autopsy stuff

Question 1

what two categories do most autopsies fall under in most countries?

Answer 1

those performed under instruction of a legal authority

those performed with permission from deceased’s relatives to gather info on the nature and extent of the deceased’s disease

Question 2

why are medico-legal autopsies performed?

Answer 2

to determine the cause of death and to collect evidence to use in prosecution of those responsible for the death

Question 3

when are clinical autopsies performed?

Answer 3

on patients who die in hospital

Question 4

why are clinical autopsies performed?

Answer 4

certified cause of death given by clinicians with primary responsibility for the patient shows a 30% discrepancy with cause found at autopsy

Question 5

how can clinical autopsy be useful?

Answer 5

more accurate data about cause of death: clinical audit, education of clinicians and national allocation of health resources, determining extent of disease and response to treatment

Question 6

what is an advantage of clinical autopsy?

Answer 6

simple and cost-effective compared to modern methods of in-vivo imaging

Question 7

what is happening to the rate of hospital autopsies?

Answer 7

declining

Question 8

what is the prevalence of types of autopsy in the UK?

Answer 8

hospital - less than 10%

medico-legal - more than 90%

Question 9

when are deaths ‘presumed natural’?

Answer 9

cause of death not known

not seen by doctor in last illness (within 14 days)

Question 10

when are deaths ‘presumed iatrogenic’?

Answer 10

peri/postoperative deaths
anaesthetic deaths
abortion
complications of therapy

Question 11

when are deaths ‘presumed unnatural’?

Answer 11

accidents
industrial death
suicide
unlawful killing
neglect
custody deaths
war/industrial pensions

Question 12

doctors and referrals for autopsy

Answer 12

have no statutory duty to refer
common law duty
GMC guidance

Question 13

registrar of BDM and referrals for autopsy

Answer 13

have a statutory duty to refer

Question 14

where do referrals for autopsy come from, other than doctors and registrars of BDM?

Answer 14

relatives
police
anatomical pathology technicians
other properly interested parties

Question 15

what types of pathologists perform autopsies?

Answer 15

histopathologists and forensic pathologists

Question 16

what types of autopsies do histopathologists perform?

Answer 16

hospital and coronial autopsies

Question 17

when do histopathologists perform coronial autopsies?

Answer 17

natural deaths
drowning
suicide
accidents
road traffic deaths
fire deaths
industrial deaths
peri/postoperative deaths

Question 18

what types of autopsies do forensic pathologists perform?

Answer 18

coronial autopsies

Question 19

when do forensic pathologists perform coronial autopsies?

Answer 19

homicide
death in custody
neglect

these if they may be due to action of a third party: drowning, suicide, accidents, road traffic deaths, fire deaths, industrial deaths, peri/postoperative deaths

Question 20

what is the role of the coronial autopsy?

Answer 20

to answer:

who was the deceased?
when did they die?
where did they die?
how did they come about their death?

Question 21

what year was the coroner’s act established?

Answer 21

1988

Question 22

what is S19 of the Coroners Act (1988)?

Answer 22

allows coroner to order an autopsy where death is likely due to natural causes to obviate need for inquest. no power to authorise special investigations

Question 23

what is S20 of the Coroners Act (1988)?

Answer 23

allows coroner to order an autopsy where death is clearly unnatural and inquest will be needed. can authorise special investigations

Question 24

when were the Coroners Rules established?

Answer 24

1984

Question 25

what is R5 of the Coroners Rules (1984)?

Answer 25

autopsy as soon as possible

Question 26

what is R6 of the Coroners Rules (1984)?

Answer 26

by a pathologist of suitable qualification and experience

Question 27

what is R10 of the Coroners Rules (1984)?

Answer 27

report findings promptly and only to coroner

Question 28

what is R11 of the Coroners Rules (1984)?

Answer 28

autopsy only on appropriate premesis

Question 29

when were the Amendment Rules established?

Answer 29

2005

Question 30

what are the Amendment Rules (2005)?

Answer 30

pathologist must tell coroner what materials have been retained
coroner authorises retention and sets disposal date
coroner informs family of retention
family has choices
coroner informs pathologist of family’s decision
pathologist keeps record
autopsy report must declare retention and disposal

Question 31

what choices do family have in the Amendment Rules (2005)?

Answer 31

return material to family
retain for research/teaching
respectful disposal

Question 32

when was the Coroners and Justice Act established?

Answer 32

2009

Question 33

what changes are in the Coroners and Justice Act (2009)?

Answer 33

affects S19/20 - coroner can defer opening the inquest and launch investigation instead
enshrines a system of medical examiners
little practical change to the pathologist
inquests have conclusions, not verdicts

Question 34

when was the Human Tissue Act established?

Answer 34

2004

Question 35

what does the Human Tissue Act (2004) require?

Answer 35

S16(2): autopsies only to be performed on licensed premises
license holder
consent from relatives for any use of tissue if not subject to coronial legislation or retained for criminal justice purposes
public display requires consent from deceased

Question 36

what are the penalties of the Human Tissue Act (2004)?

Answer 36

3 years imprisonment and/or a fine

Question 37

what are the stages of the autopsy?

Answer 37

history/scene
external examination
evisceration
internal examination
reconstruction

Question 38

what is involved in external examination?

Answer 38

identification
disease and treatment
injuries

Question 39

how is someone identified in an external examination in autopsy?

Answer 39

formal identifiers
gender, age
body habitus
jewellery
body modification
clothing

Question 40

what are the steps involved in evisceration?

Answer 40

Y shaped incision
open all body cavities
examine all organs in situ
remove thoracic and abdominal organs 
remove brain

Question 41

what is studied in internal examination in autopsy?

Answer 41

heart and great vessels
lungs, trachea, bronchi
liver, gallbladder, pancreas
spleen, thymus, lymph nodes
genitourinary tract
endocrine organs
central nervous system