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Forensic MBBS > Thanatology > Flashcards

Thanatology Flashcards

1
Q

Death is defined in the article

A

46 IPC

It is defined in Declaration of Sydney

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2
Q

Mode of death were given by

What are the modes of death

A 
Bichat 
1. Coma
2. Syncope
3. Asphyxia 
Bishop tripod of life : circulation, respiration and brain function
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3
Q

Atria Mortis

A

Somatic death

Failure of bishop tripod

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4
Q

Supra vital interval

A

The period of 2-3 hours between atria mortis and molecular/cellular death
Organ harvesting and Zasko phenomenon (tendon reaction) are related to this period

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5
Q

Philadelphia protocol

A

Protocol for brain death
The below two criteria should be fulfilled for atleast 2 hours:
1. Hayward criteria-Related with cortical brain death
2. Minnesota criteria-Related with brain stem death

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6
Q

Human organ transplantation act

A

In 1994
Amended to human organ tissue transplantation act
Any kind of organ trafficking,… is punishment is minimum 10 years and five is 20L- 1Cr
Tissue trafficking 3-5 years and fine is 10 lakh

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7
Q

Changes in the human organ transplantation act

A

Grandparents and grandchildren are allowed for donation or receiving organs
Switching organs between families is allowed

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8
Q

Organ that is never transplanted

A

Urinary bladder

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9
Q

Suspended animation

A

No sign of life but the person is alive
Resuscitation is required
Metabolic activity of body is decreased to low level

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10
Q

Suspended animation examples

A 
Examples:
A) anaesthesia
B) new born
C) cholera, concussion
D) drowning 
E) electrocution
FG
H) hypothermia and hyperthermia
I) insanity
(Trance , a yoga posture-voluntary))
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11
Q

Earliest change after death is

A

Insensibility and loss of voluntary power

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12
Q

Early post mortem changes

A 
Changes of skin
Eye
Algor mortis
Livor mortis
Rigor mortis
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13
Q

Delayed post mortem changes

A

Decomposition and putrefaction

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14
Q

Tests for death

A 
These are not used nowadays
Test for circulation:
1. Diaphanus test
2. Magnus test
3. I-CARD dye test

Test for respiration
Winslow test

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15
Q

What are the post mortem changes seen after death

A
  1. Length of a person increases by 2-3 cm due to relaxation of intervertebral discs
  2. Eye changes:
  3. Algor mortis: decrease in temperature
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16
Q

Kevorkian sign

A

Rail roading sign
Seen few minutes after death
Earliest sign
Retinal vessels appear segmented

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17
Q

Eye changes after death

A
  1. Kevorkian sign
  2. Potassium ion and hypoxanthine increases in vitreous humour:
    Potassium ion is measured using Sturner formula or Madea formula
    It can be used to measure time after death
  3. Corneal clouding in 3 hours
  4. Cornea becomes opaque in 2-4 hours
  5. Intraocular tension
  6. Tache-Noire
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18
Q

Changes in intraocular tension after death

A

It falls from 25 mm Hg (normal)
To 3 mm Hg in 30 minutes
To zero in 2 hours

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19
Q

Tache Noire

A

A scleral change
A triangular projection due to epithelial cell debris
Generally seen in 3 hours after death

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20
Q

Most accurate site for measuring body temperature

A

Rectum

Subhepatic region to a lesser extent

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21
Q

What are the changes in temperature following death

A

It is a inverted sigmoid curve
Initially there is a isothermic plateau phase that lasts for about 3 hours
After 24 hours it becomes stable
Can be used to measure TSD (time since death)

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22
Q

Rate of fall of temperature after death

A 
In summer 0.75•F/hr or 0.5•C/hr
In winter 1.5•F/hr or 0.7•C/hr
Time since death = (normal BT-rectal temp)/rate of fall
If in centigrade:
Time =NBT-(RT+3)
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23
Q

Post mortem caloricity

A

In some cases after death the temperature rises for 2 hours

  1. Septicaemia, cholera (bacterial activity increases)
  2. Strychnine poisoning, tetanus (muscle activity increases)
  3. Sunstroke, pontine haemorrhage (heat regulation fails)
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24
Q

Livor mortis

A

PM lividity/ PM staining/ vibices/ suggilation / hypostasis
It is the reddish-blue staining of skin (rete mucosum) seen in dependent parts of the body for to accumulation of deoxygenated blood

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25
Q

Glove and stocking pattern

A

It is the livor mortis seen on a hanging body

Rate mucosum is seen in the hands and feet (the dependent parts)

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26
Q

Time since death and livor mortis

A 
Shortly after death: visible
4 hours: developed
6-12 hours: maximum 
7-8 hours: position is fixed
persists till putrefaction
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27
Q

Secondary lividity

A

If the body is moved within 7-8 hours, secondary lividity is observed

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28
Q

Livor mortis and cause of death

A
  1. CO poisoning: cherry red
  2. Cyanide poisoning: bright red/ brick red
  3. Hypothermia: bright pink
  4. H2S poisoning: blue-green
  5. Phosphorus: dark brown
  6. Opium toxicity: black
  7. Clostridium perfringes toxicity or septicaemia: bronze
  8. Oxidising poison (benzene, nitrate, chlorate, aniline): chocolate brown
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29
Q

Rigor mortis/ cadaveric rigidity

A

Stiffening of muscle
Shortening of muscle
Sommer’s movement
Mechanism was discovered by Shaiparo
Due to ATP depletion or lactic acid accumulation
It follows the primary relaxation phase (which starts immediately after death)
It is followed by secondary relaxation (decomposition)

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30
Q

Rigor mortis starts with which muscle

A

1st muscle is heart muscle in 0.5-1 hour

In upper eyelid it starts at 2-3 hours

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31
Q

Rigor mortis and climate

A

In summer it takes about 18-36 hours to develop

In winter it takes 1-2 days

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32
Q

The onset and duration of rigor mortis depends on

A
  1. Climate
  2. Thin/thick muscle
  3. Rate of ATP depletion
  4. Muscle activity
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33
Q

Nysten law

A

Rigor mortis appears and disappears from eyelids to toes

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34
Q

Rule of 12

A

Rigor mortis
In first 12 hours: appears in all muscles
In next 12 hours it remains in all muscles
In next 12 hours it disappears from all muscles
Therefore rigor mortis exists for about 36-48 hours

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35
Q

Variations of rigor mortis

A
  1. In foetuses below 7 months of age, it is absent since actin and myosin are absent
  2. In children, old people and violent death, the onset is early and duration is short
  3. In wasting diseases like TB, typhoid, cholera also same situation occurs
  4. In toxicities like, organophosphorous, strychnine and arsenic
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36
Q

Why in children and old people ,the onset is early and duration is short

A

In children and old person the muscle mass is less so ATP depleted faster

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37
Q

Why in violent death, the onset is early and duration is short

A 
Muscle activity is more in 
drowning
Heat stroke 
Throttling 
Cut throat
Fire arm injury
ATP depleted faster
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38
Q

In organophosphorous toxicity, what changes occur in rigor mortis

A

In organophosphorous toxicity, rigor mortis onset is earlier

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39
Q

Strychnine and arsenic poisoning and rigor mortis

A

In strychnine poisoning: (steal)
Early onset
Long duration

In arsenic poisoning: (all)
Late onset
Long duration

40
Q

Rigor mortis and ATP

A

Starts when ATP is 85% of normal and reaches its maximum when ATP is 15% of normal

41
Q

Specific effects of rigor mortis on muscle

A

Heart appears as a ventricular hypertrophy
In pregnant uterus it will lead to post mortem delivery
In the erector piles muscle it will lead to goosebumps or cutus anserina

42
Q

Other post mortem muscle stiffening

A
  1. Heat stiffening
  2. Cold stiffening (-5•C or lower freezing of body fluids)
  3. Gas stiffening (has formed on decomposition)
  4. Cadaveric spasm
43
Q

Heat stiffening

A

Occurs when temperature is greater than 65•C
Same mechanism causes pugilistic attitude
Coagulation of muscle protein

44
Q

Cadaveric spasm (how is it different from rigor mortis)

A 
Just after death
Instantaneous rigor
Involved only in few voluntary muscle like those of hand
Gives response to electric stimuli 
Cannot be broken 
Gives an idea of mode of death
45
Q

Situations in which cadaveric spasm occurs

A 
A. Asphyxiation 
B. Brain injury
C. Cerebral injury
D. Drowning (clenched hand with grass) and Dinitro-cresol poisoning 
E. Exhaustion
F. Fear and fire-arm injury
46
Q

Decomposition versus putrefaction 🆚 autolysis

A

Decomposition is by external bacteria
Putrefaction by gut bacteria
Autolysis own enzymatic activity
First sign is the clouding of cornea

47
Q

Decomposition changes

A
  1. Colour changes
  2. Gas
  3. Liquefactive necrosis
48
Q

Most common bacteria involved in decomposition and its optimum temperature

A

Clostridium welchi
Its optimum temperature is 21 to 38°C
Main enzymatic activity is lecithinase (a lytic enzyme)

49
Q

First external change of decomposition

A

Greenish/ reddish purple discolouration of right iliac fossa (caecum)
Sulfa Hb (Hb degradation product) from H2S
In summer it occurs in 12-18 hours
In winter it occurs in 1-2 days

50
Q

First internal sign of decomposition

A
  1. Brownish discolouration of the intima of the aorta
    (then)
  2. Colour change of the undersurface of liver
51
Q

Second change of decomposition is

A 
Marbelling :
Superficial vein becomes prominent
Due to sulfa Hb (greenish brown/ reddish purple)
Seen from 24-36 hours
Common sites are chest, thigh, neck
52
Q

Third change of decomposition

A

Maggots:
Blue bottle fly like Musca domestica or M. vicinia
These flies lay eggs in moisture containing areas like nasal/oral or injured parts
Seen 2-3 days (in rainy season:1-2 days)

53
Q

8 stages of maggots or larva was identified by

A

Megnin

54
Q

Number of days taken for a maggot to become a pupae

A

3-6 days

55
Q

Number of days taken for pupa to become an adult fly

A

3-6 days

56
Q

Forensic entomology

Forensic entomotoxicology

A

Forensic entomology is the study of insects/ flies on the body
Forensic entomotoxicology is the study of poisons using insects/flies of the body

57
Q

Gas formation, when and where

A

2-3 days
Face, abdomen, scrotum
Post mortem purge

58
Q

Other post mortem changes after decomposition seen within 5 days

A

After 2-3 days nail, hair become loose
After two days the teeth become loose
After 3-5 days, glove and stocking pattern and skin is peeled off and the sutures of the skull get separated

59
Q

Post mortem purge

A

After 2-3 days, due to gas formation, gastric contents come out through oral/ anal orifices (not vomiting)
Respiratory content comes out through nostrils (not frothing)

60
Q

Colliquative necrosis

A

Seen after 5-10 days, it is the liquefactive necrosis

61
Q

Internal organ decomposition

Sequence

A
  1. Larynx and trachea (exposed to air)
  2. Stomach, intestine, spleen (SIS)
  3. Liver and lung (2L)
  4. Brain➡️ heart ➡️ kidney (BHK)
    …
    Last organ
    Prostate gland /non gravid nucleus
    Then bone
62
Q

Foamy liver/ honeycomb liver

A

Liver is the third organ to undergo decomposition
Gas bubbles are formed leading to the appearance
In 24-36 hours after death

63
Q

Best organ for DNA analysis is

A

Spleen

64
Q

Best organ for DNA analysis after decomposition is

A

Brain

65
Q

The first and the last amino acid to disappear from bone

A

First amino acid to disappear is proline and hydroxy proline

Last amino acid is glycine

66
Q

Less than 7 amino acids suggests the bone is

A

100 years old

67
Q

After ___ the cut surface of bone is fluorescent

A

35 years

68
Q

Bone decomposition starts at

A

3-10 years

69
Q

Nuclear features of the body persists for

A

2-3 years

70
Q

Casper Dictum

A 
Given by Taylor
Rate of decomposition in different climate
Gives idea of time since death
Rate:
Air> water > soil
1 week > 2 weeks > 8 weeks
71
Q

Modifications of decomposition

A
  1. Adipocere/ saponification/ grave wax

2. Mummification/ desiccation

72
Q

Adipocere is seen in

A

Starts in fatty areas like face, abdomen, breast, buttocks,… and then moves other parts
Seen when the body is immersed in water or warm, damp, humid climates

73
Q

Adipocere mechanism

A

Fatty acid is hydrogenated and hydroxylated by lipase of Clostridium welchii
And then combines with Ca+2 and Ammonium ion

74
Q

Pseudosmell

A

Adipocere when combines with ammonia gives a ammoniacal smell
Which might remain in the clothes of autopsy surgeon called pseudosmell

75
Q

Adipocere starts at

A

3 days and continues upto 3 weeks in India

76
Q

Adipocere appearance

A

Fresh adipocere:
White, soft, moist

Old adipocere:
Yellow, hard, brittle

Appears like rancid butter

77
Q

Adipocere is not found in

A

Foetuses below 7 months of age due to absence of subcutaneous fat

78
Q

Medico-legal importance of adipocere and mummification

A
  1. Climate
  2. Time since death
  3. Identification of body and injuries are preserved (lecithinase activity absent)
79
Q

Mummification

A 
Dry hot like Desert 
Dehydration
Desiccation
•Body shrinks 
•Odourless
•Natural appearance is preserved, since no lecithinase activity
•seen in IUD (intra uterine death)
80
Q

Time taken for mummification

A

3 months to 1-2 years

81
Q

Elements favouring mummification

A

Arsenic and antimony favours mummification

82
Q

Stomach emptying time

A

Light food: 1-2 hours
Empty: 2 hours
Medium food: 3-4 hours
Heavy meal: 5-8 hours

83
Q

Growth of hair and nail

A

Hair: 0.4 mm/day

Nail: 0.1 mm/day

84
Q

Pink teeth phenomenon

A

After decomposition, gums are congested which appear like pink teeth

85
Q

PM luminescence

A

Dead body may luminescence due to photobacteria, or fungi like:
•Armillaria
•Ramsbottom

86
Q

Most of viscera should be preserved at

A

4°C

But ideal temperature we use is -20°C

87
Q

Time for dead body to be preserved before autopsy

A

Minimum 72 hours according to police protocol

Human anatomy act: 48 hours

88
Q

Embalming

A

Should be done within 6 hours using by fluid
2 types: arterial and cavity
Should be done after post mortem (otherwise 201 IPC-disappearance of evidence)

89
Q

Embalming fluid composition

A 
Formaldehyde-preservative
Glycerin- wetting agent
Methanol-preservative
Phenol-germicide
Na citrate-anti coagulant 
NaCl-pH control
Water
90
Q

In embalmed body, the samples preserved for toxicology analysis

A

Buttock muscle

Vitreous, synovial fluid, bile

91
Q

Artefacts

A
  1. Prinslow-Gordon artefact:
    Extravasation of blood on neck after asphyxia
  2. Agonal artefact:
    PM ‘injury’
92
Q

Important evidence act wrt post mortem

A

107 IEA Presumption of life
Any missing person is presumed to be alive for next 30 years.
108 IEA Presumption of death:
If a person is unheard for last 7 or more years, then it is presumed to be dead.

93
Q

Henssge normogram

A

To decide time since death via temp-time relation

94
Q

Commorientes

A

When two or more people died at the same time and same event, order of death can be difficult to determine
Presumption of survivorship:
Younger person is presumed to survive more than older person
Important in transfer of will

95
Q

Definition of sudden death

A

If a person dies within 24 hours of onset of terminal illness with or without known or existing conditions
Most commonly due to CAD (LAD / widow artery)

Forensic MBBS (7 decks)

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