Forensics autopsy Flashcards

1
Q

what is hypostasis?

A

sedimentation and diffusion of red cells and plasma after death (pale at areas of support)

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2
Q

what is rigor mortis and what affects it?

A

linking of actin and myosin in absence of ATP

slower if cold, faster if warm

faster if physical exertion before death (less ATP available)

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3
Q

timing of death by temp and rigor (nb for spot assessment, not legal!)

A

warm + flaccid: <3 hrs

warm and stiff: 3-8 hrs

cold and stiff: 8-36 hrs

cold and flaccid: >36 hrs

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4
Q

types of decomposition (4)

A

putrefaction (discolouration, gas buildup, skin slippage etc)

mummification (dry decomp)

conversion to adipocere

maceration (in fetuses)

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5
Q

considerations in decomposition

A

insect activity

internal organs often better preserved than external suggests

slower decomp in water

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6
Q

cooling affected by…

A

initial body temp

body size

posture

clothing/covering

ambient temp/humidity

air movement

medium around body

hemorrhage

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7
Q

ways to identify a body

A

face

eye colour

skin colour

hair colour/structure

tattoos, scars

fingerprints

stature

sex

DNA (esp blood, spleen, muscle, bone marrow)

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8
Q

types of wounds

A

abrasion: superficial injury by blunt force or scraping
laceration: full thickness tearing injury by blunt force

incised wound: cut injury longer than deep

stab wound: cut injury deeper than long

bruise/contusion: extravascular blood under intact skin due to trauma

ecchymosis: extravascular blood under intact skin not due to trauma

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9
Q

common patterns of injury

A

tyre marks

fingers

tile pattern

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10
Q

laceration vs incision

A

laceration:

bruise and crush at edge

tissue strands across wound

no corresponding line in underlying tissue or overlying clothes

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11
Q

sudden death, think of…

A

cardiac

vascular (aortic or brain aneurysm, PE)

epilepsy

lungs (asthma, obstruction)

GI (haemorrhage, acute abdomen)

poison

suspicious

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12
Q

post-op death - categories to think of (4)

A

death from disease for which surgery perforemd

death due to other disease

death due to surgical technique

death due to anaesthetic (incl malignant hyperthermia)

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13
Q

approach to post-op death

A

clinical history and sequence of events essential!

ideally have surgeon or anesthetist present at autopsy

look for anaesthetic and surgical devices in situ (eg intubation)

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14
Q

Driver injuries in MVA

A

leg/knee against dash

leg# or hip dislocation against floor

abdo/chest against sterring wheel (look for internal injury)

face/head through windscreen

hyperflexion cervical spine (esp C5/6)

aortic rupture

impact on road/other cars

penetrating injury

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15
Q

pedestrian injuries in MVA

A

(acceleration rather than deceleration)

knees/shins against bumper

head/other injures against road/car

runover

identifying injuries (tyres, paint, glass)

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16
Q

MVA autopsy, think of… (2)

A

natural disease

toxicology (drugs and alcohol)

17
Q

considerations for drowning autopsy (5)

A

may have:

  1. drowned (why in? why didn’t get out?)
  2. died disease/injury and fell in water
  3. died disease/injury and thrown in water
  4. died of disease/injury while in water
  5. died of effects of immersion (eg vasovagal, larygnospasm)
18
Q

autopsy findings of drowning (nb: none are specific!)

A

history: scene info (tides, hazards etc), circumstance
external: plume, eardrum perf, tongue biting, injuries, immersion
internal: pleural effusion, hyperinflated lungs, subpleural haemorrhage

19
Q

types of asphyxia (= struggle to breathe against mechanical interference)

A
  1. suffocation: obstruction external orifices (look for defence marks)
  2. choking: obstruction of upper airways (usu food +/- neuro impaired)
  3. hanging: ligature using weight of body
  4. strangulation: constriction other than weight of body
  5. crush: external copression of chest (usu accidental)
  6. positional asphyxia: upside down, neck flexion etc
20
Q

autopsy findings choking

A

petechiae if retching

buccal mucosa damage

pulmonary oedema

21
Q

autopsy findings hanging

A

scene exam important

ligature: above thyroid prominence, pattern, deepest opposite point of suspension, investigate stratches

petechiae (not present if carotids completely occluded!)

22
Q

autopsy finding strangulation

A

ligature or manual: below thyroid prominence

prominent petechiae

neck dissection for bruising

hyoid and thyroid cartilage #

look for other injuries and sexual assault

23
Q

toxicology - antemortem considerations

A

dose and time

route

tolerance

?steady state (or increasing/decreasing)

24
Q

toxicology - postmortem considerations

A
  1. sampling site: central blood and urine (for screening), peripheral blood (for quantification), vitreous (esp heroin, alcohol)
  2. interval between death and sampling (bacteria and metabolism)
  3. sequestered compounds (can leach out of fat/organs even though none in blood antemortem)
  4. vitreous for beta-hydroxybutyrate (eg alc ketoacidosis)
25
Q

medical conditions affecting or affected by toxicology (5)

A

heart disease: illicit drugs lower arrythmia threshold

renal disease: excretion rates

liver disease: less drug binding protein

lung disease: susceptible to CNS depressant and alcohol

CNS: susceptible to seizures

26
Q

Systemic findings - alcoholism

A

CNS: Wernickes, executive function, respiratory centre

dilated cardiomyopathy

liver: hepatitis, cirrhosis, fatty liver

pancreatitis

GI: gastritis, varices, ulcers

fetal alcohol syndrome

cancer (vis aldehydes)

27
Q

Systemic findings - hypertension

A

renal failure/nephrosclerosis

hypertensive cardiomyopathy (hypertrophy)

atherosclerosis

dissection

cerebral haemorrhage (CVA or dementia)

28
Q

Systemic findings - diabetes

A

macrovascular disease:

atherosclerosis (via endothelial dysfunction) - MI and stroke

gangrene lower extemities

hyaline arteriosclerosis

microvascular disease:

nephropathy (glomerular, atherosclerosis and pyelonephritis)

retinopathy

neuropathy

also: infections (pneumonia, skin, kidney), ketoacidosis (check vitreous)