Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
167 Cards in this Set
- Front
- Back
|
Define: Stillbirth |
A child that has had at least 26 weeks of intra-uterine life, but that did not show any signs of life after completion of the birth |
|
|
What does section 56 of the Health Professions act state regarding procedure related deaths (specifically referring to the instances in which death 'shall not be deemed to be a death from natural cause.') |
It states: The death of a person undergoing, or as the result o, a procedure of a therapeutic, diagnostic, or palliative nature, or of which any aspect of such a procedure has been a contributory cause, shall not be deemed to be a death from natural causes. |
|
|
True or false: Regarding the first page of the DHA-1663A DNF, the ID number of the deceased should remain confidential, and therefore should not be completed |
False The patient's details, including his complete ID number, must be filled out on this page |
|
|
True or false: Regarding the first page of the DHA-1663A DNF, the doctor must sign this page before handing it to the nursing sister |
False The doctor signs on the second page of the DHA-1663A ? |
|
|
True or false: Regarding the first page of the DHA-1663A DNF, The underlying cause of death is entered on the lowest completed line |
False The cause of death is not filled in on the first page but the last one |
|
|
True or false: Regarding the first page of the DHA-1663A DNF, the smoking history of the deceased is important for mortality statistics |
True |
|
|
True or false: Regarding the first page of the DHA-1663A DNF, the nursing sister must enter her name clearly and legibly |
False The Doctor must fill out his details on the second form |
|
|
The body of a baby that weighs 3.5 kgs and has a placenta attached to the body is found on a rubbish dump. Is the following statement true or false: The doctor does not have to complete the DHA-1663 as this is a stillbirth |
False You cannot say from the information given that this was a stillbirth as the baby might have showed signs of life after birth, furthermore a form would have to have been completed in the instance that this was a stillbirth |
|
|
The body of a baby that weighs 3.5 kgs and has a placenta attached to the body is found on a rubbish dump. Is the following statement true or false: The doctor does not have to complete the DHA-1663 as this baby is not viable |
False In the case that the baby was not viable, it would be acceptable not to register its death, but this baby weighs 3.5 kgs and is more than likely to have been viable due to its weight Every death and stillbirth in the country, however, must be registered |
|
|
The body of a baby that weighs 3.5 kgs and has a placenta attached to the body is found on a rubbish dump. Is the following statement true or false: the doctor must sign the DHA-1663, the cause of death is concealment of birth |
False Concealment of birth is not a cause of death, it is a criminal offence ? |
|
|
The body of a baby that weighs 3.5 kgs and has a placenta attached to the body is found on a rubbish dump. Is the following statement true or false: An autopsy must be done to prove concealment of birth had taken place |
False Concealment of birth cannot be proven on autopsy ? |
|
|
The body of a baby that weighs 3.5 kgs and has a placenta attached to the body is found on a rubbish dump. Is the following statement true or false: An autopsy must be done to determine the cause of death |
True |
|
|
Define: Manner of death |
An indication of the circumstances surrounding the death of a person, it can be classified as homicide, suicide, accidental, natural and sometimes undetermined |
|
|
Define: Underlying cause of death |
The disease that lead the initial chain of events that eventually lead to the patients death, or the circumstances of the accident or violence which produced the fatal injury |
|
|
Define: Immediate cause of death (also called terminal) |
A term used to describe the final disease (exclusively disease and not a mechanism) that led to the death of the person |
|
|
Define: The mechanism of death |
The physiological disturbance by which a cause of death exerts its lethal effect |
|
|
Define: Laceration
|
A tearing injury of the skin that involves the full thickness of the epidermis and dermis (caused by a blunt object stretching and eventually tearing the skin) |
|
|
A patient presents with multiple lacerations on his scalp due to repeated blows from a steel pipe. Which type of injury would you expect to see in the brain with a CT scan ? |
Coup contusions Coup contusions are caused by an impact on the resting, but movable, head by a moving object (in this case the steel pipe) and they are contusions at the site of impact |
|
|
What information has to be provided to a patient, so that the consent he gives can truly be described as 'informed consent'? |
1. Patient must know his/her diagnosis or nature of their condition 2. Informed of planned interventions 3. Possible benefit of this intervention 4. Possible risks or complications 5. Alternatives to this intervention 6. Consequences of not receiving the intervention |
|
|
A doctor is accused of taking a pap smear in a female patient in a sexually suggestive manner. The patient makes a complaint of rape against the doctor at her nearest police office. Critically discuss the merits of this complaint, using two appropriate definitions from the Criminal law (sexual offences and related matters) amendment act. |
Not covered 7 marks |
|
|
A child is brought to the clinic, with complaints that he is sleepy. You notice numerous bruises on the body of the child, but he is otherwise pale. Apparently there is a fracture in the left fore-arm. Which conditions must be included in the differential diagnosis ? |
The history is suggestive of NAIC/child abuse, but other conditions that are also considered as part of the differential include: 1. Shaken Baby Impact Syndrome (a child in this case) 2. Bone abnormalities (especially osteogenesis imperfecta( 3. Vitamin and Mineral deficiencies 4. Haemophilia and other bleeding tendencies 5. Dermatitis 6. A normal 'active and accident prone' child 7. Munchausen's syndrome by proxy |
|
|
Define: Positional asphyxia |
When a person remains in a specific position for a prolonged period of time and his respiratory movements are restricted resulting in death Such as an inebriated person falling between the bed and a wall |
|
|
Define: Bolus death |
Also known as Cafe coronary syndrome When a person dies suddenly without signs of respiratory distress due to a large food bolus - the mechanism is most probably the consequence of vaso-vagal inhibition resulting in sudden cardiac arrest, rather than hypoxia |
|
|
Define: Traumatic asphyxia |
Where there is mechanical fixation of the chest that inhibits respiratory movement |
|
|
Define: Choking |
Choking refers to obstruction of the internal airways between the pharynx and the bifurcation of the trachea (as opposed to smothering which is obstruction of the external airways) |
|
|
Define: Auto-erotic asphyxia |
The practice of sexual asphyxia that accidentally results in the death of the patient |
|
|
Define: Suffocation |
Refers to decrease in oxygen tension in inhaled air or mechanical obstruction to entry of air into the external respiratory orifices |
|
|
Define: Strangulation |
Asphyxia due to force exerted by a ligature on the neck (as opposed to manual strangulation/throttling which is asphyxia due to someone physically trying to strangulate a person with their bare hands) |
|
|
What is the asphyxial mechanism of death for the following scenario ? A man is busy digging a grave, when the ground falls on him. |
Traumatic asphyxia The ground most likely did not allow for adequate movement of his chest wall to allow respiration which resulted in asphyxia and ultimately death |
|
|
What is the asphyxial mechanism of death for the following scenario ? A man is having lunch at an Italian restaurant and gets sudden respiratory distress and immediately falls down dead |
Bolus death/Cafe coronary syndrome A large bolus causes vaso-vagal inhibition resulting in almost immediate death |
|
|
What is the asphyxial mechanism of death for the following scenario ? In theater for an appendicectomy procedure, the anaesthetist set the gas machine as follows: Halothane - 20% CO2 - 50% Oxygen - 10% Nitrogen - 20% The patient dies. |
Suffocation asphyxia Due to the displacement of oxygen by inert gasses resulting in hypoxia and ultimately death |
|
|
What is the asphyxial mechanism of death for the following scenario ? A worker at a wheat farm in Malmesbury goes into a grain silo to test the quality of the grain. He does not come out. |
Suffocation asphyxia ? I do not fully understand the mechanism in this case but I believe it has to do with the displacement of oxygen by inert gasses |
|
|
True or false: Fat soluble poisons are easily excreted through the kidneys |
False This holds true for water-soluble poisons |
|
|
True or false: Small doses of DDT may accumulate in the fatty tissue of the body |
True |
|
|
True or false: An alcoholic with severe liver cirrhosis will show symptoms of DDT poisoning earlier than a healthy individual |
True |
|
|
True or false: The degree of tolerance for poisons is dependent on the LD50 of the specific agent |
False |
|
|
True or false: Red-pink discoloration of the skin might be indicative of CO poisoning, cyanide poisoning or hypothermia |
True ? |
|
|
True or false: The smell of raw almonds is associated with arsenic poisoning |
False ? |
|
|
True or false: Arsenic poisoning may cause subendocardial haemorrhages in the heart |
True ? |
|
|
True or false: Hyperkeratosis of the skin may be indicative of acute arsenic poisoning |
False ? Most likely chronic |
|
|
True or false: The test for the metabolites of cannabis can only be performed on blood serum |
False It can be performed on urine |
|
|
True or false: When organs are sent for toxological analysis, they must be fixed in formalin to prevent decomposition |
False ? |
|
|
True or false: Blood specimens must be taken from the heart in all cases when you are specially testing for poisoning |
False ? |
|
|
True or false: Hair and nails could be analyzed toxologically in cases of suspected chronic arsenic poisoning |
True ? |
|
|
The police give a very strong history that the deceased took an overdose of heroin, but the heroin level in the blood is much lower than that given in your reference book. True or false, this may be explained by: Analytic methods may vary considerably between different laboratories |
False ? |
|
|
The police give a very strong history that the deceased took an overdose of heroin, but the heroin level in the blood is much lower than that given in your reference book. True or false, this may be explained by: The half life of heroin is very short |
True ? |
|
|
The police give a very strong history that the deceased took an overdose of heroin, but the heroin level in the blood is much lower than that given in your reference book. True or false, this may be explained by: The deceased had also taken large amounts of alcohol, the blood results of which you haven't considered yet |
False ? |
|
|
The police give a very strong history that the deceased took an overdose of heroin, but the heroin level in the blood is much lower than that given in your reference book. True or false, this may be explained by: The deceased also suffered from severe chronic obstructive pulmonary disease, which contributed to his death |
False ? |
|
|
True or false: Regarding carbon monoxide poisoning, displaces iron from its position in the haemoglobin molecule, preventing oxygen from binding |
False It does not displace iron |
|
|
True or false: Regarding carbon monoxide poisoning, causes tighter binding of oxygen to the Hb molecule |
True It causes a left shift of the OHEC curve, which means that oxygen is released from Hb molecules less readily |
|
|
True or false: Regarding carbon monoxide poisoning, has a direct effect on the basal ganglia in the brain, with depression of the respiratory centres in the brain |
True Post mortem findings sometimes show cavitation and necrosis of the basal ganglia and also has a depressive effect on the respiratory centres |
|
|
True or false: Regarding carbon monoxide poisoning, binds to the lysosomes in the cell, with direct effect on the cell's oxygen consumption |
False It does not bind to lysosomes, however it is cytotoxic by interfering wit hthe normal function of other ferro-proteins, like myoglobin, and members of the cytochrome family |
|
|
Define: Tramline injuries |
These are blunt force bruises caused by trauma inflicted by a linear or longitudinal object, and consists of two parallel bruise lines due to tearing of the capillaries in this area, and a central unaffected area due to compression of the underlying tissue that is not sufficient enough to cause bruising |
|
|
Explain how the characteristics of skin and its underlying support tissues may affect the appearance of a bruise. |
Skin consists of an outer layer of epithelial cells; a dermal layer with elastic fibres, vasculature and nerve fibres; and a subcutaenous layer offering a cushion for impact to the body. Bruises are the extravascular leaking of blood into the surrounding tissues. Due to the location of most blood vessels in the skin being in the dermis, this is where bruises most commonly occur. The epidermis remains largely uninvolved. The subcutaneous tissue keeps the bleeding moderately localized. |
|
|
Broadly speaking, what are the main factors which influence the initiation and course of decomposition? Give an example of each. |
Body factors: A high water content promotes decomposition, whereas dehydration hinders the process. Presence of infection at TOD promotes decomposition. Newborns decompose slower due to their relative sterility. Environmental factors: A warm, dry climate and a very cold climate suppress putrefaction. Closed rooms with sunshine promote decomposition. The nature of the liquid the body was submerged in has a direct effect (as in the case of salt water perserving bodies). Artificial factors: The use of antibiotics prior to death with hinder the decomposition. Perseveration of the body by means of embalming suppresses microbiological activities. |
|
|
Which brain herniations occur in relation to the tentorium cerebelli ? |
Central herniation Rostral herniation Parahypocampal herniation |
|
|
Classify traumatic intracranial haemorrhages. |
Extradural Subdural Subarachnoid Intracerebral Intraventricular |
|
|
Explain the difference between primary and secondary brain injury and give an example of each. |
Primary brain injury is the injury that occurs at the time of impact. This includes scalp lesions, skull fractures, brain contusions, intracerebral haemorrhages and DAI. Secondary brain injury is the insult that occurs as a consequence of the primary injury and is often preventable and reversible. This includes secondary brain haemorrhage, abscess formation, hypoxic brain damage and secondary bacterial infection. |
|
|
Define: Common law |
Law that is based on custom and judicial precedent rather than statutes |
|
|
Define: Staturory law |
Written law, passed by a body of legislation |
|
|
Define: Constitutional law |
Body of law derived from the contry's written constitution. It is the legal ruler by which all other laws and decisions are measured. |
|
|
Make an annotated sketch of a typical contact gunshot wound over bone. |
This type of gunshot wound is characterized by: 1. Beveling of margins, indicating the direction the bullet moved 2. Splintering of small bony fragments in the direction of the bullet tract |
|
|
Which act regulates the charges applicable to drunken driving ? |
National road traffic act 93 of 1996 |
|
|
Name the charges for which an alleged drunken driver can be charged according to the law. |
Drunk driving arrests can be made in the following cases:
1. While being under the influence of alcohol/drugs and in control of a vehicle (clinical diagnosis of drunkenness while driving) 2. BAC that was not less than 0.05g/100ml, in the 2 hour period after the offence took place 3. A breath alcohol level of not less than 0.24mg/1000ml |
|
|
The practitioner should be very careful not to prescribe alcohol-containing medication to patients who may be recovering alcoholics. List three drugs that contains alcohol. |
Cough syrup Liver tonic Bioplus |
|
|
List ways in which the nature, composition, amount and strength of alcohol may affect the absorption thereof by the mucous membranes of the alimentary track. |
Maximum absorption of alcohol at 10-20% alcohol strengths. Higher would delay absorption due to irritation of gastric viscera. Greater volumes makes more contact with the membrane surface and increases gastric emptying. Absorption of beer is delayed due to lower concetration of alcohol and due to high carb content. Drinks containing gas are absorbed faster (due to surface area) Warm drinks are absorbed faster than cold ones |
|
|
Shortly describe 4 post mortem artefacts in charred bodies. |
1. Extradural haemorrhages ('boiling' blood causes this artefact) 2. Skull fractures ('steaming brain' or heat causes fracture) 3. Burn lacerations to the skin (heat contracts the dermal tissue) 4. Ante- vs post mortem burn wounds 5. Pugilistic attitude of muscles 6. Other fractures due to heat making skeletal tissue more brittle |
|
|
List the reasons why a complete autopsy has to be done on a charred body. |
They are quite obvious: 1. Identity of the victim 2. Whether the person was alive or dead before the fire started 3. To determine the cause of death |
|
|
Which bone structure is the best for determining sex ? |
Skull and pelvis |
|
|
Which bones are the best for determining age ? |
Teeth
or Pubic symphisis and sternal ribs are used. Radiologically looking at the structure of cancellous bone might also help. |
|
|
What other information may be obtained just from examining a skeleton to help with identification ? |
Clothing and jewelry Surgical prosthesis Dentition |
|
|
A patient is admitted to your casualty department following an earthquake. The building in which he was staying collapsed, trapping his legs under rubble. Approximately 36 hours later you are called to the ward because the patient has suddenly become agitated and confused, and is noted to be increasingly short of breath. What is the most likely diagnosis ? |
Fat embolism syndrome |
|
|
What are the physical sins that may assist you in the diagnosis of fat embolism syndrome ? |
Respiratory distress Neurological symptoms Anaemia Thrombocytopenia |
|
|
Explain the pathogenesis of the signs and symptoms of fat embolism syndrome. |
Fat globules enter the circulation through a bone fracture or associated trauma to subcutaneous tissue. These globules lodge in the lung and brain tissue causing the associated symptoms of these systems. Furthermore, the globules cause endothelial irritation further worsening their clinical effects. Platelets also aggregate around these globules, leading to thrombocytopenia and also peticheal haemorrhages. |
|
|
Name and describe four special types of lacerations |
Splitting of the skin: The skin is caught between two relatively hard objects and when struck in the same direction as Langer's lines it causes a clean open split of the skin. Stretch tears: When a heavy, blunt object passes over the skin, it causes extreme stretching and tearing of the skin. Decollement: The subcutaenous tissue is lacerated, with no open injury of the skin, leading to a space where fluid accumulates. Hook lacerations: A protruding object (a hook) lacerates the skin. Patterned lacerations: As seen in blows using the head of a hammer. Blunt penetrating injuries: Penetration of the skin by a relatively blunt object, such as a screwdriver. |
|
|
Define: Tattooing (in terms of gunshot wounds) |
Tatooing is the characteristic appearance caused by burnt and unburnt particles (from the actual firing of the projectile) around a gunshot wound that is present only at 50 cm - 1 m from the gunshot. |
|
|
Give three examples of causes of pseudo-tattooing. |
Missile fragments Fragments of intermediary targets Post-mortem insect bites (ants) Bleeding in hair follicles Medical manopipulation (as seen in stitching) Petichiea |
|
|
Classify the South AFrican legal system based on the origin of the law. |
The hierarchy is as follows: Common Law Statutory Law Constitutional Law Legal precedent |
|
|
Name four clinical findings that may be found in a case of paracetamol overdose. |
The toxic effects are caused by the saturation of the liver's ability to metabolize the substance. They include: 1. Metabolic acidosis 2. Hypoglycaemia 3. Arrhythmias 4. GI bleeding They also include: 1. Fatty change of the liver 2. Peri-portal haemorrhagic necrosis 3. ATN |
|
|
Use a table to distinguish between a subdural and an extradural haemorrhage in terms of appearance and origin. |
Extradural: Arterial haemorrhage, with the most common vessel being the middle meningeal artery, following a lateral skull fracture. A lens shaped haematoma is visible on brain CT. Subdural: Venous haemorrhage, with the bridging veins to the dural sinuses being the vessels involved, usually associated with sudden acceleration/deceleration injuries. On CT scan it shows a haemorrhage that follows the surface of the brain. |
|
|
As an intern, you are requested to examine a person who had allegedly driven while drunk. Name the five most important differential diagnoses that you need to keep in mind. |
Alcohol intoxication Head Injury Shock Hyper/hypoglycaemia Epilepsy (especially medical s/e and post-ictal state) Pathological brain conditions |
|
|
Explain what 'Sudden infant death syndrome' is. |
The sudden and unexpected death of a baby, usually occurring between birth and 2 years. The babies are clinically healthy before death (and at worst with only a minor symptom like mild upper respiratory tract symptoms or a mild gastroinestinal infection). The diagnosis is one of exclusion. No certain cause of death can be found even by means of a thorough death scene investigation, autopsy and laboratory examinations. |
|
|
Give 3 risk factors for SIDS. |
Factors can be divided between mother and child. Maternal: Smoking and substance abuse Anaemia UTI or VD during pregnancy Multiple pregnancies Previous natal complications Maternal age <20 years Baby: LBW One of a twin Premature Weak apgar score at birth unsatisfactory weight gain babies that are not breastfed |
|
|
A 42-year old man with a 10 year history of cirrhosis due to alcohol abuse develops spontaneous bacterial peritonitis. Septic shock develops because of E. coli bacterium, and the man dies within hours after admission to hospital. Comment on the immediate and underlying cause of death in this specific patient. |
The immediate cause of death would be Septic Shock (Escherichia coli bacterium) ; secondary to spontaneous bacterial peritonitis which would be the underlying cause of death. Furthermore, the alcoholic liver cirrhosis is a contributing cause of death but does not really belong in the fatal chain of events. |
|
|
True or false: Round supra orbital margins are suggestive of a male skull |
True If the supra orbital margins were sharp they would be more suggestive of a female skull |
|
|
True or false: A prominent mastoid process is suggestive of a male skull |
True A large, prominent mastoid process is a feature of a male skull whereas a smaller mastoid process is most likely a female skull |
|
|
True or false: A sloping forehead is suggestive of a male skull |
True A more rounded forehead is suggestive of a female skull |
|
|
True or false: Prominent frontal eminences are suggestive of a male skull |
False Small frontal eminences are more suggestive of a male skull |
|
|
True or false: A visible sagital suture is more suggestive of a male skull |
False Visibility of the sutures of the skull has no value in determining the sex of the person it belonged to |
|
|
True or false: A smooth supra orbital margin is more suggestive of a male skull |
False A round supra-orbital margin is more suggestive of a male skull |
|
|
True or false: Small parietal eminences are more suggestive of a male skull |
True Larger parietal eminences are a feature of female skulls |
|
|
True or false: A prominent glabella is associated with a male skull |
True A less prominent one is a feature of female skulls |
|
|
What is Widmark's formula ? |
A formula that is used to calculate the minimum amount of alcohol a person has ingested by using his/her mass in kg (p), concentration of alcohol in the blood expressed as g/100ml (c), and a relative constant called the distribution factor (r). Furthermore, the value calculated with these variables is multiplied by 10. The formula is as follows: A= p x c x r x 10 A= Total mass of alcohol in the body expressed in grams p= Person's weight in Kg c= BAC expressed as g/100ml r= Distribution factor |
|
|
Define: Chop wound |
A type of wounds caused by heavy instruments with serrated edges, such as an axe or machete. The wounds have an incised appearance, with or without tearing characteristics, with an underlying fracture or deep grove in the bone |
|
|
Define: Sixpenny/finger tip bruises |
Bruises caused by fingers of the abuser, usually present in cases of NAIC where the abuser's hands grabbed the body or arms of the child |
|
|
Define: Impression bruise |
A object with a specific pattern leaves a bruise with the same pattern, this helps in identifying the object with which the injury was caused |
|
|
Define: Laceration |
A type of blunt force injury that causes tearing of the skin, usually involving the full thickness of the epidermis and dermis |
|
|
Define: ABrasions |
A type o blunt force injury to specifically the superficial layers of the skin and are caused by a rough object scraping over the surface, or where a body moves while in contact with such surfaces |
|
|
Define: Impression/imprint abrasion |
A type of abrasion where the injury reflects the shape or pattern of the object causing the injury Note - It is not a true reflection of the size of the object due to the skins elasticity |
|
|
Define: Brush abrasion |
A type of abrasion that occurs when the body of a person is dragged along a rough surface, such as in the case where pedestrians are involved in MVA's |
|
|
Define: Incised wounds |
A type of sharp force injury caused by a sharp object interrupting the full thickness of the skin, with a skin wound that is longer than it is deep |
|
|
What are the possible mechanisms of injury that would cause a black eye/peri-orbital haematoma ? |
Secondary effect to scalp bruising Direct trauma to the eye A base of skull fracture |
|
|
True or false: Regarding termination of pregnancy after 20 weeks of gestation, it may be done if it poses a risk to the foetus |
True |
|
|
True or false: Regarding termination of pregnancy after 20 weeks of gestation, it may be done if it was the result of rape or incest |
False
This holds true for pregnancies between 13 and up until 20 |
|
|
True or false: Regarding termination of pregnancy after 20 weeks of gestation, it may be done if the pregnancy will endanger the woman's life |
True |
|
|
True or false: Regarding termination of pregnancy after 20 weeks of gestation, it may be done if the continued pregnancy is associated with sever malformations of the fetus |
True |
|
|
True or false: Regarding termination of pregnancy during the first 12 weeks of gestation, it may be done by a registered midwife |
True |
|
|
True or false: Regarding termination of pregnancy during the first 12 weeks of gestation, minors should be encouraged to consult with their parents |
True |
|
|
True or false: Regarding termination of pregnancy during the first 12 weeks of gestation, consultation with a medical practitioner is required |
False Only if the pregnancy is beyond 13 weeks is consultation required by law |
|
|
True or false: Regarding termination of pregnancy during the first 12 weeks of gestation, Non-mandatory and non-directive counselling should be promoted |
True ? |
|
|
A 26 year old female is admitted to the hospital in severe heart failure. The clinician diagnoses a mitral valve stenosis, and finds out that the lady has had a heart problem since she had a severe sore throat at the age of 5. After that incident she also had a mild degree of chronic glomerulonephritis. During her hospitalisation she also developed pneumonia and died 10 days after admission. Comment on her immediate and underlying cause of death as you would document it in her DNF. |
The patient's immediate cause of death was the pneumonia she developed days before she died. The underlying cause was due to her admission because of her mitral valve stenosis. Her mitral valve stenosis was due to rheumatic fever. The cardiac lesion and the RF has both been present for 21 years. The chronic glomerulonephritis is not an immediate or underlying cause of death as it did not lead to the cascade of events that eventually took the patient's life. Instead it is a contributary cause. |
|
|
True or false: Rigor mortis starts in the smaller muscle groups |
True
Due to smaller joints that immobilize quicker |
|
|
True or false: Rigor mortis may never develop in babies or cachetic bodies |
False
It develops in these cases but not to the extent that it is obviously visible, it happens in these groups of people due to their relatively low muscle mass |
|
|
True or false: Rigor mortis develops faster when there is intense exercise before death |
True
Rigor mortis happens when there is a depletion of ATP in the muscles, thus intense exercise before death prematurely depletes the ATP stores of the muscle tissue and in doing so reduced the time it will take to happen after death |
|
|
True or false: Rigor mortis causes significant shortening of muscles |
False
There is no shortening of muscle fibers, only stiffening that occurs |
|
|
True or false: Rigor mortis develops slower at low temperatures |
True At higher temperatures rigor mortis appears and disappears faster |
|
|
A foetus has a head-heal length of 9cm. What is the estimated gestational age of the foetus, according to Haases rule of thumb ? |
Up to 25cm the length in cm's is the square of the age in months. Thus the square root of 9 is 3, thus the estimated gestational age is 3 months. If however, the length was more than 25cm it is divided by 5 to get the total amount of months for estimated gestational age. |
|
|
True or false: The use of head circumference with reference tables is the best method to determine the gestation of a fetus accurately |
False The best method is using foot length with reference tables |
|
|
True or false: The crown-rump measurement multiplied by 1.618 is the best method to determine the gestation of a fetus accurately |
False The best method is the use of foot length with reference tables |
|
|
True or false: Using the crown-heel measurement with Iscan's table is the best method to determine the gestation of a fetus accurately
|
False The best method is the use of foot length with reference tables |
|
|
True or false: The use of the mass of the fetus with reference tables is the best method to determine the gestation of a fetus accurately |
False The best method is the use of the foot length with reference tables |
|
|
True or false: Use of the foot length with reference tables is the best method to determine the gestation of a fetus accurately |
True |
|
|
A patient has a contusion of the brain's surface. Describe the neuropathological consequences of this condition. |
The mechanism of injury is usually due to a contact blow. The primary injury includes- Skin lacerations of the scalp, skull fractures, contusions/lacerations of the brain or intracranial haemorrhage. Focal secondary injury includes- late haemorrhage, infections or infarctions (mechanism is usually vasospasm). Swelling might occur. These mechanisms include cerebral edema or perfusion swelling of the brain. Consequently this leads to raised intracranial pressure, if there are no successful interventions it will likely lead to brain herniation and ultimately death. |
|
|
True or false: Mummification occurs in cold, dry environments |
True |
|
|
True or false: Antemortem sepsis slows the rate of decomposition |
False Antemortem sepsis is associated with a faster rate of decomposition |
|
|
True or false: Mummification preserves wounds |
True
|
|
|
True or false: Adipocere is often found in immersed bodies |
False |
|
|
True or false: Decomposition occurs faster in soil than in air |
False |
|
|
Create a list of possible causes of sudden unexplained death in adults. |
To make sense of possible causes we divide these causes into the different systems which are most likely to have pathology within them to be responsible for SUDS.
1. Cardiovascular Disease: Vascular Narrowing or Occlusion Muscular Dysfunction Myocarditis Valvular Lesions 2. Intracranial lesions: SUDEP Intracranial haemorrhage Infective causes Intracranial haemorrhage associated with tumours 3. Respiratory system: Asphyxia Haemorrhage from airways Pneumothorax Pulmonary embolism Pneumonia 4. GI tract: Haemorrhage Ruptured enlarged viscera Fulminating diabetic ketoacidosis Acute pancreatitis 5. Urogenital: Complications of pregnancy This is not an extensive list, this is a structure used to guide your thinking process. Think logically and don't be an idiot! Ask yourself if a person could die from something, if it is possible, would they die almost instantaneously, would it fit in with SUDS ? |
|
|
Define: Sudden unexpected death |
Mason defines it as: Sudden unexpected death following so rapidly from the onset of symptoms that the cause of death could not be certified with confidence by a medical practitioner familiar with the patient |
|
|
Classify unnatural deaths in terms of the cases that need to be referred to the forensic pathology service and give appropriate examples of each. |
The four pillars of unnatural death that warrant investigation: Death caused by a force to the body: This includes physical, chemical, traumatic natural and conditions that develop secondary to trauma. Procedure related deaths: Death of a person undergoing, or as a result of, a therapeutic, diagnositc or paliative nature. Sudden and unexpected deaths: SIDS or sudden unexpected death in adults. Acts of omission or co-omission: Any death, including cases that usually would be regarded as a natural death, where there is a suspicion that the death could have been due to action or neglect from the family, responsible doctor or nursing staff. |
|
|
Name 2 acts that regulate the list of unnatural deaths in terms of the cases that need to be referred to the forensic pathology service. |
National health act, 61 of 2003 Section 56 of the Health Professions Amendment Act, 29 of 2007 Inquest act, Section 58 (1959) |
|
|
What is the WHO's definition of sudden death ? |
Any death that occurs within a 24 hour period of onset of symptoms |
|
|
Name 4 complications of myocardial infarction that can cause sudden death. |
Mural thrombosis Rupture of the heart Pericarditis Cardiac aneurysm |
|
|
An infant's cause of death has been stated 'acute asphyxial death due to overlaying by the mother'. Comment on the Doctor's, who executed the autopsy, findings: Post mortem blood oxygen saturation of 75% |
This is a very non-specific finding since cellular respiration may continue after death. |
|
|
An infant's cause of death has been stated 'acute asphyxial death due to overlaying by the mother'. Comment on the Doctor's, who executed the autopsy, findings: Petechial haemorrhages on the lungs and heart |
This is a very non-specific finding. Although these haemorrhages might occur in asphyxial death as a result of attempts to inspire against blocked airways, the typical intra-thoracic haemorrhages found in SIDS should not be confused with asphyxial petichae. |
|
|
Which visceral organs are most commonly injured in cases of NAIC ? |
The liver, and the small intestine (specifically the duodenum and jejunum) - this is due to the small intestine being 'sandwiched' between the anterior abdominal wall and the vertebral column |
|
|
In emergency situations it is not necessary to obtain informed consent for procedures. In this regards, there are four rules to be observed. List them. |
? |
|
|
List 6 factors which would increase the prominence of a bruise. |
Age of the patient - more prominent in young and elderly individuals Sex of the patient - Females bruise easier BMI of the patient - Obese individuals bruise more easily General condition of health - Underlying bleeding diatheses will cause more extensive bruising, as will states of malnutrition Skin colour - It is harder to see bruises in darker skinned individuals Anatomical structure of tissue - As is observed in certain cases where bruises are absent over anterior abdominal wall with underlying visceral damage |
|
|
Explain how a traumatic tension pneumothorax occurs and name two mechanisms whereby a tension pneumothorax may cause death. |
A tension pneumothorax is where a valve-like action is formed by the individual's chest wall which allows for air entry but not to exist, this results in an increasing pressure inside the pleural cavity. Mechanisms of death include the obstruction of venous flow to the heart; furthermore death can be due to pleural adhesions causing parasympathetic stimulation during the pneumothorax leading to sudden death. Traumatic causes include: Barotrauma or stab wounds (and other penetrating injuries). |
|
|
Briefly discuss the medicolegal importance of lividity. |
Lividity/hypostasis: When the blood circulation stops, the stagnant blood will move to the lowest part of the body because of gravity. This causes a discoloration at the lowest parts of the body. Medicolegal importance: Although it can indicate the position of the body at the time it is formed, it does not necesarily indicate the position at death; various factors influence the appearance and visibility (including skin colour, blood viscosity, pressure points and more); the colour can give you information about possible agents of poisoning (such as bright red associated with CO or cyanide, chocolate brown associated with potassium chlorate, spotty bronze due to clostridium perfringes septicaemia, and blue/black/green due to decomposition). It is also important to note that hypostasis is not the same as a bruise, i.e. it is not secondary to some sort of trauma but rather a natural phenomenon. |
|
|
Shortly describe the main systemic complications of burn wounds that can cause death. |
Toxaemia- due to fluid and electrolyte disturbances.
Infections- multiple organ dysfunction due to infection of the burnt tissue. Lungs- Acute respiratory distress syndrome Thrombo-ebmolism- Due to long periods of immobilization Stress ulcers in GI tract- May bleed and perforate Other- Includes ATN, DIC, fat embolism and hepatocellular necrosis. |
|
|
Brain contusions are a common cause of secondary brain injury. Discuss shortly the mechanisms by which brain contusions may arise, as well as the complications that may arise. |
The following are all mechanisms through which brain contusions develop: Fracture associated Impingement contusions Coup contusions Contre-Coup 'Gliding' contusions (technically not contusions but rather tissue tear haemorrhages) Complications, including both that of primary and secondary injury include: Local injuries to the overlying skin, bone (skull), and intracranial haemorrhages; furthermore late haemorrhages, with infections and infarctions may occur. This may progress to perfusion swelling or cerebral edema, consequently leading to raised intracranial pressure then herniation and ultimately death if left untreated. |
|
|
Terminal balistics is a complex component o medical and medico-legal practice. Write short notes on the importance of knowledge of terminal ballistics for the general practitioner. |
Terminal ballistics is the science of moving projectiles that involved what happens to the projectiles at the terminal part of it's course, i.e. when a projectile hits an individual (in our setting of medicine). Terminal ballistics is useful in our case as it can answer a few questions that might be useful. This includes the following: 1. Confirming what projectile hit the person, such as a bullet 2. Whether the wound is truly a gunshot wound 3. Determining the entrance and exit wounds 4. Determining the amount of times the person was hit by projectiles 5. Establishing the direction the projectile hit the individual 6. Determining the course of the projectile 7. Determining the distance at which the projectile was fired from 8. Determining what type of gun and which calibre was used 9. Establishing the manner of death (murder/suicide/accident) |
|
|
The general practitioner can make a significant contribution to the investigation into sudden and unexpected infant death. List four examples thereof. |
The general practitioner can obtain a proper history. Factors that might suggest SIDS include mild respiratory or gastro-intestinal symptoms. Establishing contact with the forensic pathologists to refer the case. Explaining to the parents. ?? |
|
|
Define: Coup phenomenon |
A coup contusion is caused by impact of the resting, but movable, head by a moving object. The lesion consists of a contusion at the site of impact. Example- A cricket bat used to beat an intruder on the head |
|
|
One of the causes of an unnatural death is physical/chemical trauma. Discuss this section of causes. |
Both of these deaths fall under the heading of deaths due to application of force on the body. Physical effects include that which was done by gunshot wounds, stab wounds or blunt force injuries. Chemical trauma refers to death caused by poisons and drugs. |
|
|
The body of a dead baby is found on a dumping site. An autopsy is done. What are the core questions a forensic practitioner has to ask to determine if this is a case of infanticide, abortion or stillbirth ? |
What was the gestational age of the baby, and was it viable ? Did the baby breathe ? If the baby lived, how long did it live ? What was the cause of death ? If the baby was stillborn, why ? How long was the baby dead before it was found ? Who is the mother ? |
|
|
Name four special types of bruises/contusions. |
Impression bruises
Tramline bruises Six-penny/fingertip bruises Peri-orbital haematoma Bite marks Self defence bruises Iatrogenic bruises Self inflicted bruises Spontaneous bruises |
|
|
What is the classical sign in a child that is a victim of NAIC. |
Fingertip or sixpenny bruises caused by the fingers of adults. The bruises are usually all at different ages.
? |
|
|
Discuss shortly how the age of bruises is determined in a case of NAIC. |
By looking at the colour of the bruises an estimated can be kept in mind of the age of patient's bruises. It is important to note that in NAIC the age of the bruises differs from the history given by the parents. It is very hard to determine the actual age of the bruises, it is only important to realise that the bruises may be of different ages. |
|
|
A man presents at your practice and asks for a paternity test. You draw blood for DNA testing. What tube will you send the blood sample in to the lab ? Which documents should accompany this sample ? |
1- The appropriate anticoagulant tube is either EDTA or CPD tubes.
2. Accompanying documents include - an ID book copy of the patient and appropriate informed consent. |
|
|
What signs are found in a body that died during immersion underwater ? |
Signs of immersion are:
Maceration of the skin (wrinkled skin) Cutis anserina (goose flesh) Typical spread of hypostasis in the limbs Mud, oil, silt or sand may be found in or on the body However, these signs are only due to immersion of the body in water and not necisarilly that the patient died due to immersion underwater (i.e. drowning) as the patient may have died before they fell into the water. Signs that suggest more specifically, drowning, include the following: Froth in the airways Typical lung changes Stomach content of water, sand or silt Cataleptic Stiffening Post mortem trauma |
|
|
A worker is found dad after being electrocuted by a high voltage cable. What mechanisms might have led to his death due to the electrocution ? |
The mechanisms of death for fatal electrocution include the following: 1. Cardiac arrhythmias 2. Respiratory arrest 3. Cardiac or respiratory arrest due to current passing through brainstem 4. Intracellular damage to heart and nervous tissue 5. Non-electric trauma - Fall from height or burns 6. Secondary complications - Including sepsis and ATN |
|
|
Name the signs found with autopsy in fat embolism syndrome. |
Post mortem signs of fat embolism syndrome include:
Petechial haemorrhages of the skin and contained within the white matter of the brain (secondary to the thrombocytopaenia associated with the pathogenesis of the syndrome) Signs of trauma that may have lead to the fat embolism - such as the responsible fracture |
|
|
Name the cardiac causes of sudden death in children. |
Cardiac COD are among the most common causes of sudden unexpected death in all age groups, causes in children however are much more often due to other cardiac conditions other than coronary artery disease, unlike in adults. These causes: Cardiomyopathies Genetic connective tissue diseases Conduction diseases Congenital heart defects Myocarditis Long QT syndrome (and other ion channelopathies) Sudden arrhythmic death syndrome |
|
|
An 11 year old child presents at your practice. She is 21 weeks pregnant and wishes to have an abortion. She doesn't want her parents to know anything about her pregnancy or intended abortion. Discuss, in terms of the Choice on Termination of Pregnancy act (No 92 of 1996) how you would council her about- The circumstances under which she may have an abortion at her current gestational age. |
Since the patient is past 20 weeks of gestation, a TOP may only be performed on her if after consultation of a medical practitioner, his/her opinion that the continued pregnancy will: 1. Endanger the woman's life 2. Result in severe malformation of the foetus 3. Would pose a risk of injury to the foetus |
|
|
She is 21 weeks pregnant and wishes to have an abortion. She doesn't want her parents to know anything about her pregnancy or intended abortion. Discuss, in terms of the Choice on Termination of Pregnancy act (No 92 of 1996) how you would council her about- Whether or not she may give informed consent for the procedure without her parent's knowledge or consent. |
In this case the patient is a pregnant minor, I would advise her to consult with her parents before the procedure. Provided that I will not deny her a TOP if she chooses not to consult them. |
|
|
Name 5 circumstances under which informed consent is not required. |
1. In emergency situations (Negotiorum gestio) 2. When a patient suffers from a serious contagious or infectious disease, he can be treated and immunized against his will 3. Therapeutic privilege 4. According to a court order 5. In the case of an arrested person 6. Mnetally retarded persons |
|
|
What is civil and criminal law and how might a doctor be influenced by each ? |
Criminal law transgression results in governmental punishment and has to be proven beyond reasonable doubt. Civil law transgression results in fines or correctional action to the benefit of the plaintiff and one party only has to make a case in balance of probability. |
|
|
Name and describe 4 factors affecting the rate of post-mortem cooling. |
The factors include: Body factors (such as starting temperature, dimensions and posture) Ambient factors- Air Immediate vicinity Fluid medium |
|
|
List 'users' rights. |
? |
|
|
List the differences of fracture of the skull in abused children and normal accidental injuries. |
Children often present with a history of having fallen of the bed. The following characteristics can however help to differentiate between child abuse and minor accidents: 1. Multiple complex fractures 2. Depressed fracture due to a severe blow 3. Maximum width of fracture more than 3mm 4. Growing fracture 5. Fracture that involves more than one bone 6. Fractures that involves bones other than the parietal bone 7. Associated intracranial injury |
|
|
Findings on autopsy during choking compared homocide-related choking ? |
? |
|
|
4 Causes of raised endogenous ethanol levels. |
Tropical thrush Coeliac disease Jejeno-ileal bypass for obesity Gastric infections Intra-gastro-intestinal fementation syndromes |
|
|
List the factors that affect the appearance and disappearance of rigor mortis. |
Factors include the following: Temperature - At higher temperatures the phenomenon appears and disappears faster. Instrinsic factors- 1. Condition of the muscles at the time of death, as in the case of rigorous exercise 2. Appears and disappears faster with younger age Rigort mortis occurs faster in electrocution deaths and disappears faster |
|
|
Translate 'Negotorum gestio' and name 4 things that need to be observed. |
Translated to english (from latin) it means observation. It is one of the instances in which informed consent for a procedure is not necessary. It is however essential that the following is observed: 1. Treatment must be essential 2. Treatment must be in the patient's best interest 3. The treatment may not be against the wishes of the patient 4. Nothing may be done that one would not normally give consent to |
