Choking — MCQs
The friend and victim had alcohol and got into an argument over a common girlfriend, following which the friend kills the victim by sitting on his chest and covering his nose and mouth. This is an example of?
A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?
Burking includes:
Tardieu spots are a feature of which of the following forms of death?
What is the term used for choking of the respiratory passage by a bolus of food?
A female was found dead in her bedroom. The room was not locked from inside. Her blood alcohol value was found to be 350 mg/dL. The picture taken at the post mortem is shown below. The diagnosis is? (AIIMS Nov 2018, AIIMS Nov 2017)
Which of the following conditions is not associated with an increased risk of malignancy?
Death of a person due to compression of the neck by another person is:
Which of the following is NOT a feature of ligature strangulation?
The Spanish windlass, a method historically used for execution, is a type of what?
Choking Indian Medical PG Practice Questions and MCQs
Question 1: The friend and victim had alcohol and got into an argument over a common girlfriend, following which the friend kills the victim by sitting on his chest and covering his nose and mouth. This is an example of?
- A. Gagging
- B. Smothering (Correct Answer)
- C. Choking
- D. Throttling
Explanation: ***Smothering*** - This scenario describes **manual obstruction** of the mouth and nose, preventing air entry without external neck compression. - The act of sitting on the chest further restricts respiratory movements, contributing to **asphyxia**. *Gagging* - Gagging refers to the obstruction of the **oral cavity** due to material placed inside the mouth, typically to prevent speaking or crying out. - While it can contribute to asphyxia, the primary mechanism described here involves external covering of both nose and mouth. *Choking* - Choking involves the **internal obstruction** of the airway, usually by a foreign body lodged in the pharynx or larynx. - This scenario explicitly details external occlusion of the respiratory orifices, not internal blockage. *Throttling* - Throttling is a form of **manual strangulation** that involves direct compression of the neck by hands or forearm. - The description of covering the nose and mouth rather than compressing the neck rules out throttling.
Question 2: A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?
- A. FB in larynx
- B. Angioneurotic edema (Correct Answer)
- C. Parapharyngeal abscess
- D. FB bronchus
Explanation: Andioneurotic edema - The combination of **tongue swelling**, **neck swelling**, **stridor**, and **hoarseness of voice** following peanut ingestion is highly suggestive of **angioneurotic edema**, a severe allergic reaction that can lead to airway obstruction [1]. - This is a life-threatening condition requiring immediate medical intervention, often associated with generalized **anaphylaxis** when triggered by allergens [2]. *FB in larynx* - While a **foreign body (FB) in the larynx** can cause stridor and hoarseness, the widespread swelling of the tongue and neck points away from a localized laryngeal obstruction [3]. - A laryngeal FB would typically be associated with a more sudden onset of choking and coughing, not diffuse edema [3]. *Parapharyngeal abscess* - A **parapharyngeal abscess** would typically present with **fever**, **severe throat pain**, and **trismus** (difficulty opening the mouth), which are not mentioned in this scenario. - The acute, rapid onset of symptoms after peanut consumption is inconsistent with the slower progression of an abscess. *FB bronchus* - A **foreign body in the bronchus** would primarily cause **coughing**, **wheezing**, and possibly **respiratory distress**, often unilateral, rather than severe global swelling of the tongue and neck. - Inspiratory stridor and hoarseness are more indicative of upper airway involvement than bronchial obstruction.
Question 3: Burking includes:
- A. Ligature strangulation
- B. Drowning mechanism
- C. Hanging technique
- D. Chest compression and airway obstruction (Correct Answer)
Explanation: ***Chest compression and airway obstruction*** - Burking is a **homicidal method** of suffocation that involves **covering the mouth and nose** (airway obstruction) combined with **compressing the chest or abdomen** to prevent breathing. - Named after **William Burke**, this technique was used to kill victims without leaving obvious signs of violence, making deaths appear natural. *Ligature strangulation* - Involves using a **cord, rope, or similar object** around the neck to compress blood vessels and/or airway. - Leaves characteristic **ligature marks** on the neck, which burking aims to avoid by using manual compression instead. *Drowning mechanism* - Involves **submersion in liquid** causing respiratory impairment and asphyxia. - Completely different mechanism from burking, which involves **manual suffocation** on dry land without water involvement. *Hanging technique* - Hanging involves **suspension of the body by the neck**, causing death through compression of neck structures. - This is completely different from burking and leaves distinct **hanging marks** on the neck, which burking specifically avoids.
Question 4: Tardieu spots are a feature of which of the following forms of death?
- A. Cyanide poisoning
- B. Mechanical asphyxia (Correct Answer)
- C. Cobra bite
- D. Organophosphate poisoning
Explanation: ***Mechanical asphyxia*** - **Tardieu spots** are **petechial hemorrhages** that occur due to increased intravascular pressure and capillary rupture, a characteristic finding in deaths caused by **mechanical asphyxia** (e.g., strangulation, hanging, traumatic asphyxia). - These spots are most commonly found in the **skin of the face and conjunctivae**, and in the pleura, pericardium, and thymus in the case of intense venous congestion from severe compression. *Cyanide poisoning* - Cyanide poisoning typically presents with a **pinkish skin color** due to high oxygen saturation in venous blood. - The characteristic odor of **bitter almonds** may be detectable. *Cobra bite* - Cobra bites are characterized by **neurotoxic effects**, leading to paralysis, respiratory failure, and ptosis. - Local effects include swelling, pain, and tissue necrosis, but not typically widespread petechial hemorrhages. *Organophosphate poisoning* - Organophosphate poisoning causes a **cholinergic crisis** with symptoms like salivation, lacrimation, urination, defecation, gastrointestinal upset, and emesis (SLUDGE syndrome) due to acetylcholinesterase inhibition. - It does not typically cause Tardieu spots as a primary post-mortem finding.
Question 5: What is the term used for choking of the respiratory passage by a bolus of food?
- A. Gagging
- B. Choking due to obstruction
- C. Cafe Coronary (Correct Answer)
- D. Suffocation due to food
Explanation: ***Cafe Coronary*** - This term describes sudden death caused by **obstruction of the airway by food**, often mistaken for a heart attack due to the sudden collapse. - It specifically refers to choking on food that leads to **asphyxiation**, frequently occurring in public eating places. *Gagging* - **Gagging** is a protective reflex that prevents objects from entering the throat or causing choking, but it doesn't describe the choking event itself. - It usually involves involuntary contractions of the pharynx and soft palate, often leading to **retching**. *Choking due to obstruction* - This is a general term for **airway obstruction** by anything, while "cafe coronary" specifically refers to food. - While accurate, it lacks the specific medical terminology used to describe food-induced fatal choking. *Suffocation due to food* - **Suffocation** is a broader term for oxygen deprivation, which can be caused by various means, not exclusively food. - While food can lead to suffocation, the term **"cafe coronary"** is more precise for the scenario of sudden death from food lodged in the respiratory passage.
Question 6: A female was found dead in her bedroom. The room was not locked from inside. Her blood alcohol value was found to be 350 mg/dL. The picture taken at the post mortem is shown below. The diagnosis is? (AIIMS Nov 2018, AIIMS Nov 2017)
- A. Traumatic asphyxia
- B. Throttling (Correct Answer)
- C. Café coronary
- D. Bansdola
Explanation: ***Throttling*** - The autopsy image shows extensive **internal hemorrhage** and disruption of neck structures, consistent with significant compressive force applied to the neck by hands, as seen in **throttling**. - **Throttling** (manual strangulation) causes deep internal injuries including fractured **hyoid bone**, damaged **thyroid cartilage**, and **strap muscle hemorrhage**, even when external marks may be minimal or absent. - The high blood alcohol level (350 mg/dL - severe intoxication) would have impaired her ability to resist, and the unlocked room suggests **homicidal** intent rather than suicide. - Key autopsy findings: **deep neck muscle hemorrhage**, **laryngeal fractures**, and **torn blood vessels** without a ligature pattern. *Traumatic asphyxia* - Traumatic asphyxia results from severe **chest/thoracic compression** leading to acute venous congestion in the head and neck region. - Classical signs include **petechial hemorrhages** on face and conjunctivae, **cyanosis** above compression level, and relatively **intact neck structures** on autopsy. - The severe internal neck damage shown in the autopsy image is **not characteristic** of traumatic asphyxia, which primarily affects superficial vessels due to back-pressure, not deep structural injury. *Café coronary* - **Café coronary** is sudden death from **food bolus aspiration** causing airway obstruction, commonly occurring in intoxicated individuals who cannot protect their airway. - Autopsy findings would show an **obstructing food bolus in the larynx/trachea** without the extensive neck trauma and hemorrhage depicted in the image. - No manual strangulation injuries would be present. *Bansdola* - **Bansdola** is a traditional method of strangulation using a **bamboo stick or rod** twisted across the neck with a rope, used historically as torture or execution. - It causes a characteristic **linear ligature mark** with underlying soft tissue injury in a horizontal pattern across the neck. - The autopsy findings in the image show **diffuse manual strangulation injury** rather than the specific linear pattern of ligature strangulation seen in Bansdola.
Question 7: Which of the following conditions is not associated with an increased risk of malignancy?
- A. Down's syndrome
- B. Turner syndrome (Correct Answer)
- C. Noonan syndrome
- D. Klinefelter syndrome
Explanation: **Explanation:** The question evaluates the association between chromosomal aneuploidies and the risk of malignancy. While many genetic syndromes predispose individuals to cancer due to genomic instability or hormonal imbalances, **Turner Syndrome (45, XO)** is generally **not** associated with an overall increased risk of malignancy compared to the general population. In fact, the risk of breast cancer is significantly lower in Turner patients due to ovarian dysgenesis and low estrogen levels. The only specific risk is a **gonadoblastoma**, which occurs only if there is cryptic Y-chromosome mosaicism (45,X/46,XY). **Analysis of Options:** * **Down’s Syndrome (Trisomy 21):** Strongly associated with a 10–20 fold increased risk of **Acute Leukemia** (AMKL/M7 in children <3 years and ALL in older children). * **Noonan Syndrome:** Often called "Pseudo-Turner," this autosomal dominant condition is associated with an increased risk of **Juvenile Myelomonocytic Leukemia (JMML)** and certain solid tumors like neuroblastoma. * **Klinefelter Syndrome (47, XXY):** These patients have a significantly higher risk of **Breast Cancer** (20–50 times higher than normal males) and **Extragonadal Germ Cell Tumors** (specifically mediastinal teratomas). **NEET-PG High-Yield Pearls:** 1. **Turner Syndrome:** Most common cause of primary amenorrhea; characterized by "streak ovaries," webbed neck, and coarctation of the aorta. 2. **Klinefelter Syndrome:** Most common cause of male hypogonadism and infertility; associated with taurodontism. 3. **Cancer Association:** Always remember the "Down-Leukemia" and "Klinefelter-Breast Cancer" links, as these are frequent examiners' favorites.
Question 8: Death of a person due to compression of the neck by another person is:
- A. Hanging
- B. Asphyxiation due to throttling (Correct Answer)
- C. Strangulation
- D. Asphyxia
Explanation: **Explanation:** The correct answer is **Asphyxiation due to throttling**. Throttling is a form of manual strangulation where the neck is compressed using the hands, fingers, or other limbs (like the forearm in a "chokehold"). By definition, it is a **homicidal** act because it requires the physical force of another person to compress the airway and neck structures. **Analysis of Options:** * **Hanging (A):** This is a form of ligature strangulation where the pressure on the neck is applied by a constricting band tightened by the **gravitational weight of the body** itself. It is most commonly suicidal. * **Strangulation (C):** While throttling is a subtype of strangulation, "Strangulation" as a general term usually refers to **Ligature Strangulation**, where a cord or wire is used. Throttling is the more specific and accurate term for compression by "another person" using manual force. * **Asphyxia (D):** This is a broad physiological state (lack of oxygen) rather than a specific mechanism of death. It is the result, not the method. **High-Yield NEET-PG Pearls:** * **Bruising Pattern:** In throttling, look for **"Six-penny bruises"** (discoid contusions) caused by fingertips and linear abrasions caused by fingernails. * **Fractures:** The **Hyoid bone** is more frequently fractured in manual strangulation (throttling) than in hanging, especially the greater cornua. * **Internal Findings:** Extensive bruising of neck muscles and soft tissues is a hallmark of throttling, whereas hanging often shows minimal internal tissue damage. * **Manner of Death:** Throttling is **always homicidal**. Hanging is usually suicidal (except for judicial hanging).
Question 9: Which of the following is NOT a feature of ligature strangulation?
- A. Horizontal ligature mark
- B. Incomplete ligature mark (Correct Answer)
- C. Marked congested face
- D. Sub-conjunctival hemorrhage
Explanation: **Explanation:** In forensic medicine, distinguishing between hanging and ligature strangulation is a high-yield competency. The correct answer is **B (Incomplete ligature mark)** because this is a characteristic feature of **hanging**, not strangulation. 1. **Why "Incomplete ligature mark" is the correct answer:** In hanging, the body's weight acts as the force, pulling the ligature upwards toward the point of suspension (knot). This creates a "gap" in the mark, making it **incomplete and oblique**. In contrast, in **ligature strangulation**, the force is applied manually and circumferentially. The ligature is usually tightened around the entire neck, resulting in a **complete, horizontal mark** situated at or below the level of the thyroid cartilage. 2. **Analysis of Incorrect Options:** * **A. Horizontal ligature mark:** This is a classic feature of strangulation. Unlike hanging (where the mark is oblique), the pressure in strangulation is applied perpendicular to the axis of the neck. * **C & D. Marked congested face and Sub-conjunctival hemorrhage:** These are prominent in strangulation. Because the pressure is maintained and often exceeds both venous and arterial pressure, there is severe venous congestion and a rise in capillary pressure, leading to a "cyanosed and bloated" appearance with petechial hemorrhages (Tardieu spots). In hanging, these features are often less pronounced due to the rapid cessation of cerebral circulation. **High-Yield Clinical Pearls for NEET-PG:** * **Hyoid Bone Fracture:** More common in strangulation (inward compression) than in hanging (outward traction). * **Fracture of Thyroid Cartilage:** More common in strangulation. * **Mode of Death:** Hanging is usually suicidal; Ligature strangulation is almost always **homicidal**. * **Exception:** A "complete" mark in hanging can occur if a running noose is used.
Question 10: The Spanish windlass, a method historically used for execution, is a type of what?
- A. Bansdola
- B. Mugging
- C. Garrotting (Correct Answer)
- D. Hanging
Explanation: **Explanation:** The **Spanish windlass** is a specific historical technique of **Garrotting** (Option C). In this method, a cord or iron collar is placed around the victim's neck and tightened by twisting a stick or a handle (the windlass mechanism) placed at the back. This causes rapid constriction of the neck, leading to death via asphyxia and obstruction of cerebral blood flow. **Analysis of Options:** * **Garrotting (Correct):** It is a form of strangulation where a ligature is tightened around the neck by a twisting mechanical force or a lever. While historically an execution method, modern "garrotting" often refers to sudden attacks from behind using a wire or cord. * **Bansdola (Incorrect):** This is a form of strangulation unique to India where the neck is compressed between two strong wooden sticks (usually bamboo), which are tied together at both ends. * **Mugging (Incorrect):** This refers to strangulation caused by compressing the victim's neck within the crook of the elbow or forearm (stranglehold). It is a form of manual/ligature-free strangulation. * **Hanging (Incorrect):** This is a form of asphyxial death caused by suspension of the body by a ligature, where the constricting force is the body's own weight. **High-Yield Pearls for NEET-PG:** * **Post-mortem findings:** In garrotting, the ligature mark is usually **horizontal**, continuous, and situated below the thyroid cartilage (unlike hanging, which is typically oblique and non-continuous). * **Fractures:** Fractures of the hyoid bone and thyroid cartilage are more common in garrotting and manual strangulation than in hanging. * **Burking:** A combination of traumatic asphyxia (chest compression) and smothering (closing nose/mouth).
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