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Forensic Pathology Boards > Forensic Pathology 2 > Flashcards

Forensic Pathology 2 Flashcards

1
Q

What does inductively coupled plasma-mass spectrometry measure in forensics?

A

Trace elements, ie selenium

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2
Q

What is gas chromatography primarily used for in forensics?

A

Low molecular weight volatiles ie ethanol

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3
Q

By which lab instrument is sodium, potassium and lithium measured?

A

Na and K: ion-selective electrode
Li: colorimetric methods
(Used to be flame photometry)

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4
Q

What does ELISA measure for in forensic lab?

A

Antibodies or antigens ie HIV testing

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5
Q

What is scanning electron microscopy/energy dispersive xray spectrometry used for?

A

Gunshot residue on clothing/skin

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6
Q

How is probability of paternity calculated? What is minimum probability of paternity?

A

1-(1/combined paternity index) x 100%

Minimum: 99% (99.5% in immigration cases)

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7
Q

What would a) osteogenesis imperfecta and b) rickets look like on X-ray?

A

A) fractures of multiple bones
B) rosary beads (widening/prominences at costochondral junctions)

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8
Q

What natural diseases besides sepsis/clotting issues are abdominal ecchymoses associated with?

A

Pancreatitis, neuroblastoma

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9
Q

What is a) beta-APP and b) p-tau protein seen in?

A

A) diffuse Axonal injury
B) CTE

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10
Q

Calcification of vessels in basal ganglia is the cause of what?

A

Past trauma (which makes it susceptible to more future trauma)

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11
Q

In subdural hemorrhage, when do you start to see a) granulation tissue including fibroblasts & endothelial cells, b) hemosiderin in macrophages

A

A) 1 week
B) ~few days with Prussian blue

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12
Q

In subdural hemorrhage, when do you start to see a) capillary dilation with perivascular neutrophils, b) true inner (leptomeningeal side) membrane, c) both outer (dural side) and inner membrane with connective tissue & hemosiderin?

A

a) <24 hrs
B) 2-4 weeks
C) 1-3 months

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13
Q

a) Fracture of proximal humerus with epiphyseal separation and b) epiphyseal separation fractures of distal humerus are common with what situations?

A

a) child abuse with severe trauma,
b) pulling or twisting of arm (can also be abuse)

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14
Q

What does laceration of labial frenula indicate?

A

Blunt trauma to face

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15
Q

When can you see retinal hemorrhages in non-traumatic cases?

A

sepsis, coagulopathy, vacuum-assisted and SVD (but disappear by 1 month)

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16
Q

What is specific within the eye for inflicted head injury?

A

1: traumatic retinoschisis (tearing of the retina away from its attachments),

#2(not as specific): optic nerve hemorrhage

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17
Q

Microscopically in rib fracture healing, when does a) new cartilage and bone start to form, and b) bony union (callus) start to form?

A

a) 1 week,
b) 3-6 weeks

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18
Q

Where specifically do inflicted injury posterior rib fractures most commonly occur?

A

costotransverse process articulation (neck, not head, of rib articulation with spine)

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19
Q

What bony injuries are associated with shaking of small child?

A

metaphyseal fractures of tibiae, distal femora, and proximal humeri; outer ends of clavicles also suggestive of non-accidental injury

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20
Q

What does fractured bone look like histologically?

A

“infarcted” appearance: pale staining /dead osteocytes and poorly staining amorphous marrow elements

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21
Q

What type of osteogenesis imperfecta can be confused with pediatric trauma and what are the characteristics?

A

type IV: osteoporosis, thin cortices, bowing of extremities, wormian bones in skull, multiple rib fractures (NO blue sclerae (that’s type 1))
- all types have type 1 collagen abnormalities

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22
Q

Besides middle meningeal artery, what can epidural hemorrhage be caused by?

A

1) tear in dural sinus i.e. superior sagittal sinus/transverse sinus (–>hemorrhage in posterior crainial fossa),
2) middle meningeal vein

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22
Q

What head injury is associated with hyperextension injury of the neck?

A

hinge fracture (blow to chin or forehead causes hyperextension of neck)

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22
Q

Difference between epidural and subdural surfaces histologically

A

Will see thick-walled middle meningeal arteries on epidural side; will see “roughed up”/torn appearance on epidural side (from evisceration)

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23
Q

What two situations commonly result in ring fractures?

A

Head impacted from above (forces base of skull down onto spinal column) or descending from height onto feet/buttocks (spinal cord thrust upward onto base of skull)

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24
Q

Besides bridging veins, what can subdural hemorrhage be caused by?

A

1) dural sinus
2) cerebral cortical arteries/veins

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25
Q

What cerebral injuries involve a) gyri vs b) sulci?

A

a) cerebral contusions,
b) hypoxic-ischemic lesions and cerebral infarcts

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26
Q

What distinguishes amyloid angiopathy-related intracerebral hemorrhage?

A

Multiple, in older people, parieto-occipital distribution

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27
Q

Does coup contusion have overlying skull fracture?

A

NO; if it did it would be called “fracture contusion” instead

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28
Q

What are a) intermediary coup? b) Gliding contusions?

A

a) deep in brain parenchyma (“in middle” of coup and contrecoup)
b) curvilinear contusions of parasaggital white matter of frontal lobes

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29
Q

What distinguishes remote cerebral contusion from remote cerebral infarct?

A

Contusions have disrupted cortical surface, infarct does not & is wedge-shaped (vascular distribution)

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30
Q

What is anhydroecgonidine specific for?

A

Metabolite for crack cocaine

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31
Q

What is dronabinol’s active ingredient?

A

Delta-9-THC
(So it’s a synthetic cannabinoid BUT an innocuous one)

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32
Q

What fatal chemical compound is in a) household cleaners, b) pesticides?

A

A) HCl and sulfur —> H2S aka hydrogen sulfide —> thiosulfate
B) AChE inhibitors

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33
Q

How quickly does ethanol metabolize?

A

15 mg/dL per hour

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34
Q

What are the gross findings fairly specific to diffuse traumatic brain injury (often with MVAs)?

A

Hemorrhages in the deep long white matter tracts, usually corpus callosum, internal capsules, and superior cerebellar peduncles,
+/- gliding contusions and intermediary coup contusions, +/-
“diffuse vascular injury” (petechiae in white matter of frontal lobe)

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35
Q

What are the microscopic findings of diffuse traumatic brain injury and how much survival time is needed to show it?

A

dystrophic axons: bulbous, eosinophilic axonal swellings, eventually beaded; >18-24 hrs;
however, b-APP highlights dystrophic axons by 2-3 hrs

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36
Q

How to tell histologically the difference between axonal injury from ischemia and traumatic axonal injury?

A

ischemia: the injury will have wacy/linear/zigzag distribution on high power
traumatic: will be more scattered/along long axis of axon

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37
Q

What is the histologic difference between red neurons (ischemia) and dark neurons (post-mortem artifact?

A

dark neurons has densely staining but less “red”, have wavy/corkscrew dendrites (tails of neurons)k, and have interspersing normal-appearing neurons

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38
Q

What are Duret hemorrhages caused by?

A

cerebral ischemia from increased ICP causing herniations –> reperfusion, aka “secondary brainstem hemorrhages”

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39
Q

What is the difference between respirator brain and persistent vegetative state?

A

There IS perfusion of the brain in persistent vegetative state, so reactive processes can occur; there is NOT perfusion of brain in respirator brain so it is bascially autolyzing and softening

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40
Q

What is Wallerian degeneration?

A

chronic changes after spinal cord injury making post-injury areas shrink & look grey (demyelinated)

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41
Q

What toxicology tissue sample is best for testing for a) TCAs, b) volatiles, c)heavy metals?

A

a) liver,
b) lung, adipose tissue
c) kidney, fingernails/toenails/hair

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42
Q

What is the best toxicology tissue specimen to get in embalmed bodies?

A

skeletal muscle from BUTTOCK

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43
Q

With what sample should toxicology of GHB be measured and why?

A

urine - because GHB is produced de novo by the body in blood but not bladder

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44
Q

What is normeperidine and its significance?

A

metabolite of meperidine (u-receptor agonist, opioid) – is more toxic than its parent drug so it can contribute to death to see high levels of the metabolite

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45
Q

What specific tissue can be studied in dopamine dysfunction conditions (i.e. excited delirium from cocaine)?

A

fresh brain–> frozen, look at substantia nigra and corpus striatum to include nucleus accumbens

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46
Q

Besides fetal squamous epithelial cells, what can you see in pulmonary arteries of the mother in amniotic fluid embolism?

A

lanugo, meconium, mucin from fetus’s intestinal tract

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47
Q

What is the most common immediate COD of eclampsia? pre-eclampsia in HELLP?

A

E: intracerebral hemorrhage,
HELLP: ruptured subcapsular hematoma of liver

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48
Q

maternal deficiency of long chain 3-OH-CoA dehydrogenase, think what?

A

acute fatty liver of pregnancy (centrilobular microvesicular steatosis, cholestasis, necrosis)

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49
Q

If placental abruption occurs a) minutes to hours vs. b) days after a maternal trauma, what are the most likely causes?

A

a) the trauma itself / b) maternal HTN, cigarette smoking, cocaine abuse

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50
Q

What kind of skull fracture in delivery of a fetus is most severe, and what is it associated with?

A

Separation (diastasis) of temporal and occipital bones at lambdoid suture – breech presentation with neck hyperextension

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51
Q

Where is birth-related SDH vs child abuse SDH located in head?

A

birth-related: posterior fossa/infratentorial
abuse: supratentorial

52
Q

What is the a) unknown persons database, and b) main DNA databank for ID?

A

a) National Crime Information Center (NCIC),
b) Combined DNA Index System (CODIS)

53
Q

Osteology: prominent nasal projection, pinched appearance of nose(anterior), prominent nasal sill (inferior), flat facial profile, V-shaped palatal arcade, Carabelli’s cusp on maxillary molar, inion hook on occipital protuberance: what race?

A

White

54
Q

Osteology: Flat facial profile, sloped and flat nasal root, broadly spaced orbits, Prominent zygomatic bones that project laterally and have supernumerary sutures, half-circle/elliptical palatal arcade, shovel-shaped incisors, wormian ossicles- what race?

A

Asian

55
Q

Osteology: flat and wide nasal region with nasal gutter, prognathism, rectangular palatal arcade, simple/straight cranial sutures, post-bregmatic (at union of coronal and Sagittal sutures) depression: what race?

A

Black

56
Q

Osteology: What are the 3 most important feature of the innominate for determining sex?

A
  1. Greater sciatic notch (thumb test)
  2. Suprapubic angle (hand at right angle, if thumb easily touches ischial ramus it’s female)
  3. Width ratio of pubis to ischial ramus (F 2:1, M 1:1)
57
Q

Osteology: what feature is associated in the innominate with previous childbirth?

A

Marked dorsal pitting

58
Q

Osteology: what are 3 differing skull features of male vs females?

A
  1. Males with wider and longer projections of their mastoid processes
  2. Female frontal bone with one central prominence, males with two
  3. Supraorbital tori/prominence in males
59
Q

Osteology: What is the most reliable bony age indicator for a) adults, b) kids?

A

A) pubic symphysis (Todd stage 1-poodle/ stage 5/6 fried chicken leg to boulder / stage 10 flattened beetle)

B) long bones

60
Q

Osteology: what is the first epiphysis to close in child long bone remains?

A

Greater tubercle of humerus (2-4 years)

61
Q

What are the first primary (deciduous) teeth to erupt and at what age? what age do the final (second molar) primary/deciduous teeth erupt?

A

1) Mandibular central incisors, 6 months
2) maxillary second molars at 24 months

62
Q

What are X-ray and autopsy findings of inhalational anthrax?

A

X-ray: widened mediastinum, pleural effusions
Autopsy: serosanguinous pleural effusions, hemorrhagic/necrotic mediastinal LNs, hemorrhagic meningitis

63
Q

What are the autopsy findings of pneumonic vs bubonic plague, and what is the organism?

A

Yersinia pestis (gram -)
Pneumonic: pneumonia, resp failure, extensive ecchymoses/DIC
Bubonic: skin pustules, hemorrhagic LNs

64
Q

What are general findings in viral hemorrhagic fever, and what is a main finding in yellow fever that differentiates it?

A

Diffuse petechiae/ecchymoses, necrosis of liver/lymph nodes with viral inclusions, DAD

Yellow fever: MIDZONAL hepatic necrosis

65
Q

What are the organism/characteristics for Tularemia and autopsy findings?

A

Francisella, nonmotile gram (-) coccobacillus

Necrotizing granulomatous lymphadenitis, typhoidal type has systemic organ necrosis

66
Q

What is the mechanism of action of nerve agents (tabun, sarin, soman, VX) and what is their antidote?

A

Acetylcholinesterase inhibition (cholinergic symptoms)

Treatment: atropine, pralidoxime, diazepam

67
Q

What does Lewisite chemical agent smell like, what does it cause, and what is the antidote?

A

Fruity odor, causes tissue necrosis and increased capillary permeability leading to shock
Treatment: BAL dimercaprol

68
Q

Allele duplication of a) CYP2D6 and b) CYP3A causes toxicity via metabolizing which drug?

A

A) codeine (increased metabolism to morphine)
B) benzos

69
Q

In the vaginal canal, long do you see a) motile sperm with tails (and what IHC can you use), b) non-motile sperm with tails, b) sperm heads only?

A

A) <12 hours, acid phosphatase and p30
B) 18-24 hrs
C) 1-5 days

70
Q

What two things should you think about with rigidity of the body including face / spasmodic contractions of the body?

A

Tetanus or strychnine poisoning

71
Q

What is seen with measles vs rabies encephalitis?

A

Measles: eosinophilic Nuclear inclusions (N M; Warthin-Finkeldey bodies)
Rabies: neurons and glial cells with CYTOPLASMIC eosinophilic inclusions(negri bodies)

72
Q

What is a) perivascular lymphocytic cuffing and b) perivascular giant cells seen in within CNS?

A

A) viral encephalitis, acute poliomyelitis, MS (also w plasma cells)
B) AIDS (in white matter), fungal infections

73
Q

Where in the brain does a) toxoplasma and b) herpes encephalitis typically infect and cause cystic degeneration/necrosis?

A

A) lateral ventricles
B) temporal lobes

74
Q

What, besides hypocoagulative states, can cause petechial hemorrhages of the brain?

A

Fat embolism, diffuse brain injury, hypertensive encephalopathy, cerebral malaria

75
Q

Histologically, what areas of the brain do you see hypoxia (necrosis) in?

A

Neocortex (layers 3,5,6) in sulci>gyri,
Hippocampus Ca1&4, purjinke cells of cerebellum

76
Q

Where do you see bilateral hemorrhagic necrosis of a) globus pallidus+/- basal ganglia, b) putamen?

A

A) carbon monoxide poisoning (carbon=earth=globe) (can also be seen with heroin, barbs, insulin OD)
B) methanol intoxication

77
Q

Multiple Yellow-brown (acute) or grey-brown (chronic) lesions in white matter around lateral ventricles and third ventricles: what disease?

A

Multiple sclerosis (areas of demyelination)

78
Q

What do you see grossly and histologically in Parkinsons?

A

Grossly: depigmentation of substantia nigra and locus ceruleus of pons
Histo: neuronal loss with depigmentation, Neuromelanin within macrophages, LEWY BODIES within cytoplasm of residual neurons (ubiquitin+)

79
Q

What 3 findings are seen with Zellweger’s syndrome?

A

Peroxisomal disorder with:
Hepatic cirrhosis, grey matter heterotopias, and polymicrogyria

80
Q

What gross and histological findings are seen with Leigh’s disease?

A

Mitochondrial disorder with Symmetrical discolored lesions in basal ganglia

Demyelination, macrophage infiltration, vascular proliferation

81
Q

What CNS changes do you see in a) Wernicke’s encephalopathy, b) vitamin B12 deficiency?

A

A) aka thiamine (but B1) deficiency: lesions in mamillary bodies, hypothalamus: hemorrhagic if acute and demyelinated if chronic

B) demyelinization (pallor) and lipid laden macrophages in lateral corticospinal tracts and dorsal columns

82
Q

What are the CNS gross abnormalities in Huntington disease?

A

Cell loss in basal ganglia, especially caudate nucleus + enlarged ventricles

83
Q

Where are CNS tumors a) germinoma and b) Schwannoma most commonly located?

A

A) pineal gland
B) cerebellopontine angle (vestibular branch of CN VIII)

84
Q

LEGAL: what is the a) Joiner standard and b) Khumo standard?

A

a) experts must limit their opinions to straight-forward extensions of the data and have limitations on what they say,
b) that all expert testimony must meet the Daubert standard

85
Q

What is the difference between telangiectasia and cavernous angioma?

A

Telangiectasia: mult vascular channels with normal tissue (i.e. brain) in between;
Cavernous angioma: thin-walled vascular channels withOUT intervening tissue

86
Q

What is Armanni-Ebstein lesion?

A

subnuclear vacuolization of renal tubules seen in hyperglycemia, hypothermia

87
Q

What is the BMI equation?

A

BMI = mass / height^2
mass in kg, height in meters

88
Q

What are the 3 metabolites diazepam gets metabolized to?

A

1) nordiazepam -> oxazepam (all other benzos have this one to)
2) temazepam -> oxazepam

89
Q

What is laminar necrosis?

A

Separation of the cortical ribbon from underlying white matter, seen in ischemia, hypoxia, sometimes hypoglycemia

90
Q

What does a) cerebral Aspergillosis look like grossly? b) cerebral Mucor?

A

Aspergillosis: Multifocal hemorrhagic abscesses (b/c hyphae of the fungus thrombose the vessel walls)
Mucor: hemorragic lesion/abescess in inferior frontal lobe (bc Mucor invades through cribriform plate)

91
Q

Picks dementia - what does brain look like grossly and what is seen microscopically?

A

cerebral atrophy with preservation of the occipital lobes (frontotemporal dementia)

Pick bodies: rounded vague/matte cytoplasmic inclusions (as opposed to shiny ones of Parkinson’s)

92
Q

ALS: what are the gross findings?

A

Atrophy of the anterior (motor, ventral) sensory roots as compared to dorsal
whiteness/demyelination of the lateral corticospinal (pyramidal) tracts

93
Q

What drugs, when administered intrathecally, cause atrophy of the spinal cord and precipitated tubulin (pink crystal) histologically?

A

colchicine for spondylitis, vincristine for leukemia

94
Q

What lesion do you see grossly in central pontine myelinolysis?

A

dark brown lesion in central mid-pons

95
Q

What is Grinker myelinopathy and where is it seen?

A

multifocal perivenous hemorrhage and necrosis in brain and cerebellum;
with carbon monoxide intoxication

96
Q

What is Alexander’s disease and what does it look like grossly & histologically?

A

GFAP-mutation disease of ASTROCYTES wherein they accumulate GFAP,
massive destruction of the white matter with preservation of overlying cortex & basal ganglia. ++ Rosenthal fibers

97
Q

Where in the brain are arachnoid cysts most commonly seen?

A

Syvian fissure (lateral temporal lobe area)

98
Q

What is hydranencephaly?

A

near absence of the cerebral hemispheres due to an intrauterine insult; brain is mostly a fluid-filled sac (“empty basket”)

99
Q

What is seen histologically with rabies encephalitis?

A

Negri bodies (pink-purple intracytoplasmic inclusions), LACK of inflammation

100
Q

What do each of the red, yellow, blue, and white boxes on the hazard diamond mean?

A

red: fire hazard (flash point temperature)
yellow: reactivity (denoate/chemical change/stability)
blue: health hazard
white: specific (acid, oxidizer, corrosive, radioactive, etc)

101
Q

What do stress gastritis vs Curling ulcers look like grossly?

A

stress gastritis: red diffuse to streaky petechiae
Curling ulcers: ulcers in proximal duodenum with burns

102
Q

What does the skull look like (and what is the terminology) in Crouzen, Saethre-Chotzen, Apert, Pfeffier, and Muenke syndromes?

A

craniosynostosis (premature fusion of the skull in an infant): scalloped ridges on the internal surface of the skull from compression of gyri, increased ICP

103
Q

Black pigmentation of the colon(melanosis coli) is seen with what?

A

laxative abuse

104
Q

Tetracycline antibiotics causes what histologically in the thyroid?

A

deposition of LIGHT BROWN pigment in follicles/ light brown colloid (it only looks black grossly)

105
Q

Adipocere is caused by what bacterial species?

A

Clostridium

106
Q

What will a) Foster slug vs b) Glaser slug look like on xray?

A

a) doughnut-like single fragment, OR multiple comma-shaped fragments
b) multiple pellets

107
Q

Splenic gamna-gandy bodies are seen histologically in what conditions?

A

1 cause = portal HTN 2/2 cirrhosis

also in sickle cell anemia, hemochromatosis

108
Q

What is the voltage cutoff for high vs low voltage electrocution?

A

1000 volts

109
Q

How many layers of fibroblasts are present in a subdural hemorrhage at a) 5 days, b) 1 week, c) 2 weeks?

A

a) 5 cells thick on dural side
b) ~14 cells thick (2x the amount of days) on dural side
c) 1/2 dural thickness on dural side, PLUS earliest neomembrane on the arachnoid side

110
Q

What is the smell and where are the following gases commonly encountered:
a) phosgene (COCl2),
b) phosphine (PH3)

A

A) odor of fresh hay/grass, with building fires with refrigeration units
B) order of garlic/decaying fish; with farms

111
Q

What is pediculosis corporis?

A

Body lice

112
Q

How many inches diameter is a a) 10 gauge, b) 16 gauge, and c) 28 gauge bore, and how would this be converted to centimetres if they show a metric ruler?

A

A) 0.775”
B) 0.662”
C) 0.550”

1 inch = 2.54 centimeters

113
Q

What is Fahr’s disease?

A

Bilateral familial idiopathic basal ganglia calcification, with psych/neuro symptoms ie Parkinsonism

114
Q

Which 0.22 projectile has a copper jacket?

A

0.22 Magnum

115
Q

What is scromboid poisoning from?

A

Fish contaminated with high levels of histamines

116
Q

What compound is vaping lung injury due to?

A

Vitamin E

117
Q

What are the ranges for mild, moderate, and severe hypothermia?

A

A) mild: 32 to 35 C
B) mod: 28 to 32 C
C) severe: <28 C

118
Q

What is Ludwig’s angina?

A

Bacterial infection / cellulitis of roof of mouth and neck, often from dental caries

119
Q

What is grade 1, 2, and 3 diffuse axonal injury?

A

Grade 1: microscopic damage to axons without gross hemorrhage
Grade 2: micro damage to axons + corpus callosum hemorrhage
Grade 3: micro damage to axons + dorsal brainstem hemorrhage (/internal capsules, cerebellar peduncles)

120
Q

What is the gross difference between primary traumatic brain stem hemorrhage and secondary (Duret) hemorrhage?

A

Primary: usually in posterior aspect of brain stem
Secondary: usually streaky and midline

121
Q

What is seen microscopically with cerebral infarcts at:
1) 1-2 days after
2) ~5 days after
3) 1 week after
4) 1 month after

A

1) eosinophilic neuronal degeneration, early neutrophils
2) early macrophages and neovascularization
3) the above plus reactive astrocytes
4) decrease in cellular elements

122
Q

What is the most common intracranial hemorrhage in neonates and what complication can it lead to?

A

Intraventricular hemorrhage, leading to hydrocephalus and polygyria(pseudopolymicrogyria: normal Histologically, unlike the malformation polymicrogyria)

123
Q

How to distinguish Histologically between a pons infarction and central pontine myelinolysis?

A

Both will have loss of tissue (pale d/t demyelination) with macrophages, but CPM will have preservation of axons and neurons

124
Q

What are the gross characteristics of the brain in Down syndrome?

A

Narrow superior temporal gurus, flattened occipital, shortened frontal lobes

125
Q

What kind of force causes an oblique fracture of the bone? What is an abulsion fracture?

A

Torsion (just like spiral)

Avulsion: fracture in area where muscles/tendons attach (epi/metaphysis)

126
Q

What metabolite of cocaine is physiologically active?

A

Norcocaine

127
Q

What does the a) modified Griess test,
B) sodium rhodizonate test,
C) dithiooxamide test detect?

A

A) nitrite compounds produced by burning of smokeless powder to figure out range of fire
B) lead residue around entrance wound
C) copper residue around entrance

128
Q

What mutation is associated with Lowe-Dietz syndrome and what COD does it predispose to?

A

TGF-beta mutation
Connective tissue disorder that predisposes to aortic dissection

129
Q

What does the M-14, M-16, and AR15A2 have in common and what is difference?

A

All can have flash suppressors

M14: 5 slits
M16: 3 slits
AR15A2: 3 slits

130
Q

How to differentiate the following birefringent crystals found in IVDA:
A) talc
B) potato and corn starch
B) microcrystalline cellulose

A

A) needle shaped, PAS NEGATIVE
B) Maltese cross, PAS positive
B) elongated rod, PAS positive

Forensic Pathology Boards (2 decks)

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