Radiology in Autopsies — MCQs
During autopsy of a fetal death case, what is the correct order of examination to differentiate between live birth and stillbirth?
What is the investigation of choice for blunt abdominal trauma in an unstable patient?
During autopsy of a 65-year-old man who collapsed while eating dinner at home, a foreign body (food bolus) is found obstructing the larynx with no other injuries. The manner of death is:
Which is the best fluid for postmortem investigation?
Underwater autopsy of the heart is done in cases of: DNB 09
A man presents to the emergency department with a head injury following a vehicular accident. What is the investigation of choice?
All of the following helps in determination of time since death, Except
Investigation of choice for acute intracerebral hemorrhage is -
After a postmortem examination, the body has to be handed over to
Incisions for medicolegal autopsy include all except?
Radiology in Autopsies Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: 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 3: During autopsy of a 65-year-old man who collapsed while eating dinner at home, a foreign body (food bolus) is found obstructing the larynx with no other injuries. The manner of death is:
- A. Intentional harm
- B. Self-inflicted harm
- C. Unintentional injury (Correct Answer)
- D. Death from natural causes
Explanation: ***Unintentional injury*** - The presence of a **food bolus obstructing the respiratory tract** in a person who collapsed while eating, with **no evidence of trauma or suspicious circumstances**, is classified as **accidental/unintentional death**. - This is the most common manner of death associated with foreign body airway obstruction, particularly in elderly individuals or those with neurological conditions affecting swallowing. - **Café coronary syndrome** (choking on food mimicking cardiac arrest) is a classic example of accidental asphyxia. *Intentional harm (Homicide)* - Homicidal foreign body aspiration would require evidence of: - **Forced insertion** of the foreign body - **Other traumatic injuries** (bruising, struggle marks) - **Suspicious circumstances** at the scene - The scenario described lacks these features, making homicide unlikely. *Self-inflicted harm (Suicide)* - Suicide by foreign body aspiration is **extremely rare** and would require: - **Evidence of suicidal intent** (suicide note, psychiatric history) - Deliberate insertion beyond the gag reflex - Accidental choking while eating does not constitute suicidal behavior. *Death from natural causes* - **Natural death** results from disease processes, not external physical agents. - A foreign body causing mechanical airway obstruction is an **external cause of death**, not a natural disease process. - Even if the person had a predisposing medical condition, the immediate cause (foreign body obstruction) makes this an unintentional injury, not natural death.
Question 4: Which is the best fluid for postmortem investigation?
- A. CSF
- B. Serum
- C. Synovial fluid
- D. Vitreous (Correct Answer)
Explanation: ***Vitreous humor*** is the **best fluid for postmortem investigation** due to its relative isolation and slow decomposition compared to other body fluids. It offers a **stable matrix** for analyzing electrolytes (especially potassium for estimating postmortem interval), drugs, and alcohol, providing a clearer picture of antemortem levels. *CSF (Cerebrospinal fluid)* is more susceptible to rapid postmortem changes and bacterial contamination. While useful in some cases, its instability makes it less reliable for general postmortem analysis compared to vitreous humor. *Serum* undergoes rapid and significant degradation after death, leading to hemolysis and the release of cellular contents. This makes postmortem serum analysis challenging as its composition quickly deviates from antemortem levels, potentially causing misleading results. *Synovial fluid* is found in joints and is prone to putrefaction and contamination soon after death. Its limited volume and rapid decomposition make it less suitable for comprehensive postmortem analysis.
Question 5: 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 6: A man presents to the emergency department with a head injury following a vehicular accident. What is the investigation of choice?
- A. MRI
- B. CECT
- C. NCCT (Correct Answer)
- D. X-ray
Explanation: ***NCCT*** - **Non-contrast Computed Tomography (NCCT)** of the head is the **investigation of choice** for acute head trauma due to its rapid acquisition, wide availability, and excellent sensitivity for detecting acute hemorrhage, fractures, and mass effects. - It rapidly identifies life-threatening conditions such as **epidural, subdural, and intracerebral hemorrhages**, which require immediate intervention. *MRI* - **MRI** is superior for detecting subtle brain tissue injuries, diffuse axonal injury, and non-hemorrhagic lesions but is generally **not the first-line investigation** in acute trauma due to longer scan times, limited availability in the emergency setting, and inability to detect acute hemorrhage as clearly as CT. - Its use is typically reserved for follow-up studies or when CT findings are inconclusive or specific soft tissue detail is required. *CECT* - **Contrast-enhanced CT (CECT)** of the head is reserved for specific indications like evaluating vascular lesions (e.g., aneurysms, arteriovenous malformations) or tumors, which are generally **not the primary concern** in the initial assessment of acute head trauma. - Administering contrast agents can delay imaging, may pose risks to patients with renal impairment or allergies, and does not significantly improve the detection of acute traumatic hemorrhage compared to NCCT. *X-ray* - **X-rays** of the skull are useful for detecting **skull fractures**, but they provide **limited information** regarding intracranial injuries or soft tissue damage, which are critical in head trauma. - They have largely been superseded by CT scans, which offer a more comprehensive view of both bony structures and intracranial contents.
Question 7: All of the following helps in determination of time since death, Except
- A. Algor mortis
- B. Rigor mortis
- C. Pugilistic attitude (Correct Answer)
- D. Livor mortis
Explanation: ***Pugilistic attitude*** - A **pugilistic attitude** is a postmortem change characterized by the posturing of the body into a "boxer-like" stance, caused by the **coagulation of muscle proteins** due to heat from a fire. - While it indicates exposure to high temperatures, it does not reliably help in determining the **time since death**. *Algor mortis* - **Algor mortis** refers to the postmortem cooling of the body. - The rate of cooling can be used to estimate the **time since death**, with various mathematical formulas and environmental factors influencing the calculation. *Rigor mortis* - **Rigor mortis** is the stiffening of muscles after death due to the depletion of **ATP** and the irreversible cross-linking of **actin** and **myosin**. - Its presence, progression, and regression provide valuable clues for estimating the **time since death**. *Livor mortis* - **Livor mortis**, or lividity, is the discoloration of the skin after death due to the **gravitational pooling of blood** in capillaries. - The onset, fixation, and distribution of lividity can help in determining the **time since death** and whether the body has been moved postmortem.
Question 8: Investigation of choice for acute intracerebral hemorrhage is -
- A. NCCT (Correct Answer)
- B. MRI
- C. PET scan
- D. None of the options
Explanation: ***NCCT*** - **Non-contrast Computed Tomography (NCCT)** is the investigation of choice for acute intracerebral hemorrhage because it can **rapidly and reliably detect acute blood** within the brain parenchyma. - Acute hemorrhage appears as a **hyperdense (bright) lesion** on NCCT, allowing for quick diagnosis and management vital in emergency settings. *MRI* - While MRI can detect hemorrhage, its sensitivity for **acute hemorrhage** can be variable, and it is **less readily available** and takes longer to perform than NCCT. - MRI is generally preferred for subacute or chronic hemorrhage, or to investigate the **underlying cause** of the bleed (e.g., tumor, vascular malformation). *PET scan* - **Positron Emission Tomography (PET) scan** primarily measures **metabolic activity** and blood flow within the brain. - It is **not suitable for detecting acute bleeding** and is typically used for diagnosing conditions like tumors, epilepsy, or neurodegenerative diseases. *None of the options* - This option is incorrect because **NCCT** is indeed the gold standard for diagnosing acute intracerebral hemorrhage.
Question 9: 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 10: Incisions for medicolegal autopsy include all except?
- A. 'Y' shaped
- B. Modified 'Y' shaped
- C. Modified 'I' shaped (Correct Answer)
- D. 'T' shaped
Explanation: **Modified 'I' shaped** - The **modified 'I' shaped** incision is not a standard or recognized incision for a medicolegal autopsy. - Standard autopsy incisions are designed to provide comprehensive access while maintaining anatomical integrity as much as possible for future viewing or reconstruction. *'Y' shaped* - The **'Y' shaped incision** is a commonly used incision in medicolegal autopsies, starting at the shoulders and meeting at the xiphoid process, then extending to the pubic symphysis. - This incision allows for optimal exposure of the neck, chest, and abdominal organs. *Modified 'Y' shaped* - The **modified 'Y' shaped incision** is a variation of the standard 'Y' incision, often used to avoid cutting through prominent scars or to provide better access in specific cases. - It maintains the general principle of broad exposure while adapting to individual circumstances. *'T' shaped* - The **'T' shaped incision** is another recognized incision, though less common than the 'Y' shape, primarily used for better exposure of the neck and chest in certain circumstances. - It involves a horizontal incision across the upper chest, intersecting with a vertical midline incision.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free