Role of the Pathologist

Question 1

Where do pathologists become involved after a sudden death?

Answer 1

Post Mortem examination

Question 2

What takes place during a Post Mortem examination?

Answer 2

• History gained from Clinical Notes and Police Reports
• Scene photos analysed
• External and internal examination of patient
• Histology
• Toxicology
• Genetics
• Identification

Question 3

What do photos of the scene add to a Post Mortem examination?

Answer 3

Gives an indication as to whether the death may be due to suspicious causes

• Suspicious vs Non-suspicious

Question 4

What can toxicology be used for in a post mortem examination, other than to identify overdose?

Answer 4

• If known patient was on medication for a certain condition, the titre of these can be checked
  => if they were not taking the medication, this may indicate their cause of death

Question 5

What is immunohistochemistry used for after identifying a tumour on autopsy?

Answer 5

Differentiate if primary or secondary tumour

Cellular analysis may also indicate original site?

Question 6

Who must consent for a patient to undergo a hospital autopsy?

Answer 6

• Family or Next of Kin

- patient also may have consented to partial or full autopsy before their death

Question 7

Who can authorise an autopsy that does NOT need familial consent?

Answer 7

Procurator Fiscal

• this is then required by law
• Can cause problems in families of certain religions who may be against autopsy

Question 8

What is involved in a “View and Grant” Post mortem examination?

Answer 8

• External examination only
• NO internal biopsies
• can still do toxicology samples on blood, urine and vitreous humour from the eye

Question 9

What is the WHO definition of Sudden or Unexpected death?

Answer 9

Death within 24 hours of symptom onset

Question 10

What clinical signs during a Post Mortem Examination would indicate a patient had hyperlipidaemia which could have contributed to their death?

Answer 10

• Bilateral diagonal ear lobe creases

- Arcus eye sign (cloudy ring around iris)

Question 11

What signs on autopsy may be indicators of a myocardial infarction?

Answer 11

• occlusion of coronary artery
• rupture of heart muscle
• haemopericardium (evident on opening chest)

Question 12

What problem in the coronary arteries may cause a patient to die suddenly although there is no physical pathology present on autopsy?

Answer 12

Coronary artery spasm

Question 13

What structural heart abnormalities may be visible on autopsy?

Answer 13

• LV hypertrophy (heart may also be weighed to indicate this)
• Aortic stenosis (calcifications present on valve)
• Cardiomyopathies (hypertrophic, dilated or restrictive)

Question 14

What type of cardiomyopathy is known to cause sudden death in young athletes?

Answer 14

Hypertrophic

Question 15

What signs can you look for on autopsy if you suspect a patient has died from an epileptic seizure?

Answer 15

• Tongue biting marks

- urine stained clothes

Question 16

If a lung tumour was found on autopsy, what other common pathology would you look for?

Answer 16

• Pulmonary embolus

- High risk of this when patient has lung cancer, and is often a cause of sudden death

Question 17

What throat condition may cause complications that result in sudden death?

Answer 17

Quincy - presents in throat but may cause tonsillar abscess that bursts and causes sudden death

Question 18

What condition has the potential to cause sudden death in children?

Answer 18

Epiglottitis - commonly caused by Haemophilus Influenzae