introduction to clinical sciences

Question 1

what are the two types of autopsies

Answer 1

hospital

medico-legal (cornial and forensic)

Question 2

around how many autopsies performed are hospital ones

Answer 2

less than 10%

Question 3

what is needed for a hospital autopsy

Answer 3

a medical certificate of cause of death

Question 4

what is the purpose of a hospital autopsy

Answer 4

to be used for teaching, research and governance

Question 5

when would a coronial autopsy be used

Answer 5

where death is not due to unlawful action

Question 6

when would a fornesic autopsy be used

Answer 6

where death is thought unlawful (murder)

Question 7

what is the role of the coronial autopsy

Answer 7

to answer the 4 Qs 
who was deceased
when did they die
where did they die
how did their death come about

Question 8

who can refer deaths to coroners

Answer 8

doctors (not statutory duty, common law duty, GMC gives guidance)
registrar of births, deaths and marriages (statutory)
relatives
police

Question 9

why are deaths referred to coroner

Answer 9

presumed natural
presumed iatrogenic
presumed unnatural

Question 10

what is a presumed natural death

Answer 10

cause of death not known
patient hasn’t seen doctor 14 days prior to death
most common

Question 11

what is a presumed iatrogenic death

Answer 11

peri/postperative deaths
anaesthetic deaths
illegal abortions
complications of therapy

Question 12

what is a presumed unnatural death

Answer 12

accidents
industrial death
suicide
unlawful killing
neglect
custody death

Question 13

what autoposies does a histopathologist perform

Answer 13

hospital and coronial
(natural deaths, drowning, suicide, accidents, road traffic deaths, fire deaths, industrial deaths and peri/postoperative deaths)

Question 14

what autopsies does a forensic pathologist perform

Answer 14

coronial autopsies
(homicide, death in custodty, neglect and any of other that may be due to an action of a thrid party)

Question 15

during an external examination what factors are looked for during identification

Answer 15

formal identifiers
gender, age
body habitus
jewellery
body modification
clothing

Question 16

what are the 4 steps of external examination

Answer 16

identification, diesease and treatment, injuries and evisceration

Question 17

what are the steps of evisceration

Answer 17

Y-shaped incision, from behind ears to clavicles and then down midline
open all body cavities 
examine all organs in situ
remove thoracic and abdo organs
remove brain

Question 18

what is checked during the internal examination of an autopsy

Answer 18

heart & greater vessels
lungs, trachea and bronchi
liver, gallbladder, pancreas
avoid lower GI if possible (infection risk)
spleen, thymus and lymph nodes
genitourinary tract (common for cancer)
endocrine organs
CNS

Question 19

what is acute inflammation

Answer 19

Acute inflammation is the initial and often transient series of tissue reactions to injury-may last from a few hours to a few days. e.g. appendicitis

Question 20

what is inflammation

Answer 20

the local and physiological response to tissue injury

not a disease but a manifestation of one

Question 21

what are the benefits of inflammation

Answer 21

involves the destruction of invading microorganisms and the walling off of an abscess cavity thereby preventing the spreas of infection

Question 22

what are the limitations of inflammation

Answer 22

disease. e.g. an abscess in the brain will act as a space-occupying lesson compressing vital surrounding structures

fibrosis resulting from chronic inflammation may distort tissues and permanently alther their function

Question 23

what are the acute inflammation steps

Answer 23

initial reaction of tissue to injury
vascular component: dilation of vessels
exudative component: vascular leakage of protein rich fluid
neutrophil polymorph (WBC) is the cell recruited to the tissue

Question 24

what are the outcomes of acute inflammation

Answer 24

resolution - goes away
suppuration - pus formation (abscess)
organisation - healing by fibrosis
or progression to chronic inflammation`

Question 25

what are the steps of organisation

Answer 25

first there must be substantial damage to connective tissue framework/tissue lacks ability to regenerate specialised cells

• dead tissues and acute inflammatory exudate are first removed from damaged areas by macrophages
• defect filled with ingrowth of specialised vascular tissue, granulation tissue (organisation)
• granulation tissue produces collagen = collagenous scar as repair

Question 26

what are some causes of acute inflammation

Answer 26

-microbial infections: pyogenic (pus causing) bacteria, viruses
-hypersensitivity reactions: parasites, tubercle bacilli
-physical agents: trauma, ionising radiation, heat, cold (frost bite)
-chemicals: corrosives, acids, alkalis, reducing agents
-bacterial toxins
tissue necrosis: ischaemic infarction