Histopathology in Autopsies — MCQs
Earliest light microscopic change in myocardial infarction is:
Which of the following is not a feature of postmortem staining?
During autopsy of a fetal death case, what is the correct order of examination to differentiate between live birth and stillbirth?
All of the following special histology stains are used to demonstrate H. pylori in gastric biopsies, except:
What does Prussian blue staining specifically detect in histology?
During autopsy for virology study which agent is used for storing tissue:
After a postmortem examination, the body has to be handed over to
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
Most reliable sign of drowning in decomposed bodies?
Tattoo is not visible on autopsy. But the presence of tattoo was informed by relative. What is the next site to check?
Histopathology in Autopsies Indian Medical PG Practice Questions and MCQs
Question 1: Earliest light microscopic change in myocardial infarction is:
- A. Waviness of the fibers (Correct Answer)
- B. Neutrophilic infiltration
- C. Phagocytic infiltration
- D. Coagulative necrosis
Explanation: ***Waviness of the fibers*** - The earliest light microscopic change in myocardial infarction is **waviness of the fibers**, which occurs within **30 minutes** post-infarction [1]. - This change indicates an initial response to ischemic injury, manifesting as **disruption in the alignment** of muscle fibers. *Coagulative necrosis* - Coagulative necrosis appears later, typically **within a few hours** to days after the onset of infarction, indicating **tissue death** due to lack of blood supply [1]. - This change is characterized by **loss of cellular outlines** and preservation of the overall tissue architecture, which is not the earliest finding. *Phagocytic infiltration* - Phagocytic infiltration, involving macrophages, occurs **days later**, following neutrophilic infiltration, and reflects the body's **cleanup process** post-necrosis. - This response is not seen until the **acute phase** of myocardial injury has progressed further. *Neutrophilic infiltration* - Neutrophilic infiltration generally starts about **4 to 6 hours** after infarction, signifying an inflammatory response but is not the earliest light microscopic change [1]. - This process involves **recruitment of immune cells** to the site of injury, reflecting ongoing damage rather than initial changes [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 552. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 548-550.
Question 2: Which of the following is not a feature of postmortem staining?
- A. Common in dependent part
- B. Appears uniformly throughout the body
- C. Occurs immediately after death (Correct Answer)
- D. Margins are sharp
Explanation: ***Occurs immediately after death*** - **Livor mortis** (postmortem staining/lividity) does NOT occur immediately after death - it typically begins **20-30 minutes** after death and becomes fully developed within **6-12 hours** - This is the correct answer as it represents a feature that is NOT characteristic of postmortem staining - The delay occurs because it takes time for blood to settle in capillaries due to gravity after circulation stops *Common in dependent part* - This IS a hallmark feature of postmortem staining - Gravity causes blood to pool in the **lowest parts of the body** (dependent areas) - Areas of pressure (where body contacts surface) appear pale due to **capillary compression** *Appears uniformly throughout the body* - This is also NOT a feature of postmortem staining (could be considered another correct answer) - Postmortem staining is **localized to dependent areas**, not uniform throughout - The distribution pattern helps determine body position after death in forensic investigations *Margins are sharp* - Postmortem lividity typically has **ill-defined, diffuse margins** rather than sharp borders - The transition between affected and unaffected areas is gradual - However, this is less definitively wrong compared to the timing and uniformity statements
Question 3: During autopsy of a fetal death case, what is the correct order of examination to differentiate between live birth and stillbirth?
- A. Thorax > head > abdomen
- B. Abdomen > thorax > head
- C. Thorax > abdomen > head
- D. Head > thorax > abdomen (Correct Answer)
Explanation: ***Head > thorax > abdomen*** - The **head** is examined first to preserve delicate structures and avoid artifactual changes that could obscure signs of **intrauterine pathology** or **trauma** related to birth. - After the head, the **thorax** is examined to assess the lungs for signs of **air insufflation** (indicating respiration) and the presence of **congenital anomalies** or injuries. *Thorax > head > abdomen* - Examining the **thorax** before the head may introduce artifacts to the head, such as **hemorrhage** or **tissue distortion**, compromising the investigation of **cephalic injuries** or malformations crucial for distinguishing **live birth** from **stillbirth**. - **Head injuries** or **intracranial bleeds** are often critical in determining the mode of delivery or potential trauma, so their undisturbed assessment is prioritized. *Abdomen > thorax > head* - Beginning with the **abdomen** risks significant disruption to the **thoracic** and **cephalic** structures as a consequence of handling and evisceration, potentially obscuring vital evidence of **respiration** or **birth trauma**. - The integrity of the **head** and **thorax** is paramount for identifying subtle macroscopic and microscopic findings that definitively point to a **live birth**, such as **pulmonary aeration** or **intracranial hemorrhages**. *Thorax > abdomen > head* - This sequence is suboptimal because starting with the **thorax** and then the **abdomen** still leaves the **head** vulnerable to post-mortem changes and handling artifacts due to the initial dissections. - Critical evidence in the head pertaining to **neurological insult** or **traumatic injury** during birth might be overlooked or misinterpreted if not examined early in a pristine state.
Question 4: All of the following special histology stains are used to demonstrate H. pylori in gastric biopsies, except:
- A. Giemsa stain
- B. Fite's stain (Correct Answer)
- C. Warthin-Starry stain
- D. Modified Steiner's stain
Explanation: ***Fite's stain*** - **Fite's stain** (or Fite-Faraco stain) is a modified acid-fast stain primarily used to detect **mycobacteria**, particularly **Mycobacterium leprae**, in tissue sections [2]. - It is not used for the identification of **Helicobacter pylori**. *Giemsa stain* - **Giemsa stain** is a common special stain used to visualize **Helicobacter pylori** directly in gastric biopsies due to its ability to stain the bacterial cytoplasm a characteristic **blue color**. - It works by staining the cytoplasmic and nuclear components of cells, making bacteria and inflammatory cells easily identifiable. *Modified Steiner's stain* - **Modified Steiner's stain** is a silver impregnation stain used to demonstrate spirochetes and other bacteria, including **Helicobacter pylori**, by staining them **black**. - It involves a silver solution that precipitates onto the bacterial surface, followed by a reducing agent to visualize the organisms. *Warthin-Starry stain* - The **Warthin-Starry stain** is another silver impregnation method widely employed for detecting spirochetes and bacteria like **Helicobacter pylori** in tissue [1]. - It renders the bacteria visible as **black** or dark brown structures against a pale yellow background, providing excellent contrast [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 771. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 385-386.
Question 5: What does Prussian blue staining specifically detect in histology?
- A. Ferric iron (Correct Answer)
- B. Ferrous iron
- C. Glycogen
- D. Lipids
Explanation: ***Ferric iron*** - The **Prussian blue reaction**, also known as Perls' stain, specifically identifies **ferric iron (Fe3+)** in tissue sections. - This stain is crucial for diagnosing conditions involving **iron overload**, such as hemochromatosis or hemosiderosis, by highlighting iron deposits as blue. *Ferrous iron* - The Prussian blue stain does **not react with ferrous iron (Fe2+)**; it specifically targets the ferric (oxidized) state of iron. - While ferrous iron is present in the body, it is not detected by this particular staining method for routine histological assessment of iron stores. *Glycogen* - **Glycogen** is a polysaccharide storage molecule and is typically stained using the **Periodic Acid-Schiff (PAS) stain**, which produces a magenta color. - Prussian blue staining is entirely unrelated to the detection of glycogen and would not highlight these molecules in tissue. *Lipids* - **Lipids** are fats and are typically stained with lipid-soluble dyes like **Oil Red O** or **Sudan Black**, especially in frozen sections to preserve their structure. - Prussian blue stain has no affinity for lipids and therefore cannot be used to detect them in histological samples.
Question 6: During autopsy for virology study which agent is used for storing tissue:
- A. Alcohol
- B. Rectified spirit
- C. Sodium chloride
- D. 50% glycerine (Correct Answer)
Explanation: ***50% glycerine*** - **Glycerine** is commonly used for preserving tissues for virological studies because it helps to maintain viral viability by preventing **desiccation** and **denaturation** of viral particles. - It acts as a **cryoprotectant**, stabilizing cell membranes and protein structures, which is crucial for subsequent **viral isolation** and detection. *Alcohol* - **Alcohol** acts as a **fixative** by denaturing proteins and dehydrating tissues, which would inactivate most viruses and make them unsuitable for viability studies. - While useful for histopathology, it is not appropriate for preserving viral infectivity or integrity. *Rectified spirit* - **Rectified spirit** is a highly concentrated form of alcohol (typically 95% ethanol), and like alcohol, it causes **protein denaturation** and **dehydration**. - This property makes it unsuitable for preserving viral viability for subsequent virological studies. *Sodium chloride* - **Sodium chloride** alone in isotonic solutions can maintain tissue hydration but does not provide adequate **viral stabilization** or protection against degradation. - It would not prevent **enzymatic degradation** or maintain viral infectivity over time, especially at room temperature.
Question 7: After a postmortem examination, the body has to be handed over to
- A. Magistrate
- B. Investigating police officer (Correct Answer)
- C. Relative of victim
- D. The civil authorities
Explanation: **Investigating police officer** - After a postmortem examination, the body is typically handed over to the **investigating police officer** because the examination is often conducted as part of a forensic investigation. - The police officer is responsible for managing the evidence and ensuring the proper chain of custody for the body in cases involving **unnatural or suspicious death**. *Magistrate* - A magistrate's role involves **judicial oversight** and issuing orders, but they do not directly take physical custody of a body post-mortem. - Their involvement typically precedes the examination, such as ordering an inquest, rather than handling the body itself. *Relative of victim* - While the ultimate disposition of the body is to the family for burial or cremation, **direct handover immediately after a forensic postmortem exam** to relatives is generally not the protocol. - The body must first be released by the authorities, often through the police, after all necessary investigative procedures are complete. *The civil authorities* - "Civil authorities" is a broad term; while the police are a type of civil authority, this option is less specific than the direct involvement of the **investigating police officer**. - Other civil authorities, such as local government agencies, do not typically take custody of a body following a postmortem examination in the context of an investigation.
Question 8: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 9: Most reliable sign of drowning in decomposed bodies?
- A. Diatoms in bone marrow (Correct Answer)
- B. Foam in airways
- C. Pleural effusion
- D. Emphysema aquosum
Explanation: ***Diatoms in bone marrow*** - The presence of **diatoms** (unicellular algae) in the **bone marrow** indicates that the individual was alive and circulatory functions were active during submersion, allowing diatoms from the inhaled water to enter the bloodstream via the alveoli and be disseminated throughout the body. - This finding is particularly reliable in decomposed bodies because **bone marrow** is a relatively protected site, and diatoms are highly resistant to decomposition. *Foam in airways* - **Foam in the airways** (frothy fluid in the trachea and bronchi) is a common sign of drowning but is highly susceptible to post-mortem changes and decomposition, making it unreliable in decomposed bodies. - It can also be found in other conditions, such as **pulmonary edema** or **acute cardiac failure**, further limiting its specificity. *Pleural effusion* - **Pleural effusion** (accumulation of fluid in the pleural cavity) is a non-specific finding that can be caused by various medical conditions, including cardiac failure, renal failure, or infection, not exclusively drowning. - In decomposed bodies, it can be difficult to differentiate true pleural effusion from **putrefactive fluid accumulation** or post-mortem transudation, reducing its reliability as a sign of drowning. *Emphysema aquosum* - **Emphysema aquosum** refers to the overdistension of the lungs due to the inhalation of water causing rupture of alveolar septa, creating a spongy appearance. - While it can be suggestive of drowning, it is often difficult to confirm in a **decomposed state** due to significant post-mortem changes and tissue fragility, which can mimic or obscure this finding.
Question 10: Tattoo is not visible on autopsy. But the presence of tattoo was informed by relative. What is the next site to check?
- A. Skin
- B. Regional lymph node (Correct Answer)
- C. Liver
- D. Vessel
Explanation: ***Regional lymph node*** - **Tattoo ink particles**, particularly nanoparticles, can migrate from the skin via lymphatic drainage and accumulate in the regional lymph nodes. - This accumulation can make the lymph nodes appear **pigmented** even if the tattoo on the skin is no longer visible due to decomposition or other factors. *Skin* - The question states the tattoo is **not visible on the skin**, implying a thorough external examination has already been performed or that the skin itself has deteriorated. - Further examination of the skin for a visible tattoo would be redundant based on the given premise. *Liver* - While the liver plays a role in detoxification, it is **not the primary site for tattoo ink deposition** after lymphatic drainage. - Ink particles are generally too large to readily pass through the lymphatic system and then diffuse into the systemic circulation to accumulate in significant amounts in the liver. *Vessel* - Tattoo ink is primarily deposited in the **dermis** and subsequently transported via the lymphatic system, not directly into blood vessels. - While some ink particles might theoretically enter the systemic circulation, they are not expected to accumulate in a way that makes blood vessels a reliable site for identification.
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