Internal Examination in Autopsy — MCQs
What is the investigation of choice for blunt abdominal trauma in an unstable patient?
Underwater autopsy of the heart is done in cases of: DNB 09
A girl from the village was found dead in the lake and was taken out. It is a case of ante mortem drowning. All are true about this case except?
Blunt trauma to right side of chest, hyperresonance on right side on percussion, dyspnea, tachypnea. Heart rate-100, BP-120/80, best initial diagnostic step is
Virchow's method of organ removal is:
Duret haemorrhage is/are seen in
In an ultrasound of the abdomen, which structure is best seen posterior to the stomach?
Postmortem examination of the stomach is done after:
On conducting the autopsy on a victim of hanging, the ligature mark is seen at the lower 1/3rd of the neck. The victim is seen to have a protruded tongue. He was found with his head hanging to his left side with saliva dribbling from the left angle of his mouth. The right pupil appears constricted and there is ptosis (drooping) of the right eyelid. Compression of which of the following structures is the most probable reason for the unilateral ptosis in this case?
During an autopsy of a decomposed body, the forensic pathologist notes marbling of the skin, bloating, and a green discoloration of the abdomen. Based on these findings, which of the following best estimates the postmortem interval?
Internal Examination in Autopsy Indian Medical PG Practice Questions and MCQs
Question 1: What is the investigation of choice for blunt abdominal trauma in an unstable patient?
- A. X-ray abdomen
- B. MRI
- C. USG (Correct Answer)
- D. Diagnostic Peritoneal Lavage (DPL)
Explanation: ***USG (FAST Exam)*** - In an **unstable patient** with blunt abdominal trauma, **Focused Assessment with Sonography for Trauma (FAST) exam** is the investigation of choice. - It is **rapid, non-invasive, and bedside**, allowing immediate detection of **free fluid** (blood) in the peritoneal cavity, pericardium, and pleural spaces without transporting the patient. - Guides immediate decision for **laparotomy** in hemodynamically unstable patients. - **Note:** In **stable patients**, **CT abdomen** is the gold standard as it provides detailed anatomical information, but it requires patient transport and time. *X-ray abdomen* - Provides limited information in blunt trauma, primarily showing **free air** (bowel perforation) or **bony fractures**. - **Not sensitive** for detecting intraperitoneal bleeding, which is the primary concern in unstable patients. *MRI* - Offers excellent soft tissue detail but is **time-consuming** and requires the patient to be **hemodynamically stable**. - **Impractical** for unstable trauma patients requiring rapid assessment and intervention. *Diagnostic Peritoneal Lavage (DPL)* - An **invasive procedure** that is sensitive for detecting intra-abdominal hemorrhage. - Has largely been **replaced by FAST exam** in most trauma centers due to FAST being non-invasive, rapid, and repeatable. - DPL has a **higher false-positive rate** and cannot identify the source of bleeding.
Question 2: Underwater autopsy of the heart is done in cases of: DNB 09
- A. Pneumothorax
- B. Air embolism (Correct Answer)
- C. Pulmonary embolism
- D. Myocardial infarction
Explanation: ***Air embolism*** - An underwater autopsy of the heart is specifically performed to detect **air embolism**. The heart, or parts of it, are submerged in water during incision, allowing any gas (air) released to be observed as bubbles rising to the surface. - This technique helps confirm the presence of **intracardiac air**, which is crucial in diagnosing fatal air embolism. *Pneumothorax* - While pneumothorax involves the presence of air, it occurs in the **pleural space**, not within the heart. - Diagnosis of pneumothorax at autopsy primarily involves checking for **collapsed lung lobes** and gas in the pleural cavity, not specific cardiac examination. *Pulmonary embolism* - Pulmonary embolism involves a **blood clot** (thrombus) obstructing pulmonary arteries, not air. - Autopsy diagnosis focuses on identifying the **thrombus** within the pulmonary vasculature. *Myocardial infarction* - Myocardial infarction is characterized by **heart muscle necrosis** due to ischemia, not air. - Diagnosis involves macroscopic and microscopic examination of the **myocardium** for signs of infarction such as pallor, hemorrhage, or inflammatory infiltrates.
Question 3: A girl from the village was found dead in the lake and was taken out. It is a case of ante mortem drowning. All are true about this case except?
- A. Froth on nose and mouth
- B. Cadaveric spasm in hand muscle
- C. Washerman hand and finger (Correct Answer)
- D. Water in the stomach
- E. Diatoms test positive
Explanation: ***Washerman hand and finger*** - **Washerman's hand and feet** (cutis anserina) refers to the wrinkled, sodden appearance of skin on the palms and soles due to prolonged immersion in water. - This is a **post-mortem change** that develops after death as a result of water absorption into the skin, typically appearing after **2-3 hours** of immersion. - While it indicates immersion in water, it does **not specifically signify ante-mortem drowning** as it can occur in bodies submerged after death (post-mortem submersion). - This is the **correct answer** to the "except" question as it is not a vital sign of ante-mortem drowning. *Froth on nose and mouth* - **Fine, white, tenacious froth** (mushroom-like foam) at the nose and mouth is a classic sign of **ante-mortem drowning**. - Results from violent mixing of air, mucus, and water in the airways during respiratory efforts while drowning. - This is a **vital sign** indicating the person was alive during submersion. *Cadaveric spasm in hand muscle* - **Cadaveric spasm** (instantaneous rigor mortis) can occur in **ante-mortem drowning** when the victim grasps objects like weeds, mud, or clothes in the final moments before death. - This represents a **vital phenomenon** reflecting a final act of vitality and strongly suggests the person was alive and conscious at the moment of submersion. *Water in the stomach* - Presence of water in the stomach is a common finding in **ante-mortem drowning** as the victim actively swallows water during the struggle and aspiration phase. - Indicates **vital swallowing** during life, supporting the diagnosis of ante-mortem drowning. - Typically, more than **500 mL** of water in stomach suggests ante-mortem drowning.
Question 4: Blunt trauma to right side of chest, hyperresonance on right side on percussion, dyspnea, tachypnea. Heart rate-100, BP-120/80, best initial diagnostic step is
- A. Needle decompression
- B. Chest X-ray (Correct Answer)
- C. O2 inhalation
- D. IV fluids
Explanation: ***Chest Xray*** - The symptoms (blunt chest trauma, dyspnea, tachypnea, hyperresonance on percussion) are highly suggestive of a **pneumothorax**. - A **Chest X-ray** is the **best initial diagnostic step** to confirm the diagnosis, determine its size, and rule out other life-threatening conditions like hemothorax or tension pneumothorax. *Needle decompression* - This is a **therapeutic intervention** for a **tension pneumothorax**, not a diagnostic step. - While the symptoms are concerning, without confirmation of a tension pneumothorax (e.g., severe hypotension, tracheal deviation, absent breath sounds), empirical needle decompression is not the first step. *O2 inhalation* - **Oxygen administration** is a supportive measure for dyspnea and hypoxemia but does not diagnose the underlying cause of the respiratory distress. - While often given immediately, it's not the primary diagnostic step to understand the chest injury. *IV fluids* - **Intravenous fluids** are used to manage hypovolemia or shock, which is not indicated by the patient's current stable blood pressure (120/80 mmHg). - There is no clinical evidence of significant blood loss or dehydration from the provided information to warrant IV fluids as the best initial step.
Question 5: Virchow's method of organ removal is:
- A. In situ removal
- B. Organs removed one by one (Correct Answer)
- C. Minimal invasive autopsy
- D. Organs removed en masse
Explanation: ***Organs removed one by one*** - Virchow's method involves the **removal and examination of each organ individually**, allowing for detailed assessment of isolated pathologies. - This systematic approach helps in identifying specific organ lesions and pathologies without damage to other organs, as is the case when they are removed in groups or en masse. *In situ removal* - This method implies that organs are **examined within the body cavity** without being fully extracted. - While some initial observations can be made in situ, a thorough examination as required by Virchow's method necessitates the complete removal of each organ. *Minimal invasive autopsy* - **Minimally invasive autopsies** involve techniques like imaging (CT, MRI) and biopsies, aiming for less disruption to the body. - This approach fundamentally differs from Virchow's traditional technique which involves a **full dissection and individual organ removal**. *Organs removed en masse* - The **en masse removal technique** (e.g., Ghon or Letulle methods) involves extracting blocks of organs connected by anatomical relationships. - This contrasts with Virchow's method, which emphasizes **individual organ removal** to avoid obscuring localized findings.
Question 6: Duret haemorrhage is/are seen in
- A. Brain (Correct Answer)
- B. Conjunctiva
- C. Pericardium
- D. Middle ear
Explanation: ***Brain*** - **Duret hemorrhages** are small, linear areas of hemorrhage found in the **midbrain** and **pons**. - They are typically associated with severe **transtentorial herniation**, where compression of brain tissue leads to stretching and tearing of small perforating arteries [1]. *Conjunctiva* - **Conjunctival hemorrhages** are superficial bleeding in the eye, often caused by minor trauma, coughing, or straining. - They are **unrelated** to Duret hemorrhages, which are specific to brainstem injury. *Pericardium* - **Pericardial hemorrhage** refers to bleeding into the sac surrounding the heart, which can lead to **cardiac tamponade**. - This condition is distinct from neurological hemorrhages and has different etiologies, such as trauma or rupture of an aneurysm. *Middle ear* - Hemorrhage in the middle ear, known as **hemotympanum**, typically results from trauma, such as a **basilar skull fracture**, or barotrauma. - It involves the ear and hearing apparatus, **not the brainstem**, and is unrelated to Duret hemorrhages.
Question 7: In an ultrasound of the abdomen, which structure is best seen posterior to the stomach?
- A. Pancreas (Correct Answer)
- B. Gallbladder
- C. Spleen
- D. Liver
Explanation: ***Pancreas*** - The **pancreas** is retroperitoneal and lies transversely across the posterior abdominal wall, making it located directly posterior to the stomach. - In ultrasound, the stomach, when filled with fluid, can act as an acoustic window to visualize the pancreas behind it. *Gallbladder* - The **gallbladder** is typically nestled in a fossa on the inferior surface of the liver, anterior to the duodenum and often anterior or inferior to the stomach [1]. - It is not positioned directly posterior to the stomach, but rather more to the right and inferior [1]. *Spleen* - The **spleen** is located in the left upper quadrant, superior and posterior to the stomach, but typically more lateral and posterior than directly behind it. - While it has a close relationship with the stomach, it is usually not considered "best seen posterior to the stomach" in the same straight-on fashion as the pancreas. *Liver* - The **liver** is primarily located in the right upper quadrant, largely anterior and superior to the stomach. - While a small portion of the left lobe of the liver can be anterior to the stomach, the bulk of the liver is not posterior to it.
Question 8: Postmortem examination of the stomach is done after:
- A. Double ligation (Correct Answer)
- B. Triple ligation
- C. Single ligation
- D. Cut open
Explanation: ***Double ligation*** - **Double ligation** of the esophagus minimizes spillage of stomach contents during organ removal and dissection, preserving the integrity of the collected sample. - This technique helps prevent contamination of other organs and the examination area, which is crucial for accurate **postmortem analysis**. *Triple ligation* - While technically more secure, **triple ligation** is generally not considered necessary for routine postmortem stomach removal due to the practicality of the procedure. - The added effort and time for a third ligature provide minimal additional benefit beyond **double ligation** in preventing spillage. *Single ligation* - **Single ligation** of the esophagus is insufficient and carries a high risk of stomach content spillage during organ manipulation. - This method is inadequate for ensuring the **integrity of the gastric sample** and preventing contamination of other organs. *Cut open* - Simply **cutting open** the stomach or esophagus prior to removal and proper isolation would lead to immediate and extensive spillage of stomach contents. - This approach would severely compromise the postmortem examination by contaminating other organs and making it difficult to assess the **gastric contents accurately**.
Question 9: On conducting the autopsy on a victim of hanging, the ligature mark is seen at the lower 1/3rd of the neck. The victim is seen to have a protruded tongue. He was found with his head hanging to his left side with saliva dribbling from the left angle of his mouth. The right pupil appears constricted and there is ptosis (drooping) of the right eyelid. Compression of which of the following structures is the most probable reason for the unilateral ptosis in this case?
- A. Left vagus nerve
- B. Right internal jugular vein
- C. Right internal carotid artery
- D. Cervical sympathetic chain (Correct Answer)
Explanation: ***Cervical sympathetic chain*** - The combination of **unilateral ptosis**, **miosis** (constricted pupil), and sometimes **anhidrosis** (lack of sweating) is characteristic of **Horner's syndrome**, which results from damage to the **cervical sympathetic chain**. - Hanging can cause compression or injury to this chain, leading to the observed **Horner's syndrome** on the ipsilateral side of the injury. *Left vagus nerve* - Compression of the **vagus nerve** is associated with cardiac arrhythmias, bradycardia, or gastric disturbances, not directly with ptosis. - The symptoms observed are specific to sympathetic dysfunction, not parasympathetic vagal stimulation. *Right internal jugular vein* - Compression of the **internal jugular vein** would cause venous congestion and edema in the head and neck, not neurological signs like ptosis or miosis. - While it can be injured in hanging, it does not directly explain the specific neurological findings. *Right internal carotid artery* - Compression of the **internal carotid artery** could lead to cerebral ischemia or stroke symptoms, such as weakness or sensory deficits, but not typically isolated ptosis and miosis. - The observed symptoms point to a specific sympathetic pathway disruption rather than arterial occlusion.
Question 10: During an autopsy of a decomposed body, the forensic pathologist notes marbling of the skin, bloating, and a green discoloration of the abdomen. Based on these findings, which of the following best estimates the postmortem interval?
- A. 7-10 days
- B. 1-2 months
- C. 2-3 weeks
- D. 3-5 days (Correct Answer)
Explanation: ***3-5 days*** - The combination of **marbling of the skin**, **bloating**, and **green discoloration of the abdomen** are classic signs of early to moderate putrefaction. These changes typically become evident within **3 to 5 days** postmortem in temperate environments. - **Green discoloration** of the abdomen is usually the first visible sign of putrefaction, appearing within 24-48 hours, followed by **bloating** due to gas production and then **marbling** as bacterial decomposition spreads through blood vessels. *7-10 days* - By **7-10 days**, decomposition would likely be more advanced, with prominent desquamation (**skin slipping**) and potentially the formation of **blisters** filled with putrefactive fluid, which are not explicitly mentioned here. - While these changes can occur within this timeframe, the observed combination specifically points to an earlier stage than a full week. *1-2 months* - At **1-2 months**, the body typically enters the **skeletonization** stage, with significant loss of soft tissues due to insect activity and continued bacteria. - The findings described (bloating, marbling, green discoloration) represent early putrefactive changes, not the advanced decomposition seen after several weeks or months. *2-3 weeks* - By **2-3 weeks**, extensive **bloating** and **tissue liquefaction** would be expected, and the body may begin to show signs of **maggot activity** if exposed to insects. - The described findings are characteristic of a less advanced stage of decomposition compared to this longer interval.
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