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MT6321 HISTOPATH > U1 LEC: POSTMORTEM EXAMINATION > Flashcards

U1 LEC: POSTMORTEM EXAMINATION Flashcards

1
Q

“We must turn to nature itself to the observations of the body in health and disease, to learn the truth”

A

Hippocrates

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2
Q

Autopsy can be categorized by five different rulings for manner of death:

A
  • natural
  • accident
  • homicide
  • suicide
  • undetermined
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3
Q

T/F: A medical examiner can order an autopsy without consent from next of kin.

A

True

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4
Q

First recorded autopsy

A

Antistius examines Julius Caesar’s body

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5
Q

T/F: One wound to the chest led to rutpure of Caesar’s aorta.

A

True

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6
Q

1806 painting by Vincenzo Camuccini

A

La mort de Cesar / The Death of Julius Caesar

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7
Q

This is an instruction manual on how to conduct medico-legal investigations, examine corpses, and determine the time and cause of death.

A

Hsi Yuan Lu / The Washing Away of Wrongs

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8
Q

Hsi Yuan Lu (The Washing Away of Wrongs) was written by?

A

1247 Song Ci

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9
Q

Forensic issues mentioned in Hsi Yuan Lu

A
  • poisoning
  • decomposition
  • wounds from various weapons
  • strangulation
  • fake wounds
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10
Q

Who conducted the first known legal autopsy with the use of human eye, in which was requested by the magistrate in Bologna?

A

Bartolomeo de Varignana (1302)

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11
Q

During the renaissance period, autopsies were watched in an operating theater and cadaver is opened by a?

A

lay dissector

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12
Q

They performed a number of autopsies and observing anatomy unseen by the naked eye.

A

Leonardo da Vinci and Michelangelo

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13
Q

Father of Modern Pathology

A

Rudolf Ludwig Karl Virchow

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14
Q

Virchow characterized a case of?

A

leukemia

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15
Q

PME is performed

wherever __________ is practiced

A

scientific medicine of high quality

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16
Q

PME is performed

when a _________ knows why he lost a patient

A

conscientious physician

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17
Q

PME is performed

when ______ is enforced

A

criminal law

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18
Q

PME is performed

when a ___________ shows accurately the causes of death and confirmed medical diagnosis for the assembling of vital statistics

A

death certificate

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19
Q

PME is performed

whenever there is _______ on causes and nature of diseases, and transplantation medicine

A

medical research

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20
Q

PME is performed

A _______ requires PME in human death for the good of medical science, for the public’s health and for the future care of living patient

A

informed society

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21
Q

Preparations before the Postmortem Examination

A
  1. Administrative preparations
  2. Preparation of the autopsy room
  3. Confirmation of the decedent identity
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22
Q

Preparations before PME

under Administrative preparations

A
  • Obtain and confirm consent
  • Obtain and review clinical records
  • Contact clinical team and staff pathologist
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23
Q

Preparations before PME

under Preparation of the autopsy room

A
  • Set up dissection instruments and tools
  • Lay out swabs, media, etc. for any ancillary studies to be performed
  • Prepare photographic equipment
  • Assemble PPE
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24
Q

Preparations before PME

under Conformation of decedent identity

A
  • most important step
  • Identifiers on the body must be confirmed and matched with autopsy consent form
  • Confirm any limitations or restrictions to the autopsy at this time
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25
Q

Documents for autopsy

A
  • Written consent from the next of kin (abide by restrictions or extent allowed)
  • Death certificate
  • Medical abstract / clinical data
  • Medicolegal clearance
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26
Q

Order of consent for autopsy

A
  1. Spouse
  2. Adult children
  3. Adult grandchildren
  4. Parent
  5. Siblings
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27
Q

T/F: If autopsy is not required by law, it cannot be done until the next of kin gives permission.

A

True

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28
Q

PME in which all body cavities are examined, including the head/brain.

A

Complete

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29
Q

PME in which may exclude examination of the head/brain.

A

Limited (Partial)

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30
Q

PME in which specific organs only are examined.

A

Selective

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31
Q

Autopsy without consent can be done under the following conditions:

A
  • ordered by police or coroner
  • necessary to complete death certificate
  • deceased gave consent before he died (Advance directive)
  • deceased military service who dies in active duty/training in military service
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32
Q

Autopsies are usually carried out within?

A

48 hours after death

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33
Q

Autopsies can be?

A

hospital-based or coronial

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34
Q

These are autopsies ordered by the state coroner.

A

Coronial autopsies

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35
Q

These are autopsies to be performed at the request of the family of the deceased.

A

Hospital based autopsies

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36
Q

Criteria for Autopsy (College of American Pathologists)

A
  1. Help explain unknown and unanticipated medical complications
  2. Cause of death/major diagnosis is not known with reasonable certainty
  3. Help to allay concerns of family or to the public regarding death, provide reassurance to them
  4. Unexpected deaths occuring during any dental, medical, or surgical diagnostic procedures
  5. Death of those who participated in clinical trials
  6. Natural unexplained deaths and not subject to forensic medical jurisdication
  7. Natural deaths, waived by forensic medical jurisdiction
  8. Deaths resulting from contagious diseases
  9. All obstetric deaths
  10. All perinatal, and pediatric deaths
  11. Deaths at any age for suspected illness or bearing on recipients of transplant organs
  12. Deaths from environmental hazard
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37
Q

CAP Criteria

  1. Deaths in which autopsy may help to explain _____________ to the attending physician
A

unknown and unanticipated medical complications

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38
Q

CAP Criteria

  1. All deaths in which the cause of death or major diagnosis is ___________ on clinical grounds
A

not known with reasonable certainty

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39
Q

CAP Criteria

  1. Cases in which autopsy may help to _________ and or to the public regarding the death, and to provide reassurance to them regarding the same.
A

to allay concerns of the family

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40
Q

CAP Criteria

  1. Deaths of patients who have participated in _________ approved by institutional review boards.
A

clinical trials

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41
Q

CAP Criteria

  1. Unexpected or unexplained deaths which are apparently ______ and not subject to a _______.
A

natural, forensic medical jurisdiction

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42
Q

CAP Criteria

  1. Natural deaths but waived by a forensic medical jurisdiction, such as:
A

a. persons dead on arrival
b. deaths in hospitals within 24 hours of admission
c. patient sustained injury while hospitalized

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43
Q

CAP Criteria

  1. Deaths resulting from ________ diseases
A

high-risk infectious and contagious

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44
Q

CAP Criteria

  1. and 10. All ____ deaths
A

obstetric, perinatal, pediatric

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45
Q

CAP Criteria

  1. Deaths at any age in which is believed that autopsy would disclose a _______ which also have a bearing on survivors or recipients of _________.
A

known or suspected illness, transplant organs

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46
Q

CAP Criteria

  1. Deaths known to have resulted from __________ hazards
A

environmental or occupational

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47
Q

This refers to a person who has jurisdiction in medicolegal cases.

A

Medicolegal examiner or coroner

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48
Q

T/F: The coroner may authorize the pathologist to proceed with an autopsy.

A

True

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49
Q

Jurisidiction for Medicolegal cases

A
  1. All deaths within 24 hours of admission
  2. Newborns in the first 24 hrs of life
  3. All injury cases
  4. All deaths due to unknown cases
  5. All deaths due to suspicious cases
  6. All abortion cases
  7. All violent deaths
  8. All accidental deaths
  9. All sudden deaths
  10. All cases without medical attendance within 36 hours prior to death
  11. All deaths due to drowning, hanging, or strangulation
  12. All deaths due to shooting, stab wounds, burns, electricity, lightning, tetanus, etc.
  13. All homicides
  14. All suicides
  15. All cases in which there is suspicion of poisoning
  16. Stillborns
  17. Prematures
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50
Q

This refers to death of an organism or bodily death (brain dead).

A

Somatic death

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51
Q

This is the earliest definition of death of an organism.

A

Cessation of circulation and respiration (1960s)

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52
Q

Criteria for pronouncement of death

A
  1. Advanced in resuscitation techniques
  2. Advanced life-sustaining equipment
  3. Redefinition from cessation to irreversible cessation
  4. Brain death
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53
Q

Criteria for pronouncement of death

  1. Advances in _____ techniques that are capable of reviving effectively cases of clinical death.
A

resuscitation techniques

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54
Q

Criteria for pronouncement of death

  1. Advanced ___________ capable of maintaining cardiovascular and respiratory functions despite severe brain injury.
A

life-sustaining equipment

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55
Q

Criteria for pronouncement of death

Redefinition from _________ of cardiorespiratory functions after resuscitation attempts

A

cessation to irreversible cessation

56
Q

Criteria for brain death

A
  • Coma and cerebral unresponsiveness
  • Apnea
  • Absent cephalic (brainstem) reflexes)
  • Electrocerebral silence
57
Q

This refers to slow breathing.

A

Apnea

58
Q

Criteria for brain death should be present for how many minutes, at least 6 hours after onset of coma and apnea?

A

30 minutes

59
Q

the American Bar Association and the National Conference of Commissioners of Uniform State Laws legislative definition of death:

A
  • Irreversible cessation of circulatory and respiratory functions
  • Irreversible cessation of all functions of the entire brain (brainstem is dead)
60
Q

American Academy of Neurology

A
  • Coma
  • Absence of multiple brain functions
61
Q

American Academy of Neurology

Absence of the ff includes:

A
  • Motor response
  • Pupillary response to light and pupils at mid- position
  • Corneal reflexes
  • Caloric response
  • Gag reflex
  • Coughing in response to tracheal suctioning
  • Sucking and rooting reflexes
62
Q

RA 7170

A

Organ Donation Act of 1991

63
Q

Amendment of RA 7170

A

RA 7885

64
Q

Medical Certification of Death

A
  • Immediate cause of death
  • Antecedent cause of death
  • Underlying cause of death
65
Q

This is the final disease, injury or complication directly causing death.

A

Immediate cause of death

66
Q

This precedes death as consequence of an underlying cause.

A

Immediate cause of death

67
Q

The violent act or accident is the ______ to an injury entered

A

antecedent

68
Q

This is the condition that led or precipitate the immediate cause of death.

A

Antecedent cause of Death

69
Q

These are other intervening causes of death occuring between underlying and immediate causes.

A

Antecedent cause of death

70
Q

This is defined for public health and legal purposes as “the disease or injury that initiated the train of events leading to death”

A

Underlying cause of death

71
Q

Other term for underlying cause of death

A

Promixate cause of death

72
Q

This is the circumstances of accident which produced the fatal injury

A

Underlying cause of death

73
Q

T/F: Without an underlying cause, the death would still have happened.

A

False

74
Q

This is the most important entry in the certificate since mortality statistics is based on this.

A

Underlying causes

75
Q

3 copies of the death certificate should be made for:

A
  • Relative
  • City Health Office
  • Funeral home
76
Q

This is death resulting from a disease.

A

Natural

77
Q

This is death resulting from environmental influence.

A

Accidental

78
Q

This is death intentionally self-inflicted.

A

Suicide

79
Q

This is death resulting from the deliberate action of another person.

A

Homicide

80
Q

This is death resulting from an unknown cause.

A

Indeterminate or Undetermined

81
Q

This refers to a continuum of changes that occur in a dead body, following death.

A

Postmortem changes

82
Q

Postmortem changes include:

A
  • Livor mortis
  • Rigor mortis
  • Decomposition
  • Taphonomy
83
Q

This is the first demonstrable change after death.

A

Algor Mortis

84
Q

This refers to the cooling of the body,

A

Algor Mortis

85
Q

1st hour

A

2 to 2.5 deg F/hr

86
Q

next 12 hrs

A

1.5 to 2 deg F/hr

87
Q

next 12-18 hrs

A

1 deg F/hr

88
Q

50% of cases, body cools at?

A

1.5 deg F/hr

89
Q

T/F: Algor mortis is not a reliable indicator as to time of death.

A

True

90
Q

This is the rigidity of the body due to hardening of skeletal muscles, caused by a series of physiochemical events after death.

A

Rigor mortis

91
Q

Rigor Mortis

lack of ATP regeneration and increased acidity result in the?

A

formation of locking-chemical bridges between actin & myosin

92
Q

Rigor Mortis

Glycogen stores are rapidly deleted, preventing energy dependent breakage of sarcomere contraction

A

Depletion of ATP and accumulation of lactic acid

93
Q

T/F: In rigor mortis, interlocking is fixed without shortening of muscle

A

True

94
Q

Rigor Mortis

Sets within?

A

2 hours after death, small muscles > larger muscle groups

95
Q

Rigor Mortis

Complete and fully fixed after approx?

A

6-12 hrs

96
Q

Rigor Mortis

Dissipates after?

A

36-48 hrs

97
Q

This is fixed rigor mortis of the upper extremities wherein the arms are suspended against gravity indicating they were previously held in that position while rigor was fixing.

A

Antigravitational rigor mortis

98
Q

This is characterized by a deep purple-red discoloration in skin and organs.

A

Livor Mortis

99
Q

Other name for Livor Mortis

A

Postmortem (Lividity) Hypostasis

100
Q

T/F: Blood supply gravitates to the skin vessels which becomes toneless and dilate after circulation ceases.

A

True

101
Q

This occurs in gravity dependent areas that come into contact with firm surfaces.

A

Blanching

102
Q

Livor mortis is spared in blanched areas due to?

A

localized pressure preventing blood from entering the skin

103
Q

Livor Mortis

Evident as early as?

A

20 mins after death

104
Q

Livor Mortis

Fully evident within?

A

4 hrs

105
Q

Livor Mortis

Fixed within?

A

8-12 hrs

106
Q

Tardien spots are also known as?

A

Tardieu petechiae, Tardieu spots

107
Q

First described tardieu

A

Auguste Ambroise Tardieu

108
Q

Evident in the death of a newborn child by strangulation or suffocation

A

Tardieu’s ecchymoses (subpleural spots of ecchymosis)

109
Q

Lividity is _____ discoloration of skin from blood pooling in dependent areas of the body.

A

pink to purple

110
Q

Tardieu spots are what colors?

A

purple to black spots

111
Q

Other Postmortem changes

A
  • Postmortem clotting of blood
  • Discoloration of tissues
  • Autolysis and putrefaction
  • Dessication (Tache noir)
112
Q

This is a horizontal linear scleral blackening along the equator of the glove of eye.

A

Tache noir de la sclerotique

113
Q

Tache noir is often initially what color in appearance, and over time becomes what color?

A

red, black

114
Q

These darken with postmortem drying.

A

Lips, tip of tongue, scrotum

115
Q

Primary Autopsy Incisions

For scalp

A

Mastoid-to-Mastoid incision

116
Q

Primary Autopsy Incisions

For trunk

A
  • I shaped
  • Y shaped
  • Modified Y shaped
117
Q

Primary Autopsy Incisions

What is commonly used for females?

A

Y shaped, Modified Y shaped

118
Q

Secondary Autopsy Incisions

Cutting of bones to expose cavities

A
  • Sawing of skull
  • Cutting of the sternal plate
119
Q

This incision is a straight line incision extending from the chin to the symphysis pubis.

A

I shaped incision

120
Q

This type of incision starts near the acromian process and progresses downwards towards the xiphoid process, then extended til the symphysis pubis.

A

Y shaped

121
Q

This incision is made from the suprasternal notch over the clavicle, to symphysis pubis.

A

Modified Y shaped

122
Q

Goal of performing the Incisions

A
  • expose chambers of heart, lungs, liver, GIT lumen
  • open urinary bladder cavity
123
Q

This technique removes and dissects organs individually.

A

Technique of Virchow

124
Q

Order of Virchow’s Technique

A

Head > Thoracic (Cervical) > Abdominal

125
Q

This technique is in-situ dissection in part with en bloc- technique.

A

Technique of Rokitansky

126
Q

This technique utilizes en bloc- technique.

A

Technique of Ghon

127
Q

This technique utilizes en masse technique.

A

Technique of Letulle

128
Q

Minimally invasive technique

A

Needle autopsy

129
Q

This refers to multiple percutaneous needle biopsies after death.

A

Blind biopsies

130
Q

This refers to extensive organ sampling or removal via a limited incision.

A

Mini-autopsy

131
Q

Non Forensic Autopsy Record Retention

Wet Tissue

A

3 months

132
Q

Non Forensic Autopsy Record Retention

Paraffin blocks, Slides, Reports

A

10 years

133
Q

Forensic Autopsy Record Retention

Wet tissue

A

3 years

134
Q

Forensic Autopsy Record Retention

Body Fluids and Tissues for Toxicology

A

1 year

135
Q

Forensic Autopsy Record Retention

Paraffin blocks, Slides, Reports, Gross Photographs/Negatives, Dried Blood stain or frozen tissue for DNA

A

Indefinitely

136
Q

Hic locus et urbi mors gaudet, succarrere vitae

A

This is the place where the dead delights teaching the living

MT6321 HISTOPATH (15 decks)

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