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Forensics > Forensic medicine > Flashcards

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
Q

what age s mummification common?

A

infants because they are sterile

may dry up before bacterial action occurs

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26
Q

Describe mummification appearance?

A

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

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27
Q

define adipocere

A

grayish greasy grave wax formation of fat(hydrolysis), most commonly in water

depends on surrounding temp, depth, presence of water currents

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28
Q

normal timing of adipocere

A

1-2 months after death

for transformation of :
-muscles at least 6 months of decay required
-soft tissue within 2 years

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29
Q

Define skeletonization

A
  • 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
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30
Q

the 3 times of death?

A

Physiological: when vital organs cease function

Estimated : best guess

Legal: time at which body was discovered or physically pronounced dead by another individual

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31
Q

3 ways of estimating TOD

A

looking
Touching
Measuring

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32
Q

time of first sign of decomposition?
what signs?

decomposition on land, water, buried

A

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

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33
Q

temperature and timing indicating PM

A

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

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34
Q

how does rigor mortis progress

A

starts in small muscles
startes 0,5-3h PM
decays after 36h

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35
Q

when will you feel a body as cold when touching?

A

when it’s more then 5C less then your own temperature

36
Q

what needs to be decided in a PM investigation?

A
  1. dead or not
  2. Manner of death
  3. Cause of death
37
Q

Manner of death?

A

Natural
Violent (Accident, suicide, homicide)

38
Q

what do to if a doctor cannot sign a death certificate indicating natural death?

A

Medico-legal investigation

39
Q

What is done in a forensic medicolegal autopsy?

A
  1. look for changes
  2. describe them
  3. name them
  4. try to explain what and how they occurred
40
Q

two types of autopsy?

A

Pathological for research or educational purpose
Forensic decided by the state (body is evidence)

41
Q

Types of identification (big groups)

A

Primary identification criteria
Secondary
Third ( assisting/additional)

42
Q

Primary identification?

A

DNA
Fingerprints
Odontology

43
Q

Secondary identification

A

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
Q

Third (assistent) identification

A

CCTV gait

45
Q

Must be decided when dealing with skeletons

A
  • 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
Q

UV fluorescence on Bone cross section showes?

A

Yellow to blue color depending on time
Blue in beginning - yellow after 20 years

47
Q

what two types of sudden cardiac death do we classify?

A

primary
secondary

48
Q

Define primary sudden CV death

A

Natural healthy individual without any obvious external influence occurring within a short period of time (minutes to hours)

49
Q

Define secondary sudden CV death

A

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
Q

what can cause sudden death due to resp failure?

A

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
Q

GI causes of sudden death

A

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
Q

define sudden infant death syndrome

A

SIDS unexpected death within first year with an unexplained cause

53
Q

modifiable risks of SIDS

A

sleeping
overheating
cigarette smoking
mild URTI
lack of breastfeeding
immunization

54
Q

SIDS autopsy shows (in 70%)

A
  • 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
Q

Define child abuse?

A

Generic term that includes all forms resulting in harm to the child:
Physical
Emotional
Sexual abuse
Neglect
Exploitation

56
Q

what are the symptoms of shaken baby?

A

Subdural hematoma and retinal bleeding in a child younger then 2

57
Q

Types of injuries?

A

Blunt force
Sharp force
Semi-sharp force

58
Q

examples of blunt force injury

A

Contusion
Abrasion
Laceration
Fractures

59
Q

Examples of sharp force injury

A

Incision
Stabbing/puncture

60
Q

Examples of semi sharp force

A

Slash/chop
Biting

61
Q

What to include when describing a wound

A

LOCATION FIRST
1. Margins (Length/depth/width)
2. Corner
3. Edge/Wall
4. Base (bottom)
5. Surrounding area

62
Q

color change of contusion

A

60 min-2 days red/blue
2-5d blue/purple
5-8d purple/green
8-10d green/yellow
10-14d brown

63
Q

Factores to look at in deciding if it is self inflicted or an assault

A

Clothes
Direction of harm
Location of harm
Depth
Defense wounds
Hesitation marks
Weapon on site
Suicide note

64
Q

Hat brim line rule

A

Injury located above hat brim mostly due to attack
Injury located on or below brim line (not face) mostly due to fall

65
Q

cranial fracture types

A

Ring fracture
Hinge fracture
Facial skeleton: Le fort fracture I, II, III

66
Q

what indicate anterior cranial fossa fracture

A

raccoon eyes, CSF from nose

67
Q

What indicated middle cranial fracture

A

CSF and blood from ears

68
Q

What indicated posterion cranial fracture?

A

Hematoma behind the ear
CSF or blood in pharynx
Salty taste

69
Q

Epidural bleeding

A

Arterial
Lense shape
Fast progression

70
Q

Subdural bleeding

A

Vein
Cresent shape
Slow progression

71
Q

Natural cause of subarachnoid bleeding?

A

Berry aneurysm breaking
Ventricular leaking due to stroke

72
Q

which brain bleeding is always traumatic?

A

epidural

73
Q

Gun shot entry wound skin?

A

Inverted skin

74
Q

Gun shot exit wound skin?

A

Everted with splits

75
Q

Gun entrance wound has?

A

small
circular
lack of tissue
margin of soot
gunpowder tattooing

76
Q

Gun exit wound has

A

bigger then entry
star shaped
irregular

77
Q

gun shot wound size vs distance

A

Contact has burned edges
larger the longer away

78
Q

Included in a rape kit

A

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
Q

Alebra equation determining body alcohol level?

A

Windmarks formula
A=ct x p x r
A= blood alhocol level + body weight x windmarks factor 0.7

80
Q

4 types of road traffic injuries

A

Pedestrian
Car occupants
Motor cycle
Pedal cycle

81
Q

Level of injury classification in road traffic accidents

A
  1. Impact by car
  2. Impact by ground
82
Q

Railway injury can occur by

A

mass disaster
accidents
suicide

83
Q

two groups of aircraft fatalities

A

large passenger aircrafts
small slow light aircrafts

84
Q

main cause of death in larg plain crash

A

deaccelerating injuries
multiple trauma
fire in the aircraft

85
Q

who is always investigated with autopsy and toxicology in a plaine crash?

A

the pilot

86
Q

estimation of post mortem interval

A
  • 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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