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Path Week 2 > Hi - Post-Mortem > Flashcards

Hi - Post-Mortem Flashcards

1
Q

describe the practical steps of a post mortem

A
  1. external examination
  2. incision from adams apple to pelvis
  3. remove ribs
  4. dissect out lungs and heart together
  5. dissect out bowel
  6. dissect out liver, stomach, pancreas, spleen
  7. dissect out kidneys, internal genitalia, ureters
  8. inspect bones for fractures, tumours
  9. assess each organ one by one
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2
Q

how can the length of time from death to post mortem affect the body

A

decomposition, decolouration, rigor mortis, temp/humidity changes, maggots, liquifactor necrosis of brain

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3
Q

why do previous heart surgeries make post mortem difficult

A

adhesions / fibrosis

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4
Q

how would pericarditis be seen in post mortem

A

adhesions

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5
Q

what is being observed in the heart at PM

A

muscle damage
valves
artery grafts
patent vessels inc coronaries
ventricles / lumen
size - hypertrophy

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6
Q

what % of body weight should the heart be in M and Fs

A

0.4% M
0.35% F

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7
Q

describe the processes that occur to the heart due to HF

A

hypertrophy
dilatation and thinning
baggy heart
end stage

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8
Q

what does a pale heart represent

A

ischaemia

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9
Q

what does a nutmeg liver indicated

A

back pressure on liver due to RHF

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10
Q

major cause of RHF

A

LHF

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11
Q

describe the steps in post MI rupture

A

MI –> fibrosis –> digestion of myocardium –> rupture

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12
Q

when would a post MI rupture happen

A

5 days post MI

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13
Q

causes of valve vegetations

A

infective endocarditis –> IVDU / dental
GI polyps
rheumatic fever

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14
Q

what is rheumatic fever

A

cross reactivity with strep sore throat

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15
Q

what valve is affected in rheumatic fever

A

mitral

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16
Q

how does a post mortem blood clot differ from an ante mortem blood clot at PM

A

PM = gelatinous
AM = vessel shape, solid, red to grey stripey colour change, valve impressions

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17
Q

what is the cause of black pigment commonly seen in the lungs

A

soot from industrialisation

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18
Q

what does frothy / bubbly fluid in lungs represent

A

pulmonary oedema

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19
Q

what is being observed in the lungs

A

parenchyma - tumours, pus, fluid
hilar - size
pleura - smooth/inflammed
airways
BVs - clots

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20
Q

thick, white, fibrotic outer covering of the lung. dx?

A

mesothelioma

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21
Q

what is the lag period of exposure in mesothelioma

A

20 years

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22
Q

what is mesothelioma

A

malignancy of pleura due to asbestos

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23
Q

what does a tumour look like at PM

A

white / creamy and invasive. like stilton

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24
Q

where does lung cancer met to

A

liver, brain, bone

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25
Q

what colour is a normal lung at PM

A

grey

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26
Q

what does a white lung at PM indicate

A

pneumonia

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27
Q

what do lung mets look like at PM

A

large white/brown circles
MANY of them

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28
Q

lumps of consolidation seen in lung at PM. Dx?

A

bronchopneumonia

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29
Q

little white dots all over lung at PM. Dx?

A

miliary TB

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30
Q

who gets miliary TB

A

homeless / IVDU
pre TB Tx

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31
Q

what does miliary TB look like

A

disseminated carcinoma

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32
Q

where is the appendix

A

end of the caecum

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33
Q

what does foecal peritonitis indicate on PM

A

perforation of bowel

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34
Q

what are outpouchings of the bowel mucosa called

A

diverticuli

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35
Q

what pathology can happen at stomach sphincter

A

H pylori
peptic ulcers

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36
Q

what 2 common pancreatic pathologies can and can’t be visualised at PM

A

cancer CAN
DM CAN’T - microscopic

37
Q

what does a cut spleen look like

A

meaty

38
Q

what does white dots on spleen indicate

A

infarction

39
Q

what causes an enlarged spleen

A

malaria
leukaemia

40
Q

what causes a small spleen & why

A

sickle cell - autoinfarcts

41
Q

what is looked at in the gall bladder

A

stones ?
bright green bile present ?
blockages ?

41
Q

what is looked at in the gall bladder

A

stones ?
bright green bile present ?
blockages ?

42
Q

white balls all through liver. Dx?

A

mets

43
Q

what would primary cancer look like in the liver

A

cirrhotic liver
single nodule

44
Q

florid fluffy area in colon. dx?

A

adenocarcinoma

45
Q

where does bowel Ca metastasise to

A

liver / lung

46
Q

what can cause a hole in the stomach

A

H Pylori
ulcer - if in peptic area
malignant - if elsewhere

47
Q

where do cancers met to commonly

A

liver
lung
brain
bone

48
Q

which 2 cancers commonly met to bone

A

breast
prostate

49
Q

what is the consequence of a diverticuli rupture

A

peritonitis
fistulae
perforation

50
Q

very bloody omental fat. Dx?

A

AAA rupture

51
Q

why do you slice through the omental fat on PM?

A

look for bleeds / cancer

52
Q

name the cancer of kidney collecting system

A

transitional cell
SCC

53
Q

name the cancer of kidney parenchyma

A

renal cell carcinoma

54
Q

which kidney stones are found in collecting ducts

A

staghorn calculi

55
Q

how easy should it be to remove capsule off kidney in healthy PM?

A

VERY easy

56
Q

nodular, pock marked kidney with capsule hard to remove from kidney. Dx?

A

HTN

57
Q

contrast kidney cyst from PCKD

A

PCKD is whole kidney replaced by cysts
benign cysts filled with turbid fluid is not uncommon

58
Q

bubbly looking kidney removed to make way for transplant. Dx?

A

PCKD

59
Q

where do emboli come from that block renal artery

A

AF / infection that is throwing off clots

60
Q

name a common gynae cancer

A

adenocarcinoma

61
Q

give 2 presentation characteristics of gynae cancer

A

late presentation
multi areas affected

62
Q

when would an ectopic burst the fallopian tube (wks)

A

8-11 weeks

63
Q

consequence of a fallopian ectopic

A

burst fallopian tube –> haemorrhage –> high fatality

64
Q

what type of cancer is in the testes

A

NOT carcinoma
yolk sac, semianoma, germ cell

65
Q

PC of testicular cancer

A

20-30 year old man
large testes

66
Q

prognosis of testicular cancer

A

good as caught early - massive testicle is hard to ignore

67
Q

apperance of testicular cancer on PM

A

looks like cheese ball

68
Q

why is it not always possible to do PM on brain

A

decomposes very quickly after death - liquid factor necrosis so liquefies

69
Q

PC of extradural haemorrhage

A

whack on the side of the head
temporal bleed causes brief LOC
lucid interval
then rapid decline & death

70
Q

what is a risk of extradural haemorrhage

A

coning due to raised ICP

71
Q

2 main causes of SAH

A

ruptured berry aneurysm !!!
trauma

72
Q

PC of SAH

A

sudden worst headache of their life - hit round the head with a baseball bat
can be small bleed (subclinical) –> fine –> HUGE bleed

73
Q

age peak of SAH

A

40

74
Q

what does haemorrhage look like PM

A

black

75
Q

pale, irregular, discoloured “cream cheese” area of brain on PM. Dx?

A

tumour

76
Q

what key definition is lost in brain tumour on PM

A

loss of white / grey matter definition

77
Q

most common brain ca

A

mets

78
Q

most aggressive brain ca

A

GBM

79
Q

very black area on brain PM. Dx? & why is it so dark

A

melanoma mets - makes melanin so is dark

80
Q

how do you write a death certificate

A

1a immediate cause of death
1b condition leading to 1a
1c condition leading to 1b

2 other present conditions not related to death

81
Q

what is a very classic old people death certificate after stroke

A

1a LRTI
1b stroke

82
Q

why would a death be referred to the coroner

A

suspicious circumstances around death or murder
sudden death
unknown cause of death
Dr not seen pt 28 days before they died
if person had their liberties removed

83
Q

what group of conditions are not liked on death certificates

A

“failures” eg heart failure - need underlying cause

84
Q

suitable alternative to cardiac failure on death certificates

A

MI / sepsis / aortic disease

85
Q

is old age acceptable as a 1a cause of death

A

YES

86
Q

is AKI / pulmonary oedema as 1a causes of death ok

A

NO - they are failures

87
Q

list common causes of sudden unexpected death in the community

A

main 2:
illicit drug use
trauma related to alcohol

other common ones:
stroke
MI
rupture AAA

88
Q

do you need consent for PMs?

A

hopsital PMs - YES
coroner PMs - NO

Path Week 2 (18 decks)

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