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Forensic medicine Flashcards

1
Q

Definition of death

A

Cessation of life either
* heartbeat,
* respiratory movements,
* circulation
* or absence of carotid pulse

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2
Q

3 types of death?

A

Cellular
Brain
Somatic

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3
Q

What is cellular death?

A

cessation of cellular respiration followed by loss of metabolic activity

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4
Q

is death a sudden event?

A

No it is a process

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5
Q

how long after death does some cells live?

A

WBC up to 12 h
Neurons 3-7 minutes
Bone and skin days

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6
Q

define somatic death?

A

Loss of vital signs such as
* reflexes,
* heartbeat and
* respiration
The individual is irreversible unconscious

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7
Q

Define brain death?

A

Clinical diagnosis with irreversible damage to the brain

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8
Q

Early PM changes?

A

Livor mortis
Rigor mortis
Algor mortis

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9
Q

Late PM changes

A

Decomposition
Mummification
Adipocere
Skeletonization

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10
Q

Early PM signs in the eyes?

A

Loss of corneal reflex/light reflexes
Retinal vessels fragment - trucking/shunting
Loss of intraocular pressure

tache noire if eyelids are not closed after death

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11
Q

When may Livor mortis be absent

A

young
Old
Anemia
Major blood loss

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12
Q

why do we get livor mortis

A

hypostasis and RBC accumulate where gravity is highest

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13
Q

Hypostasis may have different colors in which cases

A
  1. Cherry pink in CO paisoning
  2. Brick red in cyanide poisoning
  3. Bronze in clostridium perfringens infection
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14
Q

Nysten rule of rigidity

A

< 30 min nothing
30 min-3h jaw and face become rigid
6h-24h all muscles are rigid
>24h rigidity starts to diminish

flaccid again from >36 hrs

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15
Q

difference between rigor mortis and cadaveric rigidity?

A

Rigor mortis is a physiological phenomenon occuring over time
Cadaveric rigidity is due to the person clinching muscles at time of death (stress)

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16
Q

Algor mortis timing?

A

first 3-4h drop by 1C/h

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17
Q

what influences algor mortis?

A

Mass of body
Surface area of body
T at death
Posture of body
Clothing
Environment (warm/water)

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18
Q

where to take temperature

A

Rectum or liver

0.8 C/hr cooling
reaching 5 C within the environmental temp, it slows down

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19
Q

when and where does signs of decomposition occur?

A

in warm climate abdomen above cecum turns green after 3-4 days

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20
Q

What is marbling?
when does it happen?

A

discoloration of vessels due to bacteria multiplication and hemolysis

marbling of venous system 2-3 days after death

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21
Q

skin manifestation of decomposition?

A

blistering and peeling

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22
Q

why do we see bloating? what else can we see?

A

Bacteria cause gas
Also reason for eyes and tongue protruding

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23
Q

What is purge fluid?

A

Due do decomposition the increased pressure in the body forces fluid out of the mouth and nose

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24
Q

why does mummification happen?

A

if there is a very warm and dry environment body desiccate/dry instead

also in cool dry places

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25
what age s mummification common?
infants because they are sterile may dry up before bacterial action occurs
26
Describe mummification appearance?
Brown Dry Leatherly dehydrated and stiffened note: mummification doesn't happen to whole body, some parts may show normal soft tissue decomposition mummified tissue are not immune to degradation nor invasion by rodents, beetles, moths
27
define adipocere
grayish greasy grave wax formation of fat(hydrolysis), most commonly in water depends on surrounding temp, depth, presence of water currents
28
normal timing of adipocere
1-2 months after death for transformation of : -muscles at least 6 months of decay required -soft tissue within 2 years
29
Define skeletonization
- if burried: -loss of soft tissue takes 2 years (NOT tendons, lig, hair, nail) -after 5 years ONLY bone - corpses skeletonize in 1-2 years, unless very cold conditions if hot, skeletonization completes within weeks if aided by animals
30
the 3 times of death?
Physiological: when vital organs cease function Estimated : best guess Legal: time at which body was discovered or physically pronounced dead by another individual
31
3 ways of estimating TOD
looking Touching Measuring
32
time of first sign of decomposition? what signs? decomposition on land, water, buried
AFTER 36h green discoloration - 36-48hrs marbling: 2-3 days gas formation: 2-3 days 1week decomposition on land 2 weeks in water 8 weeks buried
33
temperature and timing indicating PM
warm and flaccid indicated <3h warm and stiff indicated 3-8h PM cold and stiff indicates 8-36h PM cold and flaccid indicated more then 36h
34
how does rigor mortis progress
starts in small muscles startes 0,5-3h PM decays after 36h
35
when will you feel a body as cold when touching?
when it's more then 5C less then your own temperature
36
what needs to be decided in a PM investigation?
1. dead or not 2. Manner of death 3. Cause of death
37
Manner of death?
Natural Violent (Accident, suicide, homicide)
38
what do to if a doctor cannot sign a death certificate indicating natural death?
Medico-legal investigation
39
What is done in a forensic medicolegal autopsy?
1. look for changes 2. describe them 3. name them 4. try to explain what and how they occurred
40
two types of autopsy?
Pathological for research or educational purpose Forensic decided by the state (body is evidence)
41
Types of identification (big groups)
Primary identification criteria Secondary Third ( assisting/additional)
42
Primary identification?
DNA Fingerprints Odontology
43
Secondary identification
Deformity Marks/birth marks Scars X-rays Personal effects and clothing Physic Ears Hair Tatoo Previous fractures Fingernails Moles Medical history like one kidney lack of organ (kidney, gb, testicle), adhesions
44
Third (assistent) identification
CCTV gait
45
Must be decided when dealing with skeletons
- is it actually **bones** - Human? -one or more bodies? - Sex (skull, pelvis: obturator foramen round in males, triangular in female) - Race (nasal opening) - Age (+/-5yrs adults) ( 0.5-2 yrs children) - Height - How long has person been dead? - can personal identity be discovered?
46
UV fluorescence on Bone cross section showes?
Yellow to blue color depending on time Blue in beginning - yellow after 20 years
47
what two types of sudden cardiac death do we classify?
primary secondary
48
Define primary sudden CV death
Natural healthy individual without any obvious external influence occurring within a short period of time (minutes to hours)
49
Define secondary sudden CV death
Coronary artery disease Hypertensive heart disease Aortic stenosis Senile myocardial degeneration myocarditis CMP (HCM, DCM, ARVCM) Long QT Brigade syndrome dissection aortic aneurism syphilitic aneurism ruptured berry aneurysm (circle of willis: subarachnoidal bleeding) cerebral haemorrhage, thrombosis , infraction, stroke)
50
what can cause sudden death due to resp failure?
Major cause of sudden death within respiratory organs is **vascular** P.E DVT Lobar pneumonia Asthma Massive hemoptysis (TB or tumor) PTX (spontaneous idiopathic, spontaneous of newborn) Primary pulmonary HTN Epiglottitis (bacterial, thermal, blunt)
51
GI causes of sudden death
Severe GI bleeding (gastric/dudenal ulcer, esophageal varices) Mesenteric thrombosis (rapid but NOT sudden) intestinal infarct (strangulated hernia, volvulus) Peritonitis (peptic ulcer, diverticulitis, tumor) Pancreatitis WaterFriderichsen Syn DM
52
define sudden infant death syndrome
SIDS unexpected death within first year with an unexplained cause
53
modifiable risks of SIDS
sleeping overheating cigarette smoking mild URTI lack of breastfeeding immunization
54
SIDS autopsy shows (in 70%)
* Intrathoracic petechia on pleura, epicardium and thymus * Inflamed laryngeal and tracheal mucosa * pulmonary edema ITS A DIAGNOSIS OF EXCLUSION These signs give rise to misapprehension that SIDS was caused by mechanical suffocation
55
Define child abuse?
Generic term that includes all forms resulting in harm to the child: Physical Emotional Sexual abuse Neglect Exploitation
56
what are the symptoms of shaken baby?
Subdural hematoma and retinal bleeding in a child younger then 2
57
Types of injuries?
Blunt force Sharp force Semi-sharp force
58
examples of blunt force injury
Contusion Abrasion Laceration Fractures
59
Examples of sharp force injury
Incision Stabbing/puncture
60
Examples of semi sharp force
Slash/chop Biting
61
What to include when describing a wound
LOCATION FIRST 1. Margins (Length/depth/width) 2. Corner 3. Edge/Wall 4. Base (bottom) 5. Surrounding area
62
color change of contusion
60 min-2 days red/blue 2-5d blue/purple 5-8d purple/green 8-10d green/yellow 10-14d brown
63
Factores to look at in deciding if it is self inflicted or an assault
Clothes Direction of harm Location of harm Depth Defense wounds Hesitation marks Weapon on site Suicide note
64
Hat brim line rule
Injury located above hat brim mostly due to attack Injury located on or below brim line (not face) mostly due to fall
65
cranial fracture types
Ring fracture Hinge fracture Facial skeleton: Le fort fracture I, II, III
66
what indicate anterior cranial fossa fracture
raccoon eyes, CSF from nose
67
What indicated middle cranial fracture
CSF and blood from ears
68
What indicated posterion cranial fracture?
Hematoma behind the ear CSF or blood in pharynx Salty taste
69
Epidural bleeding
Arterial Lense shape Fast progression
70
Subdural bleeding
Vein Cresent shape Slow progression
71
Natural cause of subarachnoid bleeding?
Berry aneurysm breaking Ventricular leaking due to stroke
72
which brain bleeding is always traumatic?
epidural
73
Gun shot entry wound skin?
Inverted skin
74
Gun shot exit wound skin?
Everted with splits
75
Gun entrance wound has?
small circular lack of tissue margin of soot gunpowder tattooing
76
Gun exit wound has
bigger then entry star shaped irregular
77
gun shot wound size vs distance
Contact has burned edges larger the longer away
78
Included in a rape kit
Paper bags for evidence collection Swabs (vaginal, anal, oral mucosa, thighs Urin collection for STD Blood collection Comb for hair Envelops for victim clothing's Nail pricks Documents and question sheets
79
Alebra equation determining body alcohol level?
Windmarks formula A=ct x p x r A= blood alhocol level + body weight x windmarks factor 0.7
80
4 types of road traffic injuries
Pedestrian Car occupants Motor cycle Pedal cycle
81
Level of injury classification in road traffic accidents
1. Impact by car 2. Impact by ground
82
Railway injury can occur by
mass disaster accidents suicide
83
two groups of aircraft fatalities
large passenger aircrafts small slow light aircrafts
84
main cause of death in larg plain crash
deaccelerating injuries multiple trauma fire in the aircraft
85
who is always investigated with autopsy and toxicology in a plaine crash?
the pilot
86
estimation of post mortem interval
* 30mins: NO lividity nor rigor mortis * 30min-3hrs: lividity and post mortem rigidity (face, jaw) * Lividity blanches until about 12hrs * Rigidty is established by 6 hrs, remains so for 36hrs * Lividity becomes fixed at 18hrs * >24hrs: rigidity diminishes, body become flaccid again from 36hrs onwards * green discoloration of skin on cecum after 3-4 days * marbling of venous system 1 week after death

Forensics (1 decks)

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