Internal Examination — MCQs
Autopsy finding after 24 hours in a case of death due to myocardial infarction is
Which of the following is false regarding cranial trauma?
Underwater autopsy of the heart is done in cases of: DNB 09
The dead body of a 20 year old man found in the sea was brought in for postmortem examination. Which of the following findings would you see in seawater drowning? 1. Hemoconcentration 2. Pulmonary edema 3. Hyponatremia 4. Hypernatremia 5. Hemolysis
Certain obligations on the part of a doctor who undertakes a postmortem examination are the following, EXCEPT:
Virchow method of autopsy includes:-
Medicolegal autopsy requires the permission of
Which of the following is the most important objective of a medicolegal autopsy?
During autopsy of a fetal death case, what is the correct order of examination to differentiate between live birth and stillbirth?
Predisposing factors of puerperal sepsis are following except:
Internal Examination Indian Medical PG Practice Questions and MCQs
Question 1: Autopsy finding after 24 hours in a case of death due to myocardial infarction is
- A. Coagulative necrosis. (Correct Answer)
- B. Fat necrosis.
- C. Liquefactive necrosis.
- D. Caseous necrosis.
Explanation: ***Coagulative necrosis*** - Coagulative necrosis is the predominant histological finding after **myocardial infarction**, typically occurring within the first 12 hours [1]. - It results in preserved tissue architecture with **cellular outlines** remaining visible, indicating ischemic tissue damage [1,2]. *Liquefactive necrosis* - Commonly associated with **bacterial infections** or brain infarction, it leads to the transformation of tissue into liquid pus, which is not characteristic of myocardial infarction. - It occurs later and is not typically observed in heart tissue within 12 hours post-infarction. *Fat necrosis* - Primarily occurs due to damage to **adipose tissue**, as seen in cases of pancreatitis or trauma, and is not relevant to myocardial injury. - It is characterized by the release of **lipases** and fatty acids, a response not seen in myocardial infarction. *Caseous necrosis* - Often associated with **tuberculosis** or fungal infections, presenting as cheese-like necrotic tissue, it is not a feature of myocardial infarction. - This type of necrosis appears much later and reflects chronic granulomatous inflammation rather than acute ischemic damage. **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. 552-554.
Question 2: Which of the following is false regarding cranial trauma?
- A. Depressed skull is associated with brain injury at the immediate area of impact
- B. Raccoon eyes seen in subgaleal hemorrhage (Correct Answer)
- C. Carotid-cavernous fistula occur in base skull
- D. Post traumatic epilepsy seen in 15%
Explanation: ***Raccoon eyes seen in subgaleal hemorrhage*** - **Raccoon eyes** (periorbital ecchymosis) are typically seen with **anterior cranial fossa fractures**, not subgaleal hemorrhage. - Subgaleal hemorrhage is a collection of blood between the galea aponeurotica and the periosteum, usually causing diffuse **scalp swelling**. *Depressed skull is associated with brain injury at the immediate area of impact* - A depressed skull fracture means a portion of the skull is pushed inward, directly impacting the underlying **brain tissue**. - This can lead to localized **contusions**, **lacerations**, or **hematomas** at the site of impact. *Carotid-cavernous fistula occur in base skull* - **Carotid-cavernous fistulas** (CCF) commonly result from **traumatic rupture** of the internal carotid artery within the **cavernous sinus**. - This type of injury is often associated with **severe skull base fractures**, particularly those involving the sphenoid bone. *Post traumatic epilepsy seen in 15%* - The incidence of **post-traumatic epilepsy** (PTE) after severe head injury ranges from 5% to 15%, making 15% a plausible, though upper-end, estimate. - Risk factors for PTE include **depressed skull fractures**, **intracranial hematomas**, and **early seizures**.
Question 3: 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 4: The dead body of a 20 year old man found in the sea was brought in for postmortem examination. Which of the following findings would you see in seawater drowning? 1. Hemoconcentration 2. Pulmonary edema 3. Hyponatremia 4. Hypernatremia 5. Hemolysis
- A. 2,4 and 5
- B. 2,3 and 5
- C. 1 and 3
- D. 1 and 4 (Correct Answer)
Explanation: ***1 and 4*** - In **seawater drowning**, the hypertonic seawater (3-4% salt) creates an osmotic gradient that pulls plasma fluid from the blood into the alveoli, leading to **hemoconcentration**. - The absorption of hypertonic seawater into the bloodstream results in **hypernatremia** and hyperchloremia. - These are the characteristic electrolyte and hematologic findings specific to seawater drowning. *2, 4 and 5* - While **hypernatremia** is correct, this option incorrectly includes **pulmonary edema** (which is non-specific to drowning type) and **hemolysis** (which is characteristic of freshwater drowning, not seawater). - **Hemolysis** occurs in freshwater drowning when hypotonic water enters the bloodstream, causing red blood cells to swell and lyse. *2, 3 and 5* - This option is incorrect as it includes findings characteristic of **freshwater drowning**: **hyponatremia** and **hemolysis**. - In freshwater drowning, hypotonic water absorption causes hemodilution (not hemoconcentration), leading to hyponatremia and hemolysis. - **Pulmonary edema** is present in both types but does not differentiate between them. *1 and 3* - While **hemoconcentration** is correct for seawater drowning, **hyponatremia** is incorrect. - Hyponatremia is a feature of freshwater drowning due to dilution of serum sodium by absorbed hypotonic water.
Question 5: Certain obligations on the part of a doctor who undertakes a postmortem examination are the following, EXCEPT:
- A. Routinely record all positive findings and important negative ones
- B. He must keep the police informed about the findings (Correct Answer)
- C. The examination should be meticulous and complete
- D. He must preserve viscera and send for toxicology examination in case of poisoning
Explanation: ***He must keep the police informed about the findings*** - This is **NOT a formal obligation** of the doctor conducting a postmortem examination. - The doctor's primary duty is to conduct a thorough, objective examination and prepare a **formal postmortem report** that is submitted to the authority who requisitioned the examination (magistrate/police as per CrPC Section 174). - While findings may eventually reach the police through the official report, there is **no obligation to informally update or keep police informed** during the examination process. - The doctor's role is that of an **independent expert witness** to the court, not an investigative assistant to the police. - Maintaining independence and objectivity requires the doctor to document findings formally rather than providing ongoing informal updates to investigating officers. *Routinely record all positive findings and important negative ones* - This IS a **fundamental obligation** for any doctor performing a postmortem examination. - Both positive findings (pathological changes, injuries) and significant negative findings (absence of expected pathology) must be documented to provide a comprehensive and accurate record. - This meticulous documentation ensures the **integrity, reliability, and legal validity** of the postmortem examination and its conclusions. *The examination should be meticulous and complete* - This IS a **professional, ethical, and legal obligation** for any doctor undertaking a postmortem examination. - A systematic and thorough examination of all body systems is essential to accurately determine the cause of death and identify all relevant findings. - Incomplete examinations can lead to **missed diagnoses and miscarriage of justice** in medico-legal cases. *He must preserve viscera and send for toxicology examination in case of poisoning* - This IS a **crucial obligation** when poisoning is suspected or cannot be ruled out based on the postmortem findings. - Relevant viscera (liver, kidney, stomach contents) and bodily fluids (blood, urine) must be preserved in appropriate containers for subsequent toxicological analysis. - This step is **essential to confirm or exclude toxicological involvement** in the death and is a standard protocol in medico-legal postmortem examinations as per established guidelines.
Question 6: Virchow method of autopsy includes:-
- A. Organs are removed one by one (Correct Answer)
- B. In situ dissection combined with en bloc removal
- C. Organs are removed en bloc
- D. Organs are removed En masse
Explanation: ***Organs are removed one by one*** - The **Virchow method** of autopsy involves the systematic removal and examination of each organ individually. - This technique emphasizes the **in-depth inspection** of each organ for pathological changes, one at a time. *In situ dissection combined with en bloc removal* - This describes a combination of techniques, not solely the Virchow method. **In situ dissection** involves examining organs within the body cavity. - Removing organs **en bloc** refers to taking out groups of organs together which is characteristic of other methods like Ghon or Letulle. *Organs are removed En block* - The **en bloc method** (e.g., Ghon's method) involves removing entire organ systems or groups of organs together to preserve anatomical relationships. - This is distinct from the Virchow method, where individual organs are taken out separately. *Organs are removed En masse* - The **en masse method** (e.g., Letulle's method) involves removing all organs in a single block, maintaining all anatomical connections. - This is a more extensive removal technique compared to the Virchow method of individual organ removal.
Question 7: Medicolegal autopsy requires the permission of
- A. Relative
- B. Medical superintendent
- C. Magistrate
- D. Police (Correct Answer)
Explanation: ***Correct Option: Police*** - A **medicolegal autopsy** is mandated by law under **Section 174 CrPC** in cases of suspicious, unnatural, or sudden deaths. - The **police** are the **primary authority** empowered to requisition such autopsies, as they are typically the first investigating agency at the scene of unnatural death. - **No consent from relatives is required** for medicolegal autopsies, as the state has a legal interest in determining the cause of death. - This is the most common scenario in routine medicolegal practice. *Incorrect Option: Relative* - Consent from relatives is required for **clinical/hospital autopsies** (Section 176 IPC), performed for medical education, audit, or research purposes. - In medicolegal autopsies, the **legal mandate overrides familial consent**, and relatives cannot refuse such an autopsy. *Incorrect Option: Medical superintendent* - A **medical superintendent** oversees hospital administration but does **not have legal authority** to order a medicolegal autopsy. - Their role is limited to facilitating the autopsy within hospital premises once legally sanctioned by competent authority. *Incorrect Option: Magistrate* - While an **Executive Magistrate also has legal authority** under Section 174 CrPC to order medicolegal autopsies, this is **less common in routine practice**. - Police are typically the first responders and primary investigating authority in cases of unnatural death. - Magistrate involvement is more common in complex cases or when specifically required by legal circumstances. - In the context of "routine" medicolegal autopsy permission, **police** is the most appropriate answer.
Question 8: Which of the following is the most important objective of a medicolegal autopsy?
- A. Manner of death
- B. Cause of death (Correct Answer)
- C. Time since death
- D. All of the options
Explanation: ***Cause of death*** - Ascertaining the **cause of death** is the primary objective of a medicolegal autopsy, as it identifies the disease or injury responsible for physiological derangement leading to death. - This determination is crucial for legal proceedings and public health data, providing the foundational medical reason for the individual's demise. *Manner of death* - While important, the **manner of death** (homicide, suicide, accidental, natural, undetermined) is a classification based on the cause of death and other investigative findings, making it a secondary objective derived from the primary cause. - The manner specifies how the cause of death arose, but the autopsy's direct medical contribution is establishing the cause itself. *Time since death* - Estimating the **time since death** is a significant aspect of a medicolegal autopsy, aiding in establishing timelines for investigations. - However, it is a piece of crucial information that supports the investigation rather than the ultimate objective of understanding why the person died. *All of the options* - Although all mentioned aspects are important components of a comprehensive medicolegal autopsy report, pinpointing the **cause of death** is the singular, most fundamental objective around which other conclusions are built. - The cause of death forms the basis for subsequent legal and public health classifications and without it, other aspects would lack their primary context.
Question 9: 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 10: Predisposing factors of puerperal sepsis are following except:
- A. Multiparity (Correct Answer)
- B. Placenta previa
- C. Cases of manual removal of placenta
- D. Repeated internal examinations specially in the case of premature rupture of membrane
Explanation: ***Multiparity*** - **Multiparity**, defined as having given birth to more than one child, is generally considered a protective factor rather than a predisposing factor for puerperal sepsis. - While it was historically associated with some obstetric complications, modern evidence does not support it as a direct risk factor for puerperal sepsis. *Placenta previa* - **Placenta previa** increases the risk of hemorrhage and the need for interventions such as manual removal of the placenta or cesarean section, all of which elevate the risk of infection. - The abnormal placental implantation itself can lead to a more traumatic delivery and exposure to infection. *Cases of manual removal of placenta* - **Manual removal of the placenta** involves direct digital exploration of the uterine cavity, which introduces bacteria into a potentially sterile environment. - This procedure also causes trauma to the uterine lining, creating an entry point for infection. *Repeated internal examinations specially in the case of premature rupture of membrane* - **Repeated internal examinations**, especially after **premature rupture of membranes (PROM)**, repeatedly introduce microorganisms from the vagina into the sterile uterine cavity. - PROM itself removes the protective barrier against ascending infection, making frequent examinations particularly risky.
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