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Forensic medicine > Death & related matters > Flashcards

Death & related matters Flashcards

1
Q

what is apparent death?

A

aka. suspended animation

no or minimal signs of life, but responsive to prolonged resuscitation

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2
Q

Give examples of when you apparent death might be observed.

A

electrocution, drowning, overdose, hypothermia, and in children

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3
Q

what is somatic (clinical) death traditionally based on?

A

traditionally based on the Triad of Bichat
“the failure of the body as an integrated system associated with irreversible loss of circulation, respiration and innervation”

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4
Q

Summarise the Triad of Bichat

A

Loss of spontaneous heartbeat
Irreversible loss of capacity to breathe
Irreversible loss of consciousness

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5
Q

What is the legal definition of death?

A

TRICK Q
There is no legal definition of death - brain death is the nearest equivalent.
Brain stem death is a necessary component since it controls innervation, spontaneous respiration & heartbeats.

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6
Q

The brain stem is damaged in persistent vegetative state - true or false

A

false

there is cortical damage but the brain stem is intact

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7
Q

what can cause damage to the cortex in PVS?

A

cardiac arrest, hypoxia, trauma, poisoning, hypoglycaemia

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8
Q

How do you know the BS is intact in PVS?

A

spontaneous breathing + heartbeat

eyes open/close cyclically, swallow, grimace

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9
Q

A person in persistent vegetative state is awake and aware of self / environment but unable to speak or move - true or false

A

false
Awake but UNaware of self/environment
No speech or purposeful movement

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10
Q

The assessment for PVS includes ?

A

No spontaneous meaningful motor response, incl. voice.
No language comprehension or expression.
No sustained, reproducible, purposeful or voluntary behavioural response to normal or noxious visual, auditory or tactile stimulus.

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11
Q

What duration of brain damage + lack of awareness of self is required to be classed as PVS?

A

> 6 or 12 months

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12
Q

cortical atrophy is seen in PVS - why?

A

from months/years of inactivity ± hypoxia

ventricles are dilated and reduced grey/white matter

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13
Q

A person in PVS will have spontaneous breathing and heartbeats - true or false

A

true

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14
Q

A person with BS death will have spontaneous heartbeats - true or false

A

true!

however it is due to artificial ventilation, would not occur if not ventilated

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15
Q

Which carries a greater moral dilemma: PVS or BS death?

A

PVS (“allow person to die?”) vs. stop ventilating a corpse in BS death

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16
Q

haemorrhage in upper pons would be fatal - true or false

A

true
haemorrhage in upper pons = brainstem = primary BS lesion
knocks off vasomotor, RAS-activating and respiratory centres

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17
Q

Sensory input from the whole body has to pass the brainstem before reaching the cortex - true or false

A

sensory input form everywhere except smell and vision needs go via BS to reach cortex

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18
Q

Motor output from the cortex has to go through the BS before reaching the rest of the body - true or false

A

true

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19
Q

which cranial nerves cannot be tested at bedside?

A

1, 11 and 12 cannot

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20
Q

how is brain stem activity tested at the bedside?

A

BS activity tested at bedside by testing CNs

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21
Q

What are specific signs of BS activity?

A

epileptic fit
decorticate rigidity (abnormal flexion)
+ve Doll’s eye reflex (eyes remain fixed on moving head)

22
Q

how many doctors need to perform the tests to confirm BS death?

A

2 senior doctors (>5y) perform the tests separately

23
Q

In BS death, the cause of the coma is unknown - true or false

A

false

to diagnose BS death, you must know the cause of the coma and exclude reversible causes

24
Q

Hypoxia, hypotension and a SOL could cause a deep coma - true or false

A

true

these could cause a reversible deep coma requiring artificial ventilation

25
Q

List some CN reflexes which are in-line with BS death.

A 
pupils non-reactive to light
no corneal reflex
no nystagmus upon ear irrigation
no grimace to pain
no gag reflex
26
Q

what test can be done to confirm BS death and specifically, that respiration is irreversibly damaged?

A

apnoea test
give 100% O2 for 10mins
5% CO2 for 5 mins
then disconnect from ventilator for 10mins

if respiration was intact, the rising CO2 would stimulate spontaneous breathing

27
Q

Transplantation from a person with BS death = which type of donor?

A

cadaveric transplantation/ donnor

28
Q

In a homologous transplant, which tissues can be harvested?

A

skin graft, bone graft, own blood

29
Q

Which tissues can be donated from a live donor for transplant?

A

blood, bone marrow, kidney, part of liver

30
Q

What does the Human Tissue Act 2004 (Eng/Wales) regulate?

A

Regulates removal, storage and use of human tissue.
Creates new offence of ‘DNA theft’
Makes it lawful to preserve organs of deceased for transplantation
Authorises museums to move human remains

31
Q

What does the Human Tissue (Scotland) Act 2006 cover?

A

Same things as 2004 Act re. transplantation etc.
Also:
Allows tissue samples that the PF no longer requires to be kept for education, training or research
Defines ‘nearest relative’ and makes provisions about related matters
Amends the Anatomy Act of 1984 to allow for practice of surgical reconstruction on cadavers and prevents unlicensed exhibition of bodies/parts in public under guise of education or art

32
Q

Why was the Anatomy Act of 1832 created?

A

to stamp out body snatching and enable people to donate their body to medical science

33
Q

Any UK doctor who knows the cause of death can complete the MCCD - true or false

A

false
Scotland: any Dr who know CoD can do it
RUK: only Dr who attended during last illness (<14d) or Dr who attended regularly during last illness and has viewed body can do it

34
Q

In Scotland, a dr seeing a body for the 1st time can certify death - true or false

A

true

this is not the case in RUK

35
Q

How many days does an informant have to register a death at the Registrar office?

A

7 days in Scotland (21 days if stillbirth)

5 days in RUK

36
Q

The certifying Dr in Scotland, can certify without viewing the body after death - true or false

A

true
they need not have attended in last illness or view the body after death - as long as they know the COD, they can certify

37
Q

What weeks of gestation correlate with still birth and miscarriage?

A

stillbirth >20w

miscarriage <20w

38
Q

a death related to food poisoning should be referred to the PF - true or false

A

true

39
Q

a death related to a vehicular accident should be reported to the PF - true or false

A

true

40
Q

What needs to be proven in a case of alleged negligence?

A
  1. legal duty of care owed
  2. breach of duty by omission or commission
  3. provable causal link between actions and harm
41
Q

how many drs are required for an autopsy for a suspected suicide?

A

1 Dr

42
Q

how many Drs required for the autopsy of a suspicious death?

A

2 Drs

2 also for RTA or homicide

43
Q

the PF must report cases where an FAI is mandatory to the Crown office - what are 2 examples of this situation?

A

fatal accident at work
death in custody
both require FAIs

44
Q

In which circumstances will a Coroner’s inquest adjourn for?

A

murder, manslaughter, infanticide
death by dangerous driving
suicide with abetment

they CIs may resume after criminal proceedings

45
Q

PF must report the death of a police officer to Crown Office - true or false

A

true

46
Q

What does the PF want to know when investigating a death under medical care?

A

Was the patient properly examined?
Were all due precautions followed?
Were there any special risks which should have been discovered?

47
Q

Which deaths under medical care should be referred to PF?

A

clinically unexplained e.g. unexpected re. condition
attributable to diagnostic or therapeutic hazard
negligence suggested
death during anaesthesia
complication of surgery or anaesthesia

48
Q

do deaths related to fires, burns and scalds need to be referred to PF?

A

yes

49
Q

what is liver mortis

A

a dark purple discolouration of the skin resulting from gravitational pooling of blood in the veins and capillary beds of dependent parts of the corpse.

50
Q

difference between hypostasis and lividity?

A

trick question - hypostasis is a synonym for lividity

Forensic medicine (10 decks)

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