor child
  4. father or mother
  5. next of kin (specify relationship)
  6. person assuming custody for burial
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14
Q

On the Parkland permit, how do you fill out next of kin?

Can the permit be faxed or given over the phone?

A

On PMH permit all the next of kin are listed. Cross them out until you find one. Circle it and tell the pathologist why the others were unavailable.

It can be faxed but can NOT be given over the phone.

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15
Q

What is the most common limitation put on hospital autopsies?

A

NO HEAD

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16
Q

When is the death certificate filled out by the attending?

A 
When the patient:
1. died under the care of the physician
2. natural cause 
3. ME deems it natural 
All other circumstances are filled out by the ME, coroner or justice of the peace.
17
Q

What is the difference between a ME and a coroner?

A

Coroners are elected officials that may not have any medical training. they can do death certificates.
ME are MD board certified

18
Q

What is the definition of “cause of death”?

A 
it is the condition, defect, injury or process that initiated the patients demise (no matter how long prior to death this change took place). 
ex. Hepatic encephalophathy DUE TO
Cirrhosis DUE TO
Hep C DUE TO
Renal transplant DUE TO
renal failure DUE TO
chronic polynephritis DUE TO 
UTI DUE TO
neurogenic bladder DUE TO
spina bifida.

The cause of death is spina bifida.

19
Q

What is manner of death?

What are the 5 manners of death?

A

Manner of death is determined by the event that initiated the death regardless of how much time has passed.

  1. natural
  2. suicide
  3. homicide
  4. undetermined
  5. accident
20
Q

How would an overdose be classified in terms of manner of death?

A

Undetermined because you don’t know if it was suicide or an accident

21
Q

What is the mechanism of death?

A 
The physiological derangement by which the death resulted. 
ex. 
Arrythmia
exsanguination
sepsis 
asphyxia
22
Q

What 4 things should NEVER be listed as cause of death on the death certificate?

A
  1. cardiopulmonary arrest
  2. anoxic encephalopathy
  3. respiratory failure
  4. intracranial bleed
    bc this is saying, the heart stopped beating, they stopped breathing, there is no brain function.
    aka a description of EVERY dead person
23
Q

What are the four techniques used for organ removal?

A
  1. Virchow- organ by organ (most common and fastest)
  2. LEutelle/Rokitansky/En-bloc resection - take everything out from tongue to rectum with connections in tact
  3. Rokitansky- in situ with biopsies (don’t take organs out)
  4. Ghon- distinct organ blocks (1. thoracic 2. abdominal 3. GU)
24
Q

What parts of the body are never excised in an autopsy?

A

face, neck, upper extremities
(tongue and neck are removed through the Y incision so the face can be intact)
Incision into the skull goes ear-to-ear sparing the face

25
Q

What are 8 reasons why an autopsy is beneficial?

A
  1. examine disease process and mechanism of death
  2. answer clinician questions (find emboli etc)
  3. Detect infectious processes for public health
  4. ID hereditary diseases that can have implications for the family
  5. etiology of disease
  6. Teaching, education, research of med students, residents, faculty
  7. protect physicians from lawsuits
  8. Document clinical therapies and treatments for effectiveness
26
Q

What are the two biggest limitations of an autopsy?

A
  1. Can identify structural defects but not functional defects (ex. coronary artery disease can be ID’d but not electrolyte disorders or arrhythmias, infectious diseases, endocrinopathies)
  2. It looks at the patient in a single point of time so you can’t see the evolution of the disease

Fundamentals 3- Heme (19 decks)

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