ZAPOROZHYE STATE MEDICAL UNIVERSITY THE DEPARTMENT OF PATHOLOGICAL ANATOMY AND FORENSIC MEDICINE WITH MEDICAL LAW

METHODIC RECOMMENDATIONS FOR MAKING UP "ACT OF FORENSIC-MEDICAL RESEARCH" (BASIC GUIDELINES)

ZAPOROZHYE 2012

The methodic recommendations are made by Professor Tumanskiy V.A., associate professor Tumanskaya L.M. and assistant Zubko M.D.

The methodic recommendations are assigned for the students of 4-th course for medical and pediatric faculties for the active study and optimum learning forensic medicine in the Zaporozye State Medical University in accordance with the requirements of "Program of the forensic medicine".

"We must have the courage to know the causes of death"

(Ramsey Clark)

Substantiation of the theme: forensic pathology an examination of the body after death is the study of the physiologic processes that ultimately lead to death and the circumstances under which these processes were placed in motion. To accomplish this end it is implicit that a thorough external and internal examination of the deceased be undertaken. A medico-legal autopsy is conducted in cases, in which the circumstances of the death suggest that the death was caused by homicide, suicide or accident. Autopsies are usually performed within 24-48 hours after discovering the body, with the full medicolegal and law enforcement investigation ongoing. The purpose of an autopsy is to examine a dead body and make a legal record as soon as the dead body was discovered. Autopsies are usually made at the tanatolody department, though some of them are made at the scene of death. Objectives: - to extend students knowledge about method of carrying out forensic autopsy; - to teach students how to make up "Act of forensic-medical research".; Lesson plan: 1. To check initial level of knowledge on the topic. 2. To discuss of the key questions. 3. Carrying out demonstrational autopsy. 4. Independent work under supervision of the teacher: -drawing up an introduction and research part of "Act of forensic-medical research". 5. To discuss about basic guidelines for making conclusion and forensic diagnosis. 6. To check exit level of knowledge on the topic. 7. Concluding remarks of the teacher. Equipment

1. Dead body, which should be examined by forensic medical expert 2. Set of instruments for research of dead body; 3. Devices and materials, reagents, glass containers with , small bottles on 10 ml, 10% solution of formalin, subject glasses, bandage for the withdrawal of blood on a gauze, scales for weighing of internal organs. 4. Schematic image of body. Chart of description of dead body during its examination. 5. Video film. Before the practical class, the student should know: 1. Cases when forensic examination is assigned and is necessary (according to articles 75 and 76 of Criminal-Procedural Code of Ukraine). 2. Duties, rights and responsibilities of forensic medical expert. 3. Rules of forensic autopsy and stages of autopsy. 4. Reasons for forensic autopsy. 5. Objects of forensic autopsy. 6. The morphological structure and topography of all organ and tissues. 7. Be familiar with nomenclature associated with autopsy procedures. Activity Activity 1. Multiple choice questions for verification of initial level of knowledge: 1. How long after offensive death is the temperature of a dead body is equal to the ambient temperature? a) in 3-5 hours. b) by the end of the first day c) by the end of the second day. 2. How many degrees does the temperature of dead body decrease on the average after the death? a) 1 degree; b) 2,5-3 degrees;

c) 5 degrees. 3. What is the mechanism of formation of livor mortis? ) redistribution of blood in vessels at agony. ) change of physical and chemical properties of blood. ) postmortem transferring of blood to the vessels of subjacent parts of body. 4. How much time after death can livor mortis change its position after moving the dead body? a) after 4-5 hours. b) after 12-15 hours. c) after 24 hours. 5. In which of the following causes of death livor mortis will be more visible? a) asphyxia by hanging. b) sword-cut of neck with the damage of large vessels. c) chronic nephrite, complicated by uremia. 6. In which of the following causes of death livor mortis will be less visible? a) in the case of death from a hemorrhage in a brain. b) in the case of poisoning the oxide of carbon. c) at death from the loss of blood. 7. Determine the duration at which rigor mortis develops after death? ) in 5-10 minutes. b) in 30-40 minutes. c) in 2-4 hours. 8. Determine the time at which rigor mortis starts to disappear after death? ) in 48 hours. b) in 24 hours. c) in 12 hours.

9. What is the cause of formation of parchment spots? ) shedding of epidermis with the subsequent drying out. b) imbibition. c) development of putrid changes of skin. 10. When do the Lyarshes spots appear? ) at downward position. ) at the repletion of connecting shells of eyes. ) at drying out of connecting shells of eyeballs. 11. What is the difference between sudden and unexpected death? ) are they synonymous? ) or are they different types of death. 12. According to world health organization, sudden death is stated, when the time from the appearance of first clinical symptom to death is ) 6 hours. ) 10 hours. ) more than one day. 13. Which of the following diseases takes place in sudden death? ) Cardiovascular system ) Central and peripheral nervous system. ) Respiratory system. Answers 1.b; 2.; 3.b; 4.; 5.; 6.b; 7.b; 8.; 9.; 10.b; 11.; 12.; 13. Recommended Literature:
1. Main literature

 Babanin A.A., Belovitsky O.V., Skrebkova O.Yu. Forensic medicine. Textbook // Simferopol, 2007. 464 p.
2. Additional literature

. . . - .: , 1987. , .- : , 1995. .., .., .. - : .- .: , 2002. - / . . . . . /. - .: , 1991. Zagorulko A. Short lectures on Pathology. - Simferopol, 2002. 6. Rezek PR, Millard M. Autopsy Pathology: A Guide for Pathologists and Clinicians. Springfield, III: Charles C Thomas; 1963. Block of Information The medico-legal autopsy differs from the hospital autopsy in two major aspects: 1. Purpose: the aims of the death investigation are to answer the following questions: Who died? (identification of the deceased) Where? (place of death) When? (time of death) Why? (cause of death) How? (manner and mechanism of death) Who, when, where, why, how and what are the questions that the autopsy assists in answering. Who has died is not usually at issue, but establishing identity can be a problem in some instances. There may be no circumstantial evidence of the identity of a person found dead, or visual identification may be impossible because of

decomposition, fire damage, physical disruption or mutilation. In all of these circumstances special techniques will be required and then identification becomes a multidisciplinary effort. Radiology, dentistry, anthropology, law enforcement, criminalistics and molecular biology may be involved. The commonest methods of scientific individualization are fingerprints, dentistry and radiography. DNA analysis is increasingly used. The essential principle of individualized identification is to make a match between a unique feature, physically part of the body, and an antemortem record of that unique feature. This requires an accurate and reliable antemortem record. In exceptional circumstances it may be necessary to resort to the less robust methods of photographic superimposition and facial reconstruction. 2. Technique: the external examination has much greater importance then the one at the hospital, because of the dissection techniques and examinations. Evidential materials, report formulation and commentaries are done by other methods. The autopsy findings will have a Cause of Death, which will include any factors directly contributing to or causing the death (i.e. blunt force trauma or a cardiac event); and Manner of Death, which include Natural, Accident, Suicide, Homicide and Undetermined. The Mechanism of Death, or the instrument or action causing death, is often overlooked. This notation may include stab wounds, gunshot wounds, ligature strangulation, drug overdose, etc. The autopsy may support the pre-autopsy investigation and medical records, or possibly make a determination that seems unrelated to the event. An example of this is a motor vehicle collision caused by the driver having a sudden cardiac event which caused death before the accident. This is a Natural death which caused the accident. Often we see deaths caused by blunt force injuries as a result of the accident, which is ruled an Accident. The least desirable or used finding, Undetermined is used when there has been no definitive finding as to the Manner, and possibly Cause, of death at the conclusion of the complete autopsy protocol and concurrent investigation(s). This is often seen in cases where the preponderance of one Manner does not prevail, but is consistent with or equal to another. One example of this might be a hunting incident where the decedent was alone, had suicidal history and

a thorough autopsy and investigation was inconclusive as to the totality of Accident versus Suicide. Manner of Death "how" the person died; a one word description of intentions and circumstances which led to the stated medical cause of death. There are five: natural is a death caused solely by disease or the aging process; accident is a death caused by an unexpected or unplanned event; suicide is a death solely by an intentional act of the decedent, knowing that

the act may cause death and without regard to the intent to cause death; homicide is the killing of a human being by another human being. The legal

definition includes intentional and unintentional acts. A state execution or personal self defense are examples of legal and medical homicides; whereas a death from a motor vehicle accident is a medical accident but could be charged as a legal vehicular homicide; undetermined is used when the information pointing to one manner of death

is no more compelling than one or more other competing manners of death in thorough consideration of all available information. For example, a gunshot wound without determining intent to inflict the wound would be Undetermined Suicide versus Accident. A temporary Manner of Death used until further laboratory tests determine the actual Cause of Death. This allows for the disposition of the remains until the final autopsy report is available and the final certification of death made. Cause of Death the underlying disease or injury that is the specific and immediate medical reason for death. This area of the death certificate has two components: part one: beginning with the immediate cause of death (e.g., Cirrhosis), followed by conditions resulting in the immediate cause of death (e.g., chronic ethanol abuse); part two: significant, but non-contributing medical conditions (e.g., chronic tobaccosmoker).

Results of forensic-medical autopsy must be written in the form of the document called "Conclusion of forensic-medical examination" (when the resolution of police is valuable) or "Act of forensic-medical research" (on the basis of police direction). Both of these documents have the same structure, which consists of introduction, research part and conclusion. Introduction. The introduction includes information about when, where, on what basis and who studied the corpse, the passport data of the deceased (if we know), who was present at the examination of the cadaver. This part also includes section "List of questions to be answered during the examination" and "Circumstances of the case". List of questions to be answered during the examination List of questions which should be solved during the examination depends on the supposed cause of death. CIRCUMSTANCES OF THE CASE. This section consists of one or two paragraphs briefly describing the perimortem circumstances known before the time of autopsy. The pathologist has to describe the details of death from the resolution of police, expert report of investigation of the corpse at the scene of crime (upon arrival at the scene, the investigator should observe, photograph, and graphically document /i.e., on body diagram form/ all postmortem changes. Inconsistencies between postmortem changes and body location may indicate the movement of the body and validate or invalidate witness statements. This information is essential to the pathologist before the autopsy begins). The pathologist has to use medical or hospital notes and other information from documents (such as surrounding circumstances; life history, psychiatric data, and other related information) which was taken to the tanatolody department with dead body. This narrative is important because it summarizes initial investigative findings and oral reports of witnesses, also includes evidence found at the scene, such as: projectiles, syringes, paraphernalia, disarray of the scene, vomitous, etc. RESEARCH PART

The research part includes external and internal examination. During the external phase, the forensic medical expert the outside of the body, looking for evidence of injury, evidence of disease and evidence that things are normal. At this time, the physician also collects things that can be sent to other laboratories to be studied by other types of scientists who can contribute to the picture of how the person died. Such things may include clothing, paint chips from a pedestrian struck by a vehicle, or hair, fluids or tissue from the object that caused trauma. During the internal phase of the autopsy, the body is opened with incisions, similar to what a surgeon would use, but larger. During a standard autopsy, the brain and the organs in the neck, chest, abdomen and pelvis are examined. If there is information in the history, the external exam or x-rays that lead the pathologist to believe that there may be important information in other parts of the body, additional incisions may be made. EXTERNAL EXAMINATION The external examination is an essential component of the postmortem examination and constitutes the first part of the forensic autopsy. This is a detailed head to toe examination of the naked body, documenting stains and soiling, general and specific individualizing characteristics, post-mortem changes (temperature, lividity, rigor mortis, putrefaction). The external examination embraces everything on and upon the body, including clothing, general body characteristics, specific identifying characteristics, physical evidence and medical paraphernalia. In hospital cases, the external examination of the body may or may not be very important. The external exam in most hospital cases takes only a few minutes, and only in rare case it lasts quite long. In medicolegal autopsies, the external exam is very important, not only with regard to the cause-of-death issues (injuries), but also with regard to identification. The cause of death and other issues (time of death estimation, trace evidence collection, sexual activity, clothing retention, etc) can be identified by external examination. The external examination (trace evidence collection, photography, documentation of injuries) in a complex homicide case may require several hours.

Examination of the clothing is a valuable part of the autopsy The clothing can provide a wealth of useful information on the lifestyle of the decedent, events surrounding the death and the cause of death. Each article of clothing should be described in appropriate detail and, when the body is unidentified, details of the labels and laundry marks as well. The clothing should be listed, examined and described with regard to type of garment, its colour, quality, degree of a deterioration and consistence, tears, loss of buttons or disarrangement indicating a struggle. Description of stains on the clothing is a vital important too (bloodstains, seminal stains, grease stain, etc., should be described). The location, extent and type of staining or soiling of the body are described e.g. dual flow pattern of blood from a wound, high velocity impact blood spatter from gunshot wound, coffee grounds vomitus and melaena (upper gastrointestinal hemorrhage), antiseptic from medical intervention. Cuts, holes or blackening from firearm discharges should be noted and compared with the injuries on the body. Recovery of trace evidence from clothing may be undertaken either at the scene of death or in the autopsy room, depending upon local practice and the nature of the case. Trace evidence might include hairs, fibers, paint chips, glass fragments, vegetation and insects. The collection and storage of this trace evidence must meet the legal requirements for the chain of custody. Stains, scuff-marks and tears to clothing may assist in traffic accident reconstruction or in clarifying events surrounding a death. Gunshot holes and stab wounds to clothing provide useful information in themselves, but more so when correlated with the underlying injuries to the body. Bloodstain patterns to clothing may illuminate the events following trauma and the activities of the victim prior to collapse.

Jewelry may provide evidence of identification; medical bracelets and necklaces may indicate a chronic disease; pockets may contain medication or drugs of abuse; and personal papers may give information on identity, medical history and lifestyle. The clothes should be removed carefully without tearing them to avoid confusion of signs of struggle. Wet clothing should be hung up to dry but should not be heat dried. Poison stains, vomit or fecal matter should be kept for analysis. INJURIES (EVIDENCE OF INJURY) All injuries are described systematically either by grouping them according to anatomical location, e.g. right arm, anterior chest, left leg (as in multiple injuries in vehicular collisions), or in numerical order (e.g. when the number of injuries is few or when each and every injury is particularly important as in multiple stab wounds). Injuries are described as to their type, e.g. bruise, abrasion, laceration, incised wound, puncture or stab wound, gunshot wound, burn, fracture. Injuries should be described with regard to their location, size, shape and colour. The location of the wound is given by general description (e.g. on the left side of the face, or over the rib cage, immediately below the left breast) and by precise location in relation to fixed anatomical landmarks (analogous to latitude and longitude). Suitable vertical landmarks are the heel, superior margin of the pubic symphysis, superior anterior iliac crest, supra-sternal notch, orbital ridge, and crown. Suitable horizontal landmarks are any midline structures, e.g. umbilicus, midline of the sternum and glabella. The size of an injury is measured in two dimensions. The shape can be related to a geometric shape or a common object. Internal injuries are described in continuity with the related externally apparent injuries, e.g. the bruising and abrasion to the chest, then the fractured ribs, then the lacerated lung and haemothorax. This organisation of the final report frequently does not correspond with the order of dissection and dictation of findings. The external wounds should be systematically examined taking up each part of the body in turn. SIGNS OF MEDICAL INTERVENTION

This includes all medical instruments attached to, or accompanying, the body, e.g. urinary catheter, endotracheal tube, oral airway, rods for external fixation of fractures, arterial and intravenous lines, intravenous solutions or blood (with details of contents). External surgical incisions are described in continuity with the internal evidence of surgery. General body characteristics are recorded, namely: general condition of the body (well developed, well nourished, appearance consistent with known age); racial group; length of the body (in centimeters), weight; configuration of the head. In the normal person, the skull viewed laterally is of an oval shape, larger above than below, and wider behind than in front. In the infant note the condition of the fontanelles. The anterior fontanell (site of junction of the coronal and sagittal sutures, which is called bregma) normally closes by the age of 16 to 18 months. The junction of the sagittal and lambdoidal sutures is known as lambda, the site of the posterior fontanelle, which normally closes by the age of 1 or 2 months. For example: delayed closure of the fontanelles is frequently noted in hydrocephalus, congenital syphilis and cretinism. Bulging fontanelles suggest increased intracranial pressure. Sunken fontanelles are indicative of dehydration. head hair (colour, dyed, style, balding, texture, straight or curly, distribution and length in centimeters). the eyebrows should be examined noting any loss (as an example, there is a characteristic loss of hair over the outer third or more, on either side, in myxedema). When examining the eyelids note any change in color, swelling, lacerations, contusions, etc.; general condition of the skin (rash, petechiae, colour, looseness, turgor), disease, asymmetry of any part of the body or muscle wasting. Presence of stains on the skin from blood, mud, vomit, corrosive or other poisons or gunpowder, traces of sand,

ground, etc.

Presence of signs of disease, e.g., oedema of legs, dropsy, surgical

emphysema about the chest, etc.; eyes (colour, pupil size, conjunctival congestion or petechial haemorrhages, jaundice, prosthesis); nose and ear canals (blood, pus). ; earlobes (piercing, earlobe creases); face (hirsute woman, clean shaven, beard, moustache). Face also should be examined for cyanosis, petechial haemorrhages, pallor, etc. Condition of scale at palpation. Contents of nasal ducts. Mouth (opened; presence of foams at an orifice of the mouth, condition and colour of lips and a mucous membrane, vomit, blood, tablet debris, teeth, dentures; the state of the tongue, position with relation to the teeth, and the presence or absence of bruising or bite marks should be noted); the neck should than be examined noting the position of the larynx and trachea, whether they are in the midline, and palpated to detect enlarged lymph nodes, thyroid or any mass lesion (bruises, fingernail abrasions, ligature marks or other abnormalities); thorax (normally developed, atrophic, hirsute); form (cylindrical, conic, barrel [emphysematous] chest), symmetry of its structure, integrity of ribs at palpation. Note if there is evidence of curvature of the thoracic vertebral column, i.e., exaggeration of the angular curvature of the thoracic spine with the convexity directed posteriorly (kyphosis) ; mammary glands (size, form, consistence; colour and condition of nipples; nipple discharge - colour, character, amount); abdomen: form (equal, involved), colour of the skin of abdomen, hernia of white line, umbilical, inguinal, its sizes, features. Note if there is a piercing of the umbilicus; genitalia (pubic hair pattern, circumcised, palpable testes, degree and type of

hair distribution, correctness of development of external genitals, damages). At corpses of men - discharge of sperm and urine from urethra, pergament spots on the skin of scrotum. The external genitalia are examined noting general development, infection, trauma, position of the testes, palpable tumors, including presence of a hernia,

hydrocele, hematocele and edema of the scrotum and penis, which is often seen in severe cardiac failure or iatrogenic fluid overload. If either testis is absent, careful palpation of the inguinal region may locate the undescended testis in the inguinal canal. If this is the case do not confuse this with cryptorchism; in cryptorchism, the homolateral side of the scrotum is empty and poorly developed. At corpses of women discharge from vagina, colour of mucous membrane of vagina, condition of hymen, urethra). Anus - gaping, closeness, condition of surrounding skin (clean or dirty), haemorrhoid (if are available); back - condition of an integument, curvature of backbone, integrity of bones at palpation; upper and lower extremities - correctness of development, integrity of bones, the form of fingers of hands, nails, changes of the skin, etc. More specific identifying characteristics are fully described: tattoos (location, design, colour, names); scars (surgical and non-surgical, needle tracks, striae); skin lesions (naevi, senile keratoses, other skin diseases); prosthesis, pacemaker. Post-mortem changes are documented, namely: body temperature to the touch (alternatively state if the body has been refrigerated). The body begins to cool almost immediately after death and will continue until it reaches environmental temperature. The rapidity of which body temperature declines after death is dependent upon body temperature at the time of death, relation of body surface area to weight (children, debilitated and dehydrated cool much more rapidly then well nourished adults or those who are obese), amount and kind of clothing worn at the time of death, environmental temperature and the presence of air movement and whether the deceased was in water (a body will cool much more rapidly in water than air). rigor mortis (extent and degree). Immediately after death the musculature is relaxed or another way of expressing it is that the muscles are flaccid. This is followed

shortly by generalized stiffening of the muscles, which is called rigor mortis. Rigor mortis involves both voluntary (skeletal) and involuntary (smooth) muscles and is due to physiochemical changes in muscle protein. Typically it develops first in the jaw muscles, proceeding to the neck, face and upper extremities, then the lower extremities with the ankles coming last. It disappears in the same order. It should be understood this sequence is not always constant, symmetrical or regular. The degree to which rigor develops is dependent on the decedents muscular development; hypostatic lividity (distribution, dual pattern, colour, contact pallor). Livor mortis is the result of blood settling in the superficial blood vessels in the dependent parts of the body. A deceased lying on their back (supine) will show livor mortis on the back with the exception of pressure points, i.e. those parts of the body in direct contact with a surface. This is due to the fact that the superficial vessels are compressed at points of contact. These points in a supine decedent would be the occipital scalp, scapular areas, buttocks, posterior aspect of the thighs and calves, and both heels. If the decedent dies prone then the pressure points will be over the anterior aspect of the head and trunk including the forehead, nose, cheek if the head is turned to a side, chin, chest, lower abdomen and anterior thighs. The color of livor is quite variable and in dark skinned people can be difficult to see. While commonly some shade of blue, it can show a rich red hue if the body was kept in the refrigerator. degree of decomposition (putrefaction, adipocere formation, mummification, skeletonization, as appropriate). insect and animal activity. Documenting postmortem changes to the body can help in estimating the approximate time of death. Note: the onset of putrefaction can occur more rapidly in adults than in infants. INTERNAL EXAMINATION The internal portion of the examination is the central portion of the examination and deserves a thoroughness and attention to detail that justifies the autopsy and the original goals of the examination.

Body Incision: A description of the type of incision used to open the body should be given. As an example, the usual Y shaped incision is accomplished, with the superior aspect of the Y extending to the lateral ramifications of the tip of the shoulder, etc. At no time should this incision pass through gunshot wounds, stab wounds or incised wounds. The description of the Y shaped incision should be followed by a description of the subcutaneous tissue and muscle. If a pneumothorax is suspected, water is placed in the trough created by reflection of the skin and underlying soft tissue of the chest laterally and the rib cage, after which the pleural cavity is punctured under the water line. Note: samples of hair and nails are taken, and then the body is cleaned, weighed, and measured before any incisions for internal examination are made. Before getting into autopsy reports and their interpretation, take a look at a couple of WAYS IN WHICH INJURIES CAUSE DEATH: ASPHYXIA All asphyxia cases involve insufficient amounts of oxygen reaching the brain or essential organs of the body, and there are many ways in which asphyxia occurs. First of all, there are certain natural diseases which shut down the respiratory system; eg, emphysema, pneumonia, flu, asthma, larynx disorders, etc. Then, there are three common criminal means: strangulation, drowning, and smothering. STRANGULATION may be homicidal, suicidal, or accidental. The homicidal variety is usually done either manually (brute force choking around neck) or by ligature (using a rope, wire, or garrote). In hanging, the victim dies from the pressure of body weight or the neck gets broken. All cases of strangulation are characterized by the following: intensive heart congestion (enlarged heart; right side ventricle); venous engorgement (enlarged veins above point of injury); cyanosis (blue discoloration of lips and fingertips) DROWNING results from the inhalation of water which causes choking which in turn causes the rapid formation of mucus in the throat and windpipe. The spread of this thick, foamy mucus is actually what ceases respiration, and victims (even in some drug

overdose cases) will be identifiable by the presence of a "foam cone" covering the mouth and nostrils. In some cases, "dry drowning" occurs because shock causes enlargement of the larynx, and no fluids will be found in the lungs or stomach as is typical of your more common drowning where lots of liquid (as well as marine life) is often present. The classic drowning goes through five stages: SMOTHERING occurs when airways are closed by an obstructing object, such as a pillow or blanket. If a soft object has been used, the body will show no visible signs of trauma, but often there are small, discernible contusions or lacerations on the inner lips. Cyanosis may or may not be present, but there is usually what is called petechial hemorrhage -- small, pin-point blotches or dark red spots on the face, typically around the area of the eyes. WOUNDS Generally, all wounds fall into the categories of bullet wounds, stab wounds, blunt force wounds, rape wounds, poisoning (considered a toxicological type of wound), burn wounds, and traffic fatality wounds. Forensic pathologists attempt to reconstruct what happened from wound analysis as well as determine whether self-defense occurred and whether or not the wound was received prior or after death. In gunshot cases, they provide valuable ballistics information. Unless the object causing the wound hits a vital organ, the most common mechanism of death is shock -- the body simply shuts down in a more or less conscious realization that the damage (to the circulatory system) is too great for the body to repair itself. This is the much more typical pathway to death than the process of bleeding to death, but it depends on the weapon. Bullets usually shock a person to death; knives usually cause a person to bleed to death. Both internal and external hemorrhage are always present with wounds. BULLET WOUNDS follow the principles of physics. The greater the energy of the missile at the moment of impact, the greater the tissue destruction. The striking energy of a projectile is the product of its mass or weight multiplied by the square of its velocity. Because it is squared, velocity is the most important factor, not the size or

caliber of the bullet. High-impact, or magnum, rounds have greater destructive power to cause shock leading to death. Hollow points, or other fragmenting ammo are designed to spread out and hit vital organs. From a death standpoint, however, high-powered rifles kill much faster than either handguns or shotguns. Many forensic pathologists are also experts at firearms identification and the science of ballistics. Entry and exit wound areas are important to look at. Because a bullet is spinning as it hits the body, it perforates the surface of the skin quite efficiently. Therefore, the entry area is usually smaller than the exit area, and it's often possible to determine the caliber from the entry wound. Exit wounds are usually larger than entry wounds, although sometimes the bullet ricochets inside the body (owing to different tissue strength) or travels a path which is not a straight line (non-axial flight). Powder burns (there's always some scorching or burning of the skin) are examined to determine distance and direction of fire. The degree of scorching usually tells the distance, and the "contusion ring" (abrasion collar) around the bullet wound usually indicates the angle (round is straight on; oval is at an angle). The exact identification of any powder residue is not a job for the forensic pathologist, but the province of a specialist in explosives chemistry. STAB WOUNDS include slash wounds and incision wounds. Slash wounds tend to look like bullet wounds that only graze the surface of the skin. Other types of slash wounds are called "hesitation marks" commonly found in suicide cases. They are typically rectangular in shape; ie, their cuts are as wide and they are long. Incision wounds, on the other hand, always have lengths greater than their depth, and you'll easily notice that a greater amount of subsurface tissue is exposed in an almost oval fashion.. Another type of wound is the puncture wound (sometimes called a stab or "shive" wound) which has no geometric shape (except perhaps circular) and is most distinguishable by its clean-cut edges. In determining if the wound was pre- or postmortem, the general rule is that a pre-mortem wound gapes and bleeds profusely while a postmortem wound does not. Wounds where the attacker not only stuck the victim with something, but twisted the object, cause the most shock and speed up the death process whereas blood vessel hemorrhage or bleeding to death are the most common pathways to death. Generally, the depth of the wound is not all that important.

BLUNT FORCE trauma results from clubbing, kicking, or hitting the victims. The blow produces a crushing effect on the human body, resulting in contusions, abrasions, lacerations, fractures, or rupture of vital organs. Red-blue contusions are always present, but this varies by the weight of the individual (obese people bruise easier than lean people). Brain contusions are especially difficult to analyze. The general rule is that trauma will be most severe on the opposite side of impact. This is because the brain floats around inside the head, but there may be what are called contrecoups where the pathway to brain trauma has to be reconstructed. Death results rapidly whenever a skull fracture is involved. Wounds to the body area usually take longer to cause death, sometimes days. However, sometimes death occurs in a matter of hours after wounds to the body. This is due to the process of pulmonary embolism (where blood clots travel to the brain). Some resuscitative (first aid) measures cause more harm than good with blunt force injuries. POISONING is usually determinable by looking at discolorations on the body. Cherry-red lividity is usually a sign of carbon monoxide poisoning, for example. Other toxins give off unusual odors. Certainty of diagnosis, however, requires toxicological confirmation. Samples must be taken of the stomach, vomitus, kidney, lungs, and liver. BURN wounds may be caused by heat, a chemical, or electricity. Fire victims often are found in a "pugilistic" position with clenched fists, resembling the pose of a boxer. Heat generally causes the protein in the body to contract. Blood and lung samples are often taken for various reasons. TRAFFIC FATALITIES are often analyzed to determine if the victim was the driver, a passenger, or a pedestrian. Motorcycle injuries are the most severe, especially in the head area (if no helmet is worn). The drivers of automobiles will normally have a circular impression in their chest area. Passengers will normally have extensive knee and spinal injuries. Pedestrians will normally have extensive ankle injuries or injury anywhere near the lower one-third of the body (called "bumper fractures Generally, the

lower on the legs the bumper fractures, the more likely it can be said the driver attempted to brake or slow down. Run-over injuries are quite different, and distinguishable by the amount of compressed tissue damage. Forensic pathologists often check for blood alcohol and drug levels in all cases involving traffic fatalities. This is for reasons of determining negligence under civil law. Obviously, all internal organs should be inspected, weighed, and described. All positive findings should have qualifiers (measurements, color, or degree /eg, mild, moderate, severe/). As the peritoneal cavity is exposed the presence of fluid, blood or exudates should be described and the quantity recorded. If there is evidence of exudates a swab should be taken for culture before anything is done; this is taken despite the less than sterile environment of the autopsy suite. If the deceased is pregnant the pathologist should examine the large abdominal veins for air before the chest is opened and the internal mammary veins excised. The omentum should then be inspected noting its position, thickness, color and the presence of masses. If there is evidence of peritonitis it should be described. Adhesions should be noted. The position of the abdominal organs should then be ascertained. Typically cutting through the ribs adjacent to the costochondral junction opens the chest. If, however, the spinal cord is going to be examined, then the chest should be opened more laterally beginning at the level of the anterior axillary line. This gives you more room to make your electric saw cuts into the vertebral column. The pleural cavity should be examined before removing the sternum to prevent blood draining from the subclavian and jugular veins and internal mammary arteries and veins contaminating the pleural cavity fluid if it exists. If fluid is present it must be described and measured. All adhesions must be noted. Before any blood is removed from either the pleural or abdominal cavity in gunshot wound cases, care needs to be taken to make certain no missiles or fragments thereof, are inadvertently removed. In those cases in which there is an allegation of an iatrogenic cause of death due to perforation or incision of an organ or failure of a graft, etc., if possible, a hematocrit and hemoglobin level should be determined of the blood in the respective cavity. Although everyone in the autopsy suite will have no issue from experience alone to realize what is

in the cavity is blood, council for the defendant, will insist that it was fluid stained with blood and hence the perforation, etc of an organ was not responsible for the deceased demise. Again, as best as you can, try not to leave any room for doubt. Chest Before any of the organs are removed from the chest, their position should be noted. The pericardial cavity is inspected, first noting its external transparency and color. The pericardial sac is then opened with examination of the inside color and the consistency and amount of fluid recorded. If exudates are noted a swab should be taken; if blood is seen its quantity is recorded. Should adhesions be identified they are described and their position noted. The epicardium is then examined describing its color, transparency, degree of fat, appearance of blood vessels, presence of petechiae and ecchymosis/contusions. At this time blood samples should be taken from the right atrium/right ventricle and the iliac veins for toxicology noting where the samples are taken from. Blood cultures, if they are going to be taken should be done from the right atrium. The superior vena cava and its branches, aorta and the vessels arising from the arch should be inspected. The superior vena cava and the inferior vena cava as well as the epicardial vessels should be inspected for gas bubbles in the blood. then removed. The visceral pleural surface of the lungs is examined noting coloration, transparency, presence of blebs or bullae (cyst), fibrosis and tumors. The esophagus should be ligated and then transected above the ligation at the level of the arch of the aorta. Following removal of the organs in the thorax the pleural surface (parietal pleura) of the ribs, intercostals spaces, thoracic spine and diaphragm are examined. Abdomen The entire gastrointestinal tract is examined noting the presence or absence of the appendix. If the appendix is not present make certain you have examined the lower right abdominal quadrant for a scar; sometimes they can be difficult to see. When examining the gastrointestinal tract note its length, diameter, color, presence or absence of diverticulae or fistualae. At this point I would suggest taking samples of bile from The main pulmonary artery is opened and examined prior to removal of the heart. The heart is

the gallbladder and urine from the urinary bladder for toxicology. It is best to do this before removing the gastrointestinal tract, thus avoiding the possibility of lacerating either organ, most especially the latter and losing material for toxicology. Following this ligate the gastrointestinal tract at the duodenojejunal junction with a double ligature cutting between the ligatures. Then double ligate the proximal esophagus and cut between the ligatures. Remove the distal esophagus with attached stomach, duodenum and pancreas, being careful not to puncture the stomach; this is followed by removal of the gastrointestinal tract. When the rectum is incised, it should be inspected for foreign objects (packets containing drugs, money etc). At this point if an additional sample of blood is needed it can be taken from the inferior vena cava. The abdominal and pelvic viscera are than removed. Following their removal the abdominal cavity, pelvic walls, pubic rami, symphysis and lumbar vertebrae are examined. To aid this examination the iliopsoas muscles should be dissected from their attachment along the lateral surface of the vertebral bodies of T12-L4. Head The external surface of the scalp is inspected looking for any evidence of injury. A single sentence stating how the scalp is reflected should then be made, i.e. the cranial cavity is entered through a bitemporal scalp incision with reflection of the scalp anteriorly and posteriorly. The undersurface of the scalp is then examined for evidence of injury. If contusions or lacerations are seen note their number, relationship to one another, whether over the convexity, lateral, anterior, posterior, relationship to underlying plates of the calvarium (frontal, parietal, occipital, squamousal portion of the temporal or greater wing of the sphenoid bone) and whether above or below the rim of the hat line. When the calvarium is removed only an electric saw should be used; if at all possible avoid using a hammer and chisel since these may produce fractures, such as linear skull fractures extending into the middle fossae. Also, if improper autopsy technique is used two types of artifactual hemorrhage can result, one of which is intracranial. In those cases in which head injury is either noted or suspected on external examination, the head should not be opened until the thorax has been opened and the heart removed. If blood is not allowed to drain from the passively congested head, damage to the dura or venous

sinuses by the electric saw used to remove the calvarium can give rise to escaping of the blood into the subdural space thus simulating a subdural hemorrhage occurring before (antemortem) the victim died. Also, passive congestion of the head can involve the vessels of the scalp, thus enhancing a contusion of the scalp, which if no other cause of death is determined can give rise to a false determination of cause of death as do to blunt force trauma to the head. The second variety of postmortem hemorrhage due to improper autopsy technique has been discussed under pleural cavities. If the subclavian veins, jugular veins or internal mammary vessels are damaged as a result of removal of the sternum before the pleural cavities are inspected allowing for postmortem drainage, the blood accumulated can be attributed to antemortem injury. There is one exception to using an electric saw to remove the calvarium and that is in patients suspected of having Creutzfeldt-Jakob disease (CJD). air that cannot be contaminated by the bone dust. Upon removal of the calvarium its thickness should be examined, transmission of light, presence of fractures, bullet holes, burr holes or evidence of neoplastic disease should be noted. The brain is then examined as it rest within the base of the skull, noting its symmetry, appearance of the leptomeninges (are they clear, cloudy, or opaque, is an exudates present, do they have a yellow coloration, are they thickened), appearance of the convolutions (are they flattened or are the gyri narrowed, are the sulci narrowed or widened) is there any evidence of neoplastic disease. Note the presence of epidural, subdural or subarachnoid hemorrohage. If there is evidence of hemorrhage describe its appearance (whether clotted or liquid) and quantity and whether a membrane is present. If a membrane is present, does it surround the entire clot? If a membrane is present it is important that sections be taken for microscopic examination to determine its age. The brain is gently removed from the base of the skull and weighed. Following removal the fissures are inspected. The base of the brain in then examined, inspecting the circle of Wills and the main arteries, looking for atherosclerosis, thrombosis, aneurysm, and anomalies. Examine the In these cases it is recommended you use a handsaw or if you intend to use an electric saw have access to

brain for evidence of increase in intracranial pressure demonstrated by grooving of the unci, cerebellar tonsils or cingulate gyri. The cerebellum, brainstem and cranial nerves are then inspected. The pituitary is removed from the hypophyseal fossa, examined, noting its size, configuration, presence of hemorrhage, cysts, inflammation, or neoplastic disease; it is then placed in formaldehyde along with the brain for fixation. The recommended period of fixation is at least 2 weeks to 4 weeks. If the deceased brain contains a substantive quantity of subdural and or subarachnoid hemorrhage, especially at the base of the brain in the region of the circle of Willis, the quantity and location should be determined in the fresh state. If there is any adherent blood in the region of the circle of Willis or brainstem this should be gently washed away, exposing the underlying blood vessels before placing the brain in formaldehyde. If you fix the brain with blood on the surface, especially at the base of the brain, the blood will adhere to the underlying vessels precluding any attempt at examination following fixation due to the fact that when you try to remove the clotted blood from the underlying vessels they will tear. Also, blood on the brain will impair the ability of formaldehyde to fix the brain properly. If you find the formaldehyde has a pink to red color after a day or two, replace it with fresh formaldehyde. The venous sinuses are examined following which the dura is stripped from the calvarium and the base of the skull. These structures are then inspected for fractures and any other diagnostic pathology. If fractures are identified, note their length, course and whether they are depressed. Neck Organs In your dissection of the neck organs note the presence of hemorrhage in the cervical neck muscles. Examine the hyoid bones, thyroid cartilage and most especially its superior horns, cricoid, laryngeal, epiglottic and tracheal cartilages for fractures. Carefully inspect the epiglottic, laryngeal and tracheal lumens for any foreign material keeping in mind the possibility of postmortem spillage if food or gastric contents was initially seen in the oral cavity or posterior oropharynx. Examine the mucosa of the epiglottis, larynx and trachea looking for evidence of edema, inflammation, ulcers, and neoplastic disease. Is there evidence of external compression?

Note the size, number and location of the parathyroids. If there is no morphologic evidence of diagnostic pathology a representative gland should be placed in the stock jar. Examine the thyroid gland noting its size, shape, weight, appearance of its surface and anatomic location. When you serially section the gland record the presence of nodularity, cysts, and evidence of neoplastic disease. Even if the gland appears normal retain a section in the stock jar. In those who still have a definable thymus note its size, color, consistency, and weight. When weighing any organ, should it be recognized that the weight is less or greater than for that age group the expected range should be also given. Serially section the gland looking for any significant pathology and then place a section in the stock jar. Dissection of the Internal Organs The pathologist should then proceed with the dissection of the internal organs. This portion of the autopsy should follow a normal sequence, heart, aorta, lungs, gallbladder, liver, gastrointestinal tract, mesentery including the condition of the vessels, pancreas, spleen, adrenals, kidneys, bladder, ureters, uterus, fallopian tubes, ovaries, prostate, seminal vesicles, testes, retroperitoneum and bone marrow. If the case warrants the spinal cord should be examined in-situ and then carefully removed without stretching, thus avoiding artifactual lesions. Each individual organ should be described separately. It is not recommended the pathologist incorporate into a single sentence a generalized, superficial statement of a variety of organs. As an example, the heart, lungs, liver, spleen, adrenal glands, pancreas, etc. are otherwise normal. What in effect the pathologist has done is cast doubt on the thoroughness of his examination as well as making a universal judgment that all of these organs presented no evidence of significant diagnostic pathology. In effect he has precluded anyone who may read his report from reaching another conclusion based on his findings. In short the pathologist is stacking-the-deck; good science is never about stacking-the-deck, whether that be using one sentence to describe a myriad of organs or purposely destroying anatomical drawings and notes taken at the time of autopsy so that you can never be called to question regarding your observations, it is about presenting well thought out scientific evidence to support the

stated conclusions. When doing an autopsy a very simple precept should be kept in mind, several months from now, when I am sitting before a judge, jury, prosecuting and defense attorney, how will my work be judged? The description of each organ does not have to be lengthy. It should include for each organ a concise, non ambiguous, description of weight, size, configuration, surface color, consistency and the presence of pathologic changes over and above those given under evidence of internal injuries. When discussing size do not use metaphors, such as the size of a golf ball, small stone, etc or reference to nonfamiliar objects such as a millet seed or a rocs egg. In determining size utilize the metric system in three planes, typically length, width and thickness. Generally the brain, lungs, liver and spleen are weighed and not measured. There are also other accepted indicators of size. For example, in the liver, blunting of the inferior border is an indication of an increase in size, whereas sharpness is an indication of atrophy. A tense capsule is an indication of an increase in size; laxness indicates atrophy. Configuration is anything that deviates from normal. Most organs have a delicate, smooth, glistening, transparent capsule of serosa. The pathologist should look for evidence of thickening, coarseness, or dullness. Consistency refers to the softness or firmness as determined by pressure of your finger. Cohesion is a measure of the strength within tissue that holds it together, the resistance of the tissue to cutting, pressure or pulling. An organ with reduced cohesion is friable, whereas with increase cohesion it is tough or leathery. As an example, with the normal liver you should be able to gently squeeze the thumb and forefinger together through a slice 1 to 2 cm in thickness, whereas in a cirrhotic liver the consistency will be leatherlike. Every organs color should be noted. The color an organ will show naturally is a reflection of the quantity of blood within its vessels. There are, however, other colors, which can be seen such as yellow to orange due to jaundice or fatty infiltration, brown due to lipofuscin or hemosiderin, pale coloration due to anemia or loss of blood and dark red due to congestion.

Structure refers to an organs visible architecture, e.g., cortex and medulla in the kidneys, follicles in the spleen, lobules in the liver. If these organs are involved with a disease these anatomical findings may be indistinct or greatly exaggerated. Heart The hearts configuration and weight should be noted. This is followed by a description of the color, opacity, fat distribution of the epicardial surface; origin of the coronary arteries and condition of the ostia; dissection of each coronary artery noting course, degree of involvement with atherosclerosis, occlusions; right atrial examination including condition of the endocardium, patency of foramen ovale, auricular appendage, presence of thrombi; right ventricle examination noting presence of dilation and or hypertrophy, measuring thickness of the wall, measure diameter of tricuspid valve, noting condition of leaflets, measure diameter of pulmonic valve noting condition of cusps; note diameter of pulmonary artery and presence of atherosclerosis; left atrium examination noting condition of endocardium, auricular appendage, presence of thrombi; left ventricle examination noting thickness of wall as well as that of the septum, presence of dilatation, condition of endocardium, measure diameter of mitral valve and record condition of leaflets; measure aortic valve and not condition of leaflets; examine chordae tendineae for thickness, fusion, color, presence of fibrosis; serially section myocardium noting presence or hemorrhage, necrosis and fibrosis. Aorta and its Major Branches Determine diameter, color of intima, presence of atherosclerosis, note whether ulceration or calcification is present, if an aneurysm is present note type, measure length, internal diameter, degree of obstruction to flow and evidence of dissection. In regard to the major branches (brachiocephalic, left common carotid, left subclavian, celiac trunk, superior and inferior mesenteric and common iliacs) inspect the initial 2 to 3 cm. It is not recommended that you completely dissect the common carotids unless the case warrants it. The common carotids are utilized by the funeral homes for the purpose of embalming. Vena Cava and its Major Tributaries Inspect the degree of patency; appearance of the intima; presence of neoplastic disease in wall; external compromise.

Pulmonary Artery and Veins Note condition of wall; the presence of emboli or thrombi, are they adherent. Cervical, Mediastinal and Hilar Lymph Node. Note their size, color, and effacement of parenchyma. Laryngotracheobronchial Tree The larynx should be opened along its posterior midline with the mucosa being visualized by pulling apart of the lateral walls breaking the ossified thyroid cartilage. The trachea and bronchi are also opened posteriorly. If you suspect aspiration or drowning it is best to do an in-situ examination (Rokitansky method) through an anterior dissection. Note the color of the mucosa, its thickness and the contents within the lumen; is there evidence of a fistula or neoplastic disease. Esophagus Note the diameter, presence of diverticulae, ulcers, fistula, varices, strictures and perforation and neoplastic disease. If there is a suspicion of varices, they can best be visualized by everting the esophagus. Lungs Weigh each lung separately; note the color of the surface, the degree of transparency of the visceral pleura, the presence of adhesions and fibrosis; note the presence of emphysematous bullae or blebs; palpate the lungs to determine the degree of consistency; is there evidence of consolidation or mass lesions? To examine the parenchyma of each lobe make an incision parallel to the long lateral axis which ends immediately before the hilum; not the color of the parenchyma, does it exude fluid with gentile palpation, is there evidence of mass lesions or embolic infarction or cyst? Liver Before the liver is removed, the hepatoduodenal ligament should be dissected, exposing the common bile duct, hepatic portal vein and the proper hepatic artery. This ligament forms the right margin of the lesser omentum and is immediately to the right of the transparent hepatogastric ligament. Following dissection of the hepatoduodenal ligament, the hepatic nodes, celiac nodes, superior pancreatic nodes and left gastric nodes should be examined noting enlargement, color and effacement. The bile duct should be opened throughout its entire length into the cystic duct and the right and left

hepatic ducts. The proper hepatic artery is to the left of the common bile duct and immediately superior to the hepatic portal vein. The hepatic portal vein is dissected throughout its length noting the presence of thrombosis or tumor growth; if the thrombus has been gradual in its onset it will be associated with gastric and esophageal varices, splenomegaly and possibly ascities with a small liver. Such a gradual evolution of hepatic portal vein thrombosis can be associated with cavernous enlargement of the portal vein. The hepatic lymph nodes extend into the lesser omentum along the common hepatic artery and the hepatic artery proper, together with its right and left branches, as well as the bile duct. They very in number and position, but two are fairly constant: one at the junction of the cystic and common hepatic ducts, known as the cystic node (or node of the neck of the gallbladder), the other alongside the upper part of the bile duct is sometimes called the node of the anterior border of the epiploic foramen. Remove the liver and weigh it; examine the external capsule, noting adhesions, color, transparency, and lobulations; note the sharpness of the margins. Before the liver is serially section examine the gallbladder, the description of which will follow. With serial sectioning of the liver note the color of the parenchyma, presence of fibrosis, mass lesions, cyst, and areas of infarction, note any significant changes of the intrahepatic bile ducts and blood vessels. If there is intraparenchymal hemorrhage, note where and as best as you can determine its overall size. contribution to it. Gallbladder Before removing the gallbladder its overall size and shape should be noted as well as the presence of adhesions. The gallbladder is removed from the liver prior to serial sectioning and opened into a container, which is calibrated in milliliters/cc. The quantity of the bile, its color and consistency and whether stones are present is noted. If gallstones are present, their number, color, configuration, size, and the appearance of the surface should be noted. The thickness of the wall is noted followed by the appearance of the mucosa. Mesentery If substantive enough, intraparenchymal hemorrhage can be the cause of death or make a significant

Examine for fat necrosis, tumors, cysts and condition of the vessels; note the condition of the lymph nodes, their size, color, effacement of parenchyma. They number between 100 and 150 and occur in three groups: close to the wall of the intestine; among the loops and primary branches of the vessels; and along the upper part of the trunk of the superior vena cava. Gastrointestinal Tract In essence you are looking for intussusceptions, volvulus, hernias, fibrous strictures, fistula, exudates on the serosal surface, gangrene, mucosal pattern, ulcers, tumors, and contents of the lumen. In examining the stomach first note its overall size, configuration, appearance of serosal surface, presents of adhesions, evidence of neoplastic growth, appearance of the arteries supplying the stomach (right and left gastric arteries, which supply the lesser curvature and the right gastroepiploic [gastro-omental], left gastroepiploic and short gastric arteries supplying the greater curvature); and appearance of lymph nodes. Inspect the gastric lymph nodes, which consist of the left gastric, right gastro-epiploic and pyloric groups. Prior to opening the stomach, the esophagus should be opened to the esophagogastric junction, at which point the stomach contents is placed in a container recording it appearance, quantity and the presence of pills and solid food. Stomach contents can prove to be most advantageous in determining time of and cause of death. The stomach is then opened along its greater curvature observing the thickness of the mucosa, presence of ulcers, neoplastic lesions and scarring. The duodenum is opened noting the appearance of the internal surface of the ampula of vater. The mucosa is inspected for ulcers, scarring, neoplastic disease and bile staining. The jejunum and ileum mucosa are examined for scarring, strictures, diverticulum, neoplastic disease, overall color of mucosa, ulceration, and Peyers patches. If the appendix is present note its size, configuration, presence of adhesions or inflammation and neoplastic disease. If the appendix is not present record that. The colon and rectum should be examined observing their overall size, adhesions, strictures, diverticulae, neoplastic disease, and color of wall; the mucosa is inspected for color, ulcers, neoplastic disease and strictures. Pancreas

Note the weight, length and width; inspect the color, shape, consistency, lobulation, amount of fat, patency of ducts, stone formation, evidence of fibrosis, acute necrosis, hemorrhage, peripancreatic fat necrosis, neoplastic disease and atrophy. If there is not evidence of gross morphologic pathology it is recommended that a tissue sample be taken from the tail for microscopic examination due to the large number of islets in this region. Spleen Examine the splenic artery noting its condition (it gives rise to the dorsal pancreatic, superior pancreatic branches, arteria pancreatica magna, caudal pancreatic, short gastric, left gastro-epiploic and terminal splenic arteries). Inspect the pancreaticosplenic lymph nodes, which accompany the splenic artery, and are related to the posterior surface and the upper border of the pancreas; one or two of this group, are in the gastrosplenic ligament. Note the weight, length, width and depth; configuration; exterior color, opacity, wrinkling and thickening of the capsule; presence of lobulation; the appearance of the splenic pulp and its consistency, visibility of the malphighian corpuscles (bodies), presence of infarcts or mass lesions; presence of accessory spleen. If you intend to take sections for immediate microscopic examination and or the stock jar make certain they are thin for proper fixation to take place. Adrenal Glands Note the weight of each and configuration; the thickness and color of the cortex and medulla; tumor masses and their size, color, consistency; presence of periadrenal and parenchymal hemorrhage. Kidneys Prior to removal, the renal arteries and veins should be located and opened noting any thrombosis, embolization and atherosclerotic plaques; examine the ostea of the arteries. The ureters are then opened throughout their length, noting patency and condition of the mucosa. The kidneys are removed and the capsules stripped; note the color, opacity and resistance to stripping; examine the subcapsular surface for scarring, pitting, cysts, tumors, abscesses, and hemorrhage; examine the cut section of the cortex recording its thickness, color, presence of scarring, neoplastic disease, infarction, hemorrhage and

striations; note the sharpness of the corticomedullary junction; examine the pyramids noting color, presence of neoplastic disease, hemorrhage, scarring, striations, infarction; examine the pelvis noting the condition of the mucosa, the presence of an exudates, stones, hemorrhage, neoplastic disease and dilatation; inspect the condition of the peripelvic and perirenal fat. Ureters Note congenital anomalies: agenesis, hypoplasia, duplications, diverticulum, megaloureter, retrocaval ureter, ureterocele, strictures, valves; presence of ureteritis; periureteric fibrosis; leukoplakia, malaloplakia, calculi; injuries and tumors. The upper part of the ureters drain to the lateral aortic nodes; those from the succeeding part up to the pelvis drain to the common iliac nodes; those in the pelvic part drain to the common, external and internal iliac nodes. Urinary Bladder Observe the configuration of the bladder; determine volume, color, opacity of urine; inspect the trigone noting appearance and patency of urethral orifice and ureter orifices; inspect mucosa for hemorrhage, inflammation, granularity, ulcers, neoplastic disease, trabeculation, and stones; record the thickness of the wall, measuring it if it appears abnormal. The urinary bladder drains primarily to the external iliac nodes with some drainage to the internal iliac and common iliac nodes. Retroperitoneal Space Look for the presence of neoplastic disease, hemorrhage or fibrosis. Examine the lumbar, pre-arotic and celiac lymph nodes, noting the presence of enlargement, color and effacement of parenchyma. The lumbar lymph nodes include three principle groups: pre-aortic, lateral aortic (right and left), and retro-aortic. The pre-aortic group drains the viscera supplied by the ventral branches of the aorta, i.e. the abdominal part of the GI tract and its derivatives. The lateral aortic groups drain the adrenal glands, kidneys, ureters, testes, ovaries, pelvic viscera (not that portion of the GI tract within the pelvis), which includes the fallopian tubes and the upper part of the uterus and the posterior abdominal wall. The retro-aortic group has no particular area of drainage

The pre-aortic lymph nodes are directly anterior to the abdominal aorta. They receive lymph from the regional, intermediary nodes associated with the subdiaphragmatic part of the GI tract, pancreas, liver and spleen. The celiac nodes lie on the front of the abdominal aorta close to the origin of the celiac artery. Prostate Determine the weight, size, consistency, lobulation, and condition of the capsule; serially section looking for nodularity (tissue pattern), inflammation (abscesses), presence of corpora amylacea, and neoplastic disease. Due to the propensity for prostatic carcinoma to arise in the posterior lobe, this is the lobe that should be sampled assuming the remainder of the gland shows no evidence of significant diagnostic pathology. The prostate drains primarily to the internal iliac and sacral nodes. There is a trunk that drains the posterior surface to the external iliac nodes Seminal Vesicles Observe the size, shape and thickness; contents color and consistency; appearance of the mucosa. The seminal vesicle drains to both the internal and external iliac nodes. Testes Their location (are they in the scrotal sac), size, configuration; appearance of cut section noting color, consistency, presence of neoplastic disease, do the tubules string-out. The lymph drainage of the testes is to the lateral aortic and pre-aortic lymph nodes. Uterus Note the size, shape (configuration), position in pelvic cavity; note the appearance of the parametrium (connective tissue separating the supravaginal part of the cervix in front from the bladder, which extends also on to the sides of the cervix, and laterally between the layers of the broad ligament), broad ligament, mesovarium and mesosalpinx; weigh with the cervix attached; dimensions across the fundus, length and myometrial thickness; length and diameter of the cervix; appearance of the cervical os and mucosa; appearance and thickness of the endometrium; if polyps are present describe and be certain to take sections for microscopic examination; appearance of the myometrium, evidence of neoplastic disease. If neoplastic disease does involve the myometrium They are the terminal group of nodes for the stomach, duodenum, liver, gallbladder, pancreas and spleen.

describe and note its location, whether, pedunculated, sessile, intraparencymal and take samples for microscopic examination. The upper part of the body, the fundus and the fallopian tube, and the ovary drain to the lateral aortic and pre-aortic lymph nodes, with a few draining to the external iliac nodes. The region of the connection of the fallopian tube to the uterus drains to the superficial inguinal nodes. The vessels from the lower part of the body of the uterus drain mostly to the external iliac nodes, accompanying those from the cervix. Fallopian Tubes Note is length, diameter, external surface, appearance of fimbriae, presence of adhesions, tumors, cyst, and extra-uterine pregnancy. examination. Ovaries Observe the size, shape, position, adhesions; if cyst are present record their size, whether intraparenchymal or on external surface, color, appearance of inner lining, description of contents; evidence of neoplastic disease and if present the appearance of its cut surface. Should there be evidence of neoplastic disease samples of tissue should be taken for microscopic examination. Vagina Observe the condition of the mucosa. Is there evidence of a discharge, which may be creamy, foamy, mucoid, purulent (yellow or green) or bloody? Smears and cultures should be made looking specifically for one of the venereal diseases. Occasionally a foreign body is discovered, which is the underlying cause for the infection. Douches or abortifacients used in excessive strength can cause chemical vaginitis, sometimes giving rise to shedding of the entire epithelium. Hemorrhagic, granular vaginitis, most severe in the posterior fornix and associated with white discharge, is seen in trichomonas vaginitis. In those cases with a thick, white, peeling exudates Candida albicans should be considered. After the discharge is removed note the condition of the mucosa. Look for lacerations, fistulae (rectovaginal, vesicovaginal and urethrovaginal). Note the presence of tumors, cysts (Gartners duct cysts are the result of incomplete obliteration of the lower end of the Wolffian duct, appearing in the lower part of the anterolateral If there is evidence of any significant diagnostic pathology representative sections should be taken for microscopic

wall of the vagina) and endometriosis (commonly seen in the posterior fornix and rectovaginal septum as small blue foci in contracted fibrous tissue). There are three groups of nodes, which drain the vagina. The upper vessels accompany the uterine artery to the internal and external lymph nodes. The middle is drained by vessels, which accompany the vaginal artery to the internal iliac lymph nodes. The vessels of the vagina below the hymen, those of the vulva and the skin of the perineum as a whole pass to the superficial inguinal nodes, but the clitoris and labia minora drain to the deep inguinal nodes, with the clitoris sometimes also draining to the internal iliac nodes. Pelvic Lymph Nodes Lymph vessels from the pelvis, most of the pelvic viscera, and from the lateral and anterior parts of the abdominal wall, pass first through outlying groups of lymph nodes associated largely with the internal iliac arteries and their branches. They include the common iliac, external iliac and internal iliac lymph nodes. Note their size, color and effacement of their parenchyma. Bone Marrow Note the color, consistency, fat or red. At a minimum, a tissue sample should be placed in the stock jar noting in the report where the sample was taken from. Guidelines for use of Medicolegal Consultants Depending on the circumstances and necessity of the case, the medical examiner should utilize as necessary: a histology laboratory; a radiologist; an anthropologist; an odontologist; toxicology and clinical laboratory testing; radiographic equipment; body and organ scales. Microscopic Examination

During the coarse of the autopsy tissue samples from each organ should be taken for histopathologic analysis. Those samples for immediate microscopic study should be placed in a cassette, with each cassette labeled with a number. The pathologist should record the tissue sample placed in each numbered cassette. When the microscopic slides are made from the cassettes, each tissue segment should be placed on a corresponding labeled microscopic slide. Although some will place several tissue segments from a number of different cassettes due to economic reasons, this should be avoided if possible. If you have taken several tissue samples from the lungs and place them all on the same slide with no attention given to the numbered cassettes it is difficult to determine, which lung or lobe the tissue segments came from. The number of tissue segments various according to the case. There are a number of fundamental concepts that should be kept in mind when deciding how many tissue segments should be submitted for immediate microscopic analysis: confirmation of gross impressions or the presence or absence of antemortem or postmortem lesions and assistance needed in the dating of lesions resulting from blunt force trauma. There are some forensic pathologists who do not believe it is necessary to submit tissue for immediate microscopic analysis in every autopsy. As an example, a young adult male whose death is the consequence of a motor vehicular accident in which the severity of his injuries make clear the cause of death with no evidence of a natural disease process on gross examination of his organs. Other forensic pathologist disagree with the practice of not submitting at least representative tissue samples from each respective organ, i.e. heart, lung, liver, kidneys, spleen, pancreas, adrenal glands, prostate or uterus & cervix, pituitary and brain. The premise to this line of thinking is you are a pathologist first, who has subspecialized training in forensic pathology, hence in addition to determining cause and manner of death you have a responsibility to give a complete morphologic picture of the deceased at the time of their death. As an example, failure to take slides of the liver or lung would preclude a family from knowing that their father, etc. had Acute Hepatitis C or that he had minute granulomas in his lungs, which had acid fast positive bacilli. One of the truly outstanding forensic pathologists in our country, Lester Adelson, stated, Pertinent lesions and vital organs should be examined histologically, even when the

latter are grossly normal. He went on to state, From the forensic standpoint, a slide which contributes positive or negative data for establishing cause, manner, circumstances and other pertinent facets of a death investigated primarily for medicolegal purposes should be regarded as a permanent, objective anatomic record, available for whatever studies and consultation the examiner requires. James T. Weston, another highly respected forensic pathologist stated, Whether or not a microscopic examination contributes significantly to his information, an experienced pathologist always conducts such an examination in instances where he may be called upon to present evidence in a matter of civil litigation, particularly when such litigation either derives from the coexistence of natural and unnatural disease or requires testimony concerning the ultimate life span of the individual involved. It must be remembered that it is during the autopsy the pathologist has his only opportunity to acquire tissue samples, whether or not he intends to do a microscopic examination, hence it is prudent to obtain these samples in as much detail as possible. The microscopic description need only include positive findings. The pathologist should note those tissues he has examined and the exact sections he has seen the pathologic findings. Samples Submitted for Toxicologic Analysis The following samples are submitted for toxicological analysis in virtually allmedicolegal autopsies: blood, urine, bile, vitreous humor, stomach contents, liver, brain and kidney. The precise areas where blood samples should be taken have already been discussed. There are certain blood samples that should never be submitted for toxicology. Blood obtained from body cavities after evisceration should never be used as it is invariably contaminated either from urine, intestinal contents, gastric contents, lymph, pleural and abdominal fluid as well as fluid oozing from resected tissues. If upon opening the chest, and before the anterior chest plate is removed, thus transecting the internal mammary arteries and veins, and removal of the heart and lungs takes place, blood is noted in either the pleural cavity or pericardial sac, such blood can be utilized for toxicologic analysis. In some cases in which there has been substantive exsanguinating hemorrhage, this may be the only blood sample in sufficient quantity

you are going to obtain. It is important that the toxicologist knows, as always, where the blood sample has been taken. The urine sample is best obtained before the autopsy is done via a suprapubic puncture or if an indwelling catheter is in place, take the urine from there. If you are unsuccessful in acquiring urine using a suprapubic puncture, before evisceration of the abdominal organs, puncture the fundus of the bladder with a needle and syringe. If no urine is obtained in this fashion, pull the bladder up and make a long incision on its anterior surface and remove whatever urine is present with a syringe. It is important to the toxicologist that if any urine is present to remove it for toxicology. Again, it is placed in a sealed tube and appropriately labeled and refrigerated. If possible remove at least 10 cc of bile by a needle and syringe. If the bile is too viscous pour it into a container, seal it and appropriately label it followed by refrigeration. Bile is an important source for opiates, which are concentrated by the liver. Vitreous humor is particular useful for evaluation of electrolytes most especially sodium, chloride and calcium. It is also useful for determination of glucose, urea and creatine. Vitreous should be obtained from both eyes with a needle and syringe through puncture of the sclera near the outer canthus with a fine gauge needle and syringe. Following removal of the vitreous a like quantity of water should be reinjected into the eyeball to keep it normally inflated since removal of vitreous will cause the eyeball to shrink. If there are any stomach contents this should be retained for toxicologic analysis. This is important for not only aiding in the determination of cause of death but also time of death. The stomach contents should be obtained in a fashion that leads to the least contamination as possible. A safe way of obtaining stomach contents without the risk of contamination is to dissect the esophagus through the esophagogastric junction. Then invert the esophagogastric junction into a stainless container, measure and describe the contents, after which place contents in a calibrated plastic jar and seal with appropriate labeling. Any capsules or pills identified should be placed in a separate container, sealed and appropriately labeled. These containers should be refrigerated. The stomach should be completely opened and the mucosa described.

The duodenal contents should be examined as the stomach contents. Whatever content is within the duodenum should be measured, described and placed in a separate container, which is sealed and appropriately labeled. If pills or capsules are identified they should be placed in a separate container, sealed and appropriately labeled. These containers should be refrigerated. If there is concern for heavy metal poisoning, some of the jejunal and ileial contents should be placed in a plastic container sealed and appropriately labeled. The small bowel contents and mucosa should be described. In regard to large bowel contents, most toxicology laboratories prefer not to analyze fecal material. If however, there is concern that heavy metal poisoning may be involved, it is suggested a small quantity, 50 cc/grams, be placed in a plastic container sealed and appropriately labeled for possible analysis. All intestinal specimens for toxicology should be refrigerated. If there is a suspicion of poisoning, as much of the regurgitated gastric contents within the oral cavity should be collected as well as that on the face, clothing, etc. and placed in a container sealed, appropriately labeled and refrigerated for possible analysis. In regard to those deaths in which volatile, gaseous or solvents may have played a role, as soon as the chest is opened, and the pleural spaces have been examined, one lung is mobilized followed by tightly tying off the main stem bronchus. The lung is removed and placed in a nylon bag, i.e. these are the same bags that arson investigators use. The bag is sealed and appropriately labeled and taken to the toxicology lab as soon as possible. Blood that is to be analyzed for the same substances must be placed in a glass tube, which has a cap lined with aluminum or Teflon. The glass tube must be filled to the top, i.e., there can be no headspace. The specimen must be sealed, appropriately labeled and placed in a refrigerator. Typically samples of liver, kidney and brain are acquired in each case. Between 50 to 100 grams of tissue from each organ is placed in a separate container sealed, appropriately labeled and placed in a refrigerator.

If there is a suspicion that the death may have been due to a lethal injection, than the injection site is identified and a circumferential skin and underlying subcutaneous tissue or muscle is removed placed in a plastic container sealed, labeled and refrigerated. In those cases in which the patient dies during the administration of anesthesia, in addition to samples described above for determination of volatile and gaseous substances it is also recommended that samples of omental or mesenteric fat be taken as well as skeletal muscle. Forensic medical diagnosis. Diagnosis formulate, as a rule, immediately after an expert study of the corpse. In unclear cases (in cases of suspected poisoning, when the complex pathology of the painting and etc.) in the diagnosis just have to specify found morphological features, without indication of the entity. Or the formulation of a diagnosis of delayed until receipt of the results of laboratory research. Conclusion: The end result is to provide answers to questions arising from a medicolegal death investigation through proper procedures and thorough death investigations. This section is interpretative and subjective, representing the opinion of the author. It includes the cause of death as appearing on the death certificate. The commentary is in simple English and brings together all the relevant information obtained from examination of the body, the scene of death and the history of the decedent. Information obtained second-hand (hearsay) may be included e.g. from police reports, medical records, fire investigation reports. The relevant issues are addresses i.e. what happened, to who, when, where, why and how. It may be as brief or as detailed as the need dictates It is directed to the law officer investigating the death and any other legally interested parties who may obtain access to the report subsequently. The commentary is analogous summary of a hospital autopsy which brings together the pathological autopsy findings with the clinical findings and subsequent progress. SIGNATURE

All medico-legal reports require the original signature of the author. Relevant degrees and other qualifications are given. Exercises for Student's Independent Work Activity 2. To study the list of questions which should be solved during the examination in case of death caused by blunt or sharp objects? What is the cause of death? (natural or unnatural). What is the manner of death? (accidental, suicidal or homicidal). What is the time passed after death? What type of trauma instrument was used? If there were multiple wounds, which wound was fatal? How long did the victim live after the injury? In what position was the victim at the time of the assault? From what direction was the force applied?

Is there any evidence of a struggle or selfdefense? Is there any evidence of rape or other sex-related acts? Was the deceased under the influence of alcohol or any other type of drug? (The actual analysis should be done by the toxicologist) Activity 3. To study the list of questions which should be solved during the examination in case of death caused by firearm injuries? What is the cause of death? (natural or unnatural). What is the manner of death? (accidental, suicidal or homicidal). What is the time passed after death? What type of weapon was used? Where is entry and exit wound? What is the direction of wound canal? What is the distance of shot?

 If there were multiple wounds, which wound was fatal? How long did the victim live after the injury? In what position was the victim at the time of the assault? Was the deceased under the influence of alcohol or any other type of drug? (The actual analysis should be done by the toxicologist). Activity 4. To study the list of questions which should be solved during the examination in case of infant death? Was the child newborn and live-born? If the child was live-born how long he (or she) lived after the birth? Was the child full-term and mature? Are there any signs of the appropriate care of the newborn child? What is the cause of death? (natural or unnatural). What is the manner of death? (accidental, suicidal or homicidal). What is the time passed after death? What is a blood group of child? Does the found blood belongs to the newborn child or adult? Note: fetal and perinatal autopsies should include a detailed gross and microscopic examination of the placenta. In addition, pediatric autopsies require additional measurements to be taken (head circumference, abdominal circumference, etc), which should be tabulated in the report. This information places the autopsy findings within a developmental context. Activity 5. To study the list of questions which should be solved during the examination in case of sudden death: What is the cause of death? (natural or unnatural). What is the manner of death? (accidental, suicidal or homicidal). What is the time passed after death?

 Are there any injuries on the dead body? If there are What is the mechanism of their formation? and What instrument of trauma was used for that? Did the dead person suffer from any disease? Activity 6. To study the list of questions which should be solved during the examination in case of poisoning: What is the cause of death? What is the probable way of getting the poison into the organism? How much of the poison substances has got into the organism? Is the coming of death connected with individual features of a dead person for example - increased sensitivity to this poison? Has a dead person drunk any alcohol shortly before the death and how much of it he (or she) has drunk? Are there any injuries on the dead body? If there are What is the mechanism of their formation? Activity 7. To study guidelines for description and documentation of injuries A. Generally, the forensic medical expert should, if applicable: describe injury by type (i.e. gunshot wound, stab, laceration, abrasion, contusion); describe injury by location; describe injury by size; describe injury by shape; describe injury by pattern; obtain photographs of injuries so that images are clear, appropriately documented with a scale, and useful for medicolegal purposes. The condition of their edges, coagulated blood and evidence of bleeding into nearby tissues are to be noted. It should be determined whether they were caused before

or after death and their time of infliction. It is necessary to collect foreign materials, e.g., hair, grass, fibres, etc., that may be in the wound. Sketches and photographs are useful. The limbs and other parts should be examined for fractures and dislocations by suitable movements and by palpation and confirmed by dissection. B. In cases of Firearm Injuries, the forensic medical expert should: measure entrance and exit wound defect sizes; locate cutaneous wounds of the head, neck, torso, or lower extremities by measuring from the top of the head, and from either the anterior or posterior midline; locate cutaneous wounds of the upper or lower extremities by measuring from anatomic landmarks (i.e. elbow, knee); describe presence or absence of soot and stippling around entrance wounds; describe presence of abrasion ring, searing, muzzle imprint, or lacerations; correlate internal injury to external injury; describe and document the path of the wound through the body, including involved organs, major blood vessels, and associated hemorrhage; describe and document the direction of wound through the body; recover, describe and document recovered firearm projectile(s). C. In cases of Sharp Force Injuries, the forensic medical expert should: describe wound, and indicate if stab or incised, if appropriate; measure wound size; locate wound in anatomic region; correlate internal injury to external injury; describe and document the track of wound into the body, including any involved organs, blood vessels, or associated hemorrhage; describe and document the direction and estimated depth of the wound; recover, describe and document any foreign body recovered (i.e. broken blade).

D. In cases of Blunt and Patterned Injuries, the forensic medical expert should: measure injury size; describe location of injury; describe injury pattern; correlate internal injury to external injury; describe and document injuries to skeletal system; describe and document injuries to internal organs, structure, and soft tissue; photograph any significant patterned injury after cleaning with a scale. E. In Burn Injuries, the forensic medical expert should describe and document

the appearance and distribution of the burn. Activity 8. To study guidelines for making up forensic medical diagnosis: I. Basic Injury, or Disease with the list of the attributes confirming the given diagnosis. II. Complications of the Basic Injury, or Disease causally connected with approach of death. III. Accompanying changes - Injuries and Diseases, which dot not pertain to causes of death. By the end of this lesson students will be able to: Recount the basic procedure for the forensic autopsy Dissect tissues in such a way as to preserve important pathologic findings Select correct pieces of tissue for additional examinations
Describe the main changes that occur in the human body in the early stages after

death and understand how these may be utilised to help estimate the post-mortem interval Diagnose and classify death, identify the signs of death, postmortem changes,

interpret the autopsy findings, artifacts and results of the other relevant investigations to logically conclude the cause, manner (suicidal, homicidal and accidental) and time of death. Understand the basic legal aspects of medical malpractice lawsuits, and the potential roles of pathologists as defendants and consultants in such actions Understand and interpret other important medico-legal aspects of death due to natural and unnatural conditions and poisonings. Understand the postmortem processes which assist in determining time and cause of death Apply the principles involved in methods of identification of human remains by race, age, sex, religion, complexion, stature, hair, teetch, enthropometry, dactylography, foot prints, hairs, tattoos, poroscopy and superimposition techniques. Demonstrate proper technique in collecting and packaging samples trace evidence. Describe those circumstances in which specimens (fluids or tissues) should be kept for toxicological studies, and knowledge of how to do so.

PLAN of LEADTHROUGH of MEDICO-LEGAL EXAMINATION of dead BODY 1. Study of decision and questions of put to the expert. 2. Estimation of sufficientness of materials for an answer for the put questions and drafting of solicitor to the investigator about the grant of necessary materials. 3. Study of medical documents and business materials. 4. Research of dead body: examination of clothes; outward research of dead body; internal research of dead body; withdrawal, packing and direction of biological objects, instruments of trauma and clothes on laboratory researches. 5. Leadthrough of laboratory researches. 6. Study of results of laboratory researches. 7. Participating in examination of site of occurrence and interrogations of witnesses. 8. Analysis and synthesis of results of all conducted researches. 9. Drafting of diagnosis.

10. Formulation of conclusions (answers for the questions of investigator and initiative questions of expert). 11. Registration of Conclusion of expert. 12. Delivery of Conclusion.

- 1. . 2. . 3. . 4. : ; ; ; , , . 5. . 6. . 7. . 8. . 9. . 10. ( ). 11. . 12. . MIDDLE SIZES AND MASS OF ORGANS OF ADULTS , .. 1375 27-28 1250 27-28 , . 16-17 45 . 15-16 45 , . 13-14 . 13-14 , . 10,512,5 . 10,512,5

: :

360-570 325-480

360-570 325-480

26 26

26 26

16-17 16-17

16-17 16-17

0,2-0,3 0,7-1,2 9-10 9-10

0,2-0,3 0,7-1,2 9-10 9-10

1600 90-120 150-180 150-180 15-17 18-25

1600 90-120 150-180 150-180

19-21 23 11-12 10-12 2,3-3,4 4-4,5

19-21 23 11-12 10-12

25-30 3,5 5-6 7-8 3,2-4,7 2-2,7

25-30 3,5 5-6 7-8

6-9 2 3-4 3-4 1,4-2,3 2,5-3,5

6-9 2 3-4 3-4

33-41 102-117

7,8-8,1 8,7-9,4

3,4-4,5 5,4-6,1

1,8-2,7 3,2-3,6

Human Body Organs: Anatomy Of Largest, Biggest Organs System Functions And Formation
There are almost 78 organs in a human body which vary according to their sizes, functions or actions. An organ is a collection of millions of cells which group together to perform single function in a human body. The cells in these body organs are highly specialized and formed for all the necessary actions for some specific time. Out of these 78 organs of a male or female body, skin is the largest or biggest organ with respect to its size and weight. The mojor or prerequisite human organ is the brain which handles all the functions and actions of a human body. Other top ten or 10 organs of the body are given in the following list with names and functions. Skin is the largest or biggest human body organ. The average weight of skin in human body is about 10,886 grams which varies according to the size and weight of human being. Human skin is made up of different ectodermal tissues and it protects all the inner body organs like liver, glands, stomach, heart etc. Other functions are heat regulation, interaction with atmosphere, protection from diseases, absorption and sensation.

Liver is the second largest organ of male or female human body. Its average weight in a normal human body is 1,560 gms. The liver recieves blood full of digested food from the gut. It stores some foods and delivers the rest to the other cells through blood. The other function of liver is to change the left material into harmless waste called urine.

Brain is the third largest and major organ of human body. Its average weight in a normal human body is 1,263 gms. The brain controls the actions of all the body parts. There are about 100 billion cells in human brain which make about 100 trillion nerve connections with nerve cells for messaging. Medulla oblongata, Midbrain, Hind brain, Cerebellum, Spinal cord and Venticle are some of the major parts of a human brain.

Lungs is the fourth biggest organ of human beings body. The average total weight of the right and left lung in a normal human body is about 1,090 gms. The major function of lungs is to inhale oxygen and exhale carbon dioxide out of the red blood cells. The lungs can hold a total of upto 5 litres of air. The adult lungs have an internal area of over 90 meters, that is about half the area of a tennis court.

Heart is the fifth largest human body organ which is prerequisite for a living human being. The major function of the heart is to pump the blood to every part of the body to deliver the energy to every body cell. In males the average weight of heart is 315 gm while in females this weight is about 265 gms. Ventricles, atrium and aorta are some of the main parts of a human heart.

Kidneys is the sixth largest organ in every human body. There are two kidneys in every human being and the average weight of both the kidneys is about 290 grams. The major function of a kidney is to separate the waste amterial by filtering the blood. Both these kidneys filter our blood 50 times a day. If one kidney stops working the other will enlarge and do the work of two.

Spleen is 170 grams heavy and it is the seventh largest or heaviest organ of the human body. It forms the red blood cells pulp and white blood cells pulp. Therefore it is helpful in making the blood and increasing the immunity of the human being.

Pancreas is the eighth largest human organ with an average weight of 98 grams in human body. It is one of the most important gland which produces several hormones including insulin, glucagon, and somatostatin. The pancreas is a dual-function gland, having features of both endocrine and exocrine glands.

Thyroid is the ninth biggest one in human organs system. The average weight of thyroid gland in human body is 35 grams. It is the largest gland in the human body. The function of this gland is to produce thyroxine and triiodothyronine hormones.

Prostate is the tenth largest human organ gland with a weight of 20 grams. It is the

Which of the following represents the best measure available for estimating the time of death (especially within the first 18 hours after death)? The development of cloudiness in the eyes. Changes in body temperature. Hypostasis. Rigor mortis. In the case of skeletalised human remains, which of the following features is not of potential use in making a personal identification? Tattoos. Your Answer:

Forensic entomology is primarily concerned with the interpretation of insect evidence found in association with decomposing corpses discovered under suspicious circumstances. An examination of the development stages of the insects present may yield valuable information about: the post-mortem interval. Your Answer: Which of the following represents the best measure available for estimating the time of death (especially within the first 18 hours after death)? Hypostasis. Your Answer: Changes in body temperature. Correct Answer: In the case of skeletalised human remains, which of the following features is not of potential use in making a personal identification? Bone disorders. Tattoos. Dentition. Surgical implants.

The post-mortem process whereby a corpse is preserved through desiccation is termed: mummification. skeletalisation. myiasis. putrefaction.

1. An autopsy is performed to find out: What the victim's personality was like. How and why the victim died. Whether the victims was responsible for the crime.

Instructions Please choose the best answer. Questions

1. A coroner is most likely to be:

A) A police officer B) A board-certified forensic pathologist C) A board-certified family practitioner D) A physician E) An adult with no training in death investigation

2. Which of the following is most likely a death that will be investigated by the medical examiner? A) An obese woman is admitted with a pulmonary embolism and dies within 24 hours of admission B) A woman with coronary artery disease dies suddenly at home and you are covering for her treating physician C) A man with hypertension is found dead at home and police find nothing suspicious in their investigation D) A man with chest pain dies in the ER E) A man dies of a subdural hematoma after falling at home

3. Which of the following must always be written under Part I of the medical certification of death? A) An alternative cause of death B) The contributory cause of death C) The underlying cause of death D) The intermediary cause of death E) The immediate cause of death

4. The death certificate must be filled out within: A) 30 days of death B) 24 hours of notification of death C) 5 days of time of death D) 48 hours of notification of death E) 72 hours of notification of death

5. Which of the following is a underlying cause of death? A) Coronary atherosclerosis B) Multiorgan failure C) Disseminated intravascular coagulation D) Seizure E) Adult respiratory distress syndrome

6. Which of the following causes of death should be reported to the medical examiner? A) Cardiopulmonary arrest due to ruptured aortic aneurysm B) Spontaneous intracerebral hemorrhage due to hypertension and coumadin use C) Anoxic-ischemic encephalopathy due to drug overdose D) Cerebral infarction due to endocarditis due to infected intravascular catheter E) Aspiration pneumonia due to Alzheimer's disease

7. Livor mortis is: A) Muscle stiffening after death B) Pooling of blood in the dependent parts of the body after death C) Yellow discoloration of the liver after death D) Involuntary movement of the chest wall after death E) Body cooling after death

8. The first accredited osteopathic forensic pathology training program in the US is at the: A) Broward Medical Examiner Office B) New York City Medical Examiner Office C) Dallas Medical Examiner Office D) Miami-Dade Medical Examiner Office E) Los Angeles Coroner Office

9. A medical examiner autopsy does NOT require: A) Evidence collection B) A physician perform the dissection C) Identification of the body D) Photographic documentation E) Permission from the next-of-kin

10. Rigor mortis in skeletal muscle is caused by the disappearance of: A) A living spirit B) Myosin C) Unopposed sympathetic discharge D) ATP E) Core body temperature Correct Answers: 1. E 2. E 3. C 4. E 5. A 6. C 7. B 8. A 9. E 10. D

. Semen stains on clothes can be identified by ? Ultraviolet rays Spectrometry Infrared rays 3. Homicide means: The intentional taking of ones own life. The unintentional killing of a human being. The killing of a human. At what rate does the core body temperature drop per hour after death? :-) 0.8C 3C 0.6C 6. How long does the digestive process take? X 3 hours. Usually more than one day.

Which of the following death manners can be a result of a fire?

X Electrocution. Asphyxiation. X Windburn. Once the autopsy is complete, the samples of tissue are stored by:

Placing the sample in containers and putting them in a storage cupboard. Placing the samples in the bags and disposing of them. Placing the samples in either containers or bags, labeling them and :-) storing them in a refrigerated storage area. 1. When skeletons are found, the teeth are an important source of information. In such cases, which of the following statements is the most accurate? a) Teeth can indicate a person's occupation. b) Teeth can indicate a person's age. c) All three statements are true. d) Teeth can indicate a person's ethnic background. The correct answer is c) All three statements are true.

If a body is left undisturbed for how long does post-mortem staining persist 1. Few hours 2. Few days 3. Few months 4. Persists till it demerges with discoloration of putrefaction 5. Correct Answer: 4. Question 11: In rigor mortis muscle 1. Stiffens 2. Shortens 3. Stiffens and shortens 4. Stiffens and lengthens 5. Correct Answer: 3. Question 13: Presence of maggots at post-mortem indicates

1. Duration since death 2. Cause of death 3. Mode of Death 4. Posture of body at death 5. Correct Answer: 1.

Question 15: Rigor mortis first starts in 1. Upper eyelids 2. Lower eyelids 3. Lower limbs 4. Fingers 5. Correct Answer: 1. Question 17: What disappears first in Post mortem rigidity 1. Eyelids 2. Neck 3. Lower limbs 4. Upper limbs 5. Correct Answer: 1. Question 18: Post mortem staining can occur in some cases before death in 1. Children 2. Old persons 3. Cholera 4. All of the above 5. Correct Answer: 3. Question 20: Rigor mortis develops__ after death 1. 1/2 - 1 hour 2. 1-2 hours 3. 3-6 hours 4. 6-8 hours 5. Correct Answer: 3. Question 21: Post mortem staining gets fixed after 1. 2-3 hours 2. 3-4 hours 3. 5-6 hours

4. 6-7 hours 5. Correct Answer: 4.

Question 25: True about Cadaveric spasm 1. Instant in onset 2. Confined to small group of muscles 3. Occurs only in voluntary muscles 4. Indicates that the person was alive at that time 5. All of the above Correct Answer: 5.

Question 28: In a decomposed body the first sign seen is 1. Greenish discolouration over skin of right iliac fossa 2. Greenish discolouration over skin over left iliac fossa 3. Purplish black discolouration on face 4. Purplish black discolouration over lower extremities 5. Correct Answer: 1. Question 38: Hypostasis lasts for 1. Hours 2. Days 3. Weeks 4. Months 5. Correct Answer: 2. Question 39: Spinal cord is opened from 1. Frontal approach 2. Back side 3. Lateral side 4. Any of the above 5. Correct Answer: 2. Question 40: True statement about adipocere 1. It is due to dehydration of the subcutaneous tissue 2. It is due to hydrogenation of subcutaneous fat 3. It is formed in the epidermal tissues 4. It is retarded by heat and accelerated by cold 5. Correct Answer: 2.

Question 44: Correct order of putrefaction 1. Brain, Heart, Uterus 2. Brain, Uterus, Heart 3. Uterus, Heart, Brain 4. Brain, Uterus, Heart 5. Correct Answer: 1. Question 47: Post-mortem autopsy is done in 1. Whole body 2. Parts which are injured 3. Parts under inquest 4. Parts under consent from relatives 5. Correct Answer: 1 . Question 53: Post mortem cherry red discolouration is due to 1. Asphyxia 2. Carbon monoxide 3. Drowning 4. OPC poisoning 5. Correct Answer: 2. Question 69: Rate of cooling helps in determining 1. Time of death 2. Manner of death 3. Place of death 4. Cause of death 5. Correct Answer: 1. Question 71: Post mortem lividity is unlikely to develop in a case of 1. Drowning in well 2. Drowning in fast flowing river 3. Postmortem submersion 4. Drowning in swimming pool 5. Question 73: The rate of cooling down of dead bodies in tropical climate is Question 75: Mummification is due to 1. Putrefaction 2. Desication 3. Saponification 4. Necrosis 5. Correct Answer: 2.

Question 81: Maggots are seen on the dead body after 1. One day 2. 2 to 3 days 3. 3-4 days 4. One week 5. Correct Answer: 2. Question 86: Mummification refers to 1. Hardening of muscles after death 2. Colliquative putrifaction 3. Saponification ofsubcutaneous fat 4. Dessication of a dead body 5. Correct Answer: 4. Question 88: Mummification occurs when 1. High atmospheric temperature is present 2. Dry Air condition 3. Wind is present 4. All of the above 5. Correct Answer: 4. Question 89: Post mortem caloricity is seen with 1. Strychnine poisoning 2. Lead poisoning 3. Mercury poisoning 4. Phosphorus poisoning 5. Correct Answer: 1.

Test Paper : PG Medical Entrance Examination Model Paper For (Forensic Medicine) Question 1: Blood stain of humun origin is tested by 1. Preciptin test 2. Heamin crystal test 3. Haemochromogen test 4. Benzidine test 5. Correct Answer: 3.

Question 2: Widmark's formula is used for measurement of blood levels of 1. Alcohol 2. Barbiturates 3. Arsenic 4. Benzodiazepines 5. Correct Answer: 1. Question 3: Immediate stiffness post mortem occurs in 1. Cadaveric rigidity 2. Cadaveric spasm 3. Rigor mortis 4. Algor mortis 5. Correct Answer: 2. Question 4: The temperature of the body rises up for the first two hours after death. The probable condition include following except 1. Sun stroke 2. Frost bite 3. Septicemia 4. Strychnine poisoning 5. Correct Answer: 2. Question 5: Foamy liver is seen in 1. Putrefaction 2. Drowning 3. Mummification 4. Adipocere 5. Correct Answer: 1. Question 6: Post mortem staining of lower parts of hands and feet indicates 1. Prolonged suspension after death 2. Antemortem hanging 3. Death due to asphyxia 4. Drowning 5. Correct Answer: 1. Question 7: Which one of the following is NOT a principle followed in the management of missile injuries

1. Excision of all dead muscles 2. Removal of foreign bodies 3. Removal of fragments of bone 4. Leaving the wound open 5. Correct Answer: 3. Question 8: Rigor mortis is simulated by 1. Cadaveric spasm 2. Mummification 3. Algor mortis 4. All of the above 5. Correct Answer: 1. Question 9: If a body is left undisturbed for how long does post-mortem staining persist 1. Few hours 2. Few days 3. Few months 4. Persists till it demerges with discoloration of putrefaction 5. Correct Answer: 4. Question 10: A patient with myocardial infarction, after death, underwent autopsy. Microscopic examination of the cardiac tissue as part of autopsy revealed granulation tissue. The time from infarction till death is most likely to be 1. < 24 hours 2. < 2 hours 3. < 10 days 4. < 1 month 5. Correct Answer: 3. Question 11: In rigor mortis muscle 1. Stiffens 2. Shortens 3. Stiffens and shortens 4. Stiffens and lengthens 5. Correct Answer: 3. Question 12: Entire absence of fat throughout the body in post mortem is suggestive of 1. Starvation

2. Tuberculosis 3. Diabetes 4. All of the above 5. Correct Answer: 1. Question 13: Presence of maggots at post-mortem indicates 1. Duration since death 2. Cause of death 3. Mode of Death 4. Posture of body at death 5. Correct Answer: 1. Question 14: Which of the following is not a diagnostic feature for allergic fungal sinusitis? 1. CT shows hyperdense / hyperechoic mass 2. Orbital extension / orbital penetration 3. Allergic reaction / type 1 hypersensitivity 4. Steroids are used in management 5. Correct Answer: 2. Question 15: Rigor mortis first starts in 1. Upper eyelids 2. Lower eyelids 3. Lower limbs 4. Fingers 5. Correct Answer: 1. Question 16: A drug addict gives history of tactile sensations all over his body. He is likely ot have consumed 1. Opium 2. Heroin 3. Cannabis 4. Cocaine 5. Correct Answer: 4. Question 17: What disappears first in Post mortem rigidity 1. Eyelids 2. Neck 3. Lower limbs

4. Upper limbs 5. Correct Answer: 1. Question 18: Post mortem staining can occur in some cases before death in 1. Children 2. Old persons 3. Cholera 4. All of the above 5. Correct Answer: 3. Question 19: Rigor mortis is simulated by 1. Cadaveric spasm 2. Mummification 3. Algor mortis 4. All of the above 5. Correct Answer: 1. Question 20: Rigor mortis develops__ after death 1. 1/2 - 1 hour 2. 1-2 hours 3. 3-6 hours 4. 6-8 hours 5. Correct Answer: 3. Question 21: Post mortem staining gets fixed after 1. 2-3 hours 2. 3-4 hours 3. 5-6 hours 4. 6-7 hours 5. Correct Answer: 4. Question 22: A skull was found which had an oval nasal opening, horseshoe shaped palate, round orbits and a cephalic index greater than 80. The race to which it belongs is probably belongs is most probably 1. Negroes 2. Mongols 3. Caucasians 4. Aryans 5.

Correct Answer: 2. Question 23: Paultaf's hemorrhage is seen in which injury? 1. Strangulation 2. Hanging 3. Drowning 4. Burns 5. Correct Answer: 3. Question 24: Post mortem wound best differs from the antemortem wound by 1. Gaps on incising 2. No clots 3. Absence of erythema and cellular changes 4. Removable stain 5. Correct Answer: 3. Question 25: True about Cadaveric spasm 1. Instant in onset 2. Confined to small group of muscles 3. Occurs only in voluntary muscles 4. Indicates that the person was alive at that time 5. All of the above Correct Answer: 5. Question 26: Among the following, the drugs that are of use in a case of Ectopic pregnancy include 1. Adriamycin 2. Actinomycin D 3. Potassium fluoride 4. Methotrexate 5. Correct Answer: 4. Question 27: Which of the following sign will indicate that the death was antemortem 1. Cutis anserina 2. Washerwomans skin 3. Weed & grass in hands 4. Cyanosis 5. Correct Answer: 3. Question 28: In a decomposed body the first sign seen is

1. Greenish discolouration over skin of right iliac fossa 2. Greenish discolouration over skin over left iliac fossa 3. Purplish black discolouration on face 4. Purplish black discolouration over lower extremities 5. Correct Answer: 1. Question 29: Elevated levels of cyanide is seen in death due to which of the following 1. Cold 2. Scald 3. Starvation 4. Thermal burns 5. Correct Answer: 4. Question 30: Which one of the tissues putrefies late 1. Brain 2. Prostate 3. Liver 4. Stomach 5. Correct Answer: 2. Question 31: On firearm injuries, blackish discoloration around the entry wound is due to 1. Flame 2. Smoke 3. Deposition of un burnt powder 4. Hot gases 5. Correct Answer: 3. Question 32: Blood clots after__ of death 1. 1/2 hr 2. 45 min 3. 1/4hr 4. 1 1/2 hrs 5. Correct Answer: 1. Question 33: Dying deposition is recorded by 1. Doctor 2. Magistrate 3. Police officer

4. Lawyer 5. Correct Answer: 2. Question 34: A patient is brought with opium poisoning. The antagonists to opium include 1. Buprenorphine 2. Meptazinol 3. Nalorphine 4. Neostigmine 5. Correct Answer: 3. Question 35: The postmortem finding seen in smothering includes 1. Bruising in inner aspect of upper lip 2. Fracture body of hyoid 3. Fracture of cricoid 4. Curved marks on neck 5. Correct Answer: 1. Question 36: One of the following is a definite sign of death due to drowning 1. Sand and mud in the mud and nostrils 2. Fine lathery froth in mouth and nostrils 3. Washerwomans hand and feet 4. Diatoms in bone marrow 5. Correct Answer: 4. Question 37: Sentence of death is passed in which judicial court 1. High court 2. Supreme court 3. Session court 4. Assistant session court 5. Correct Answer: 1. Question 38: Hypostasis lasts for 1. Hours 2. Days 3. Weeks 4. Months 5. Correct Answer: 2.

Question 39: Spinal cord is opened from 1. Frontal approach 2. Back side 3. Lateral side 4. Any of the above 5. Correct Answer: 2. Question 40: True statement about adipocere 1. It is due to dehydration of the subcutaneous tissue 2. It is due to hydrogenation of subcutaneous fat 3. It is formed in the epidermal tissues 4. It is retarded by heat and accelerated by cold 5. Correct Answer: 2. Question 41: Aseptic autolysis is found in 1. Adipocere 2. Putrefaction 3. Mummification 4. Maceration 5. Correct Answer: 4. Question 42: Reddish brown colour in Post mortem lividity 1. CO poisoning 2. Cyanide poisoning 3. Phosphorus poisoning 4. Aniline poisoning 5. Correct Answer: 4. Question 43: Postmortem in a newborn baby is done by opening first 1. The skull 2. The chest cavity 3. The abdominal cavity 4. As per convenience 5. Correct Answer: 3. Question 44: Correct order of putrefaction 1. Brain, Heart, Uterus

2. Brain, Uterus, Heart 3. Uterus, Heart, Brain 4. Brain, Uterus, Heart 5. Correct Answer: 1. Question 45: In suspected case of death due to poisoning where cadaveric rigidity is lasting longer than usual, it may be a case of poisoning due to 1. Lead. 2. Arsenic 3. Mercury 4. Copper 5. Correct Answer: 2. Question 46: Scab or Crust of abrasion appears brown 1. Between 2-3 days 2. Between 5-6 days 3. Between 3-5 days 4. Between 12-24 hours 5. Correct Answer: 1. Question 47: Post-mortem autopsy is done in 1. Whole body 2. Parts which are injured 3. Parts under inquest 4. Parts under consent from relatives 5. Correct Answer: 1. Question 48: Activated charcoal is used in poisoning with 1. Alcohol 2. Barbiturates 3. Lead 4. Mercury 5. Correct Answer: 2. Question 49: Which of the following is true regarding cadaveric spasm 1. No primary relaxation 2. No secondary relaxation 3. No primary or secondary relaxation

4. No change 5. Correct Answer: 1. Question 50: What is suspended animation 1. The animal is suspended in air 2. Hibernation 3. The subject is alive but shows no signs of life 4. Deep sleep 5. Correct Answer: 3. Question 51: The most reliable criteria in Gustafson's method of identification is 1. Cementum apposition 2. Transparency of root 3. Attrition 4. Root resorption 5. Correct Answer: 2. Question 52: Tests for heavy metals are all except 1. Harrison and Gilfroys test 2. Neutron Emission test 3. Atomic spectroscopy 4. Paraffin test 5. Correct Answer: 4. Question 53: Post mortem cherry red discolouration is due to 1. Asphyxia 2. Carbon monoxide 3. Drowning 4. OPC poisoning 5. Correct Answer: 2. Question 54: Cardiac Polyp is a term used for Postmortem 1. Fibrinous clots in heart 2. Aneurysm 3. Infarcts in heart 4. Pale patches in heart 5. Correct Answer: 1.

Question 55: The following situations are associated with rise of temperature after death EXCEPT 1. Burns 2. Heat Strokes 3. Pontine Hemorrhage 4. Septicemia 5. Correct Answer: 1. Question 56: Blue line on the gums is seen in chronic poisoning with 1. Mercury 2. Lead 3. Arsenic 4. Antimony 5. Correct Answer: 2. Question 57: Tentative cuts are seen in a case of 1. Homicide 2. Suicide 3. Accidents 4. Fall from height 5. Correct Answer: 2. Question 58: Basophilic stippling is seen in 1. RBC 2. WBC 3. Neutrophilis 4. Basophil 5. Correct Answer: 1. Question 59: Maggots appear in body in rainy season within 1. 24 hours 2. 1-2 days 3. 2-3 days 4. 3-4 days 5. Correct Answer: 2. Question 60: Paltaufs haemorrhage may be seen in 1. Hanging

2. Drowning 3. Strangulation 4. Carbon monoxide poisoning 5. Correct Answer: 2. Question 61: Reasons for marked variation in the shape of exit wounds of rifled weapons 1. Deformation of bullet during its passage through body and thereby presenting an irregular wound 2. Absence of tumbling of the bullet in the body & hence it may not be able to exit with nose end first 3. Intact bullet in the body after striking bone 4. At times , both entry and exit wounds are of the same as in the assassination of kennedy , President of U 5. Correct Answer: 1. Question 62: In a completely charred body at autopsy medical officers can say that the burns are antemortem if he can find 1. Soot in respiratory passages 2. Cyanosis of finger nails 3. Congestion of kidney 4. Pale internal organs 5. Correct Answer: 1. Question 63: Patient of head injury, has no relatives, requires urgent cranial decompression; Doctor should 1. operate without formal consent 2. take police consent 3. wait for relatives 4. take 5. Correct Answer: 1. Question 64: Blackening and tattooing of skin and clothing can be best demonstrated by 1. Luminol spray 2. Infra red photography 3. UV light 4. Magnifying lens 5. Correct Answer: 2. Question 65: Which of the following sign will indicate that menstrual blood was antemortem

1. Alkaline 2. Doesnt clot unless mixed with semen 3. Light pink 4. Shows endometrial & vaginal cells 5. Correct Answer: 2. Question 66: Perjury means giving willfull false evidence by a witness while under oath, the witness is liable to be prosecuted for perjury and the imprisonment may extend to seven years. This falls under which section of IPC 1. 190 of Indian Penal Code 2. 191 of Indian Penal Code 3. 192 of Indian Penal Code 4. 193 of Indian Penal Code 5. Correct Answer: 4. Question 67: Which of the following is not correct regarding diatoms 1. Diatoms are aquatic unicellular plant 2. Diatoms has an extracellular coat composed of magnesium 3. Acid digestion technique is used to extract diatoms 4. Presence of diatoms in the Bone marrow is an indication of antemortem 5. Correct Answer: 2. Question 68: Which organ putrefies last in females 1. Brain 2. Breast 3. Uterus 4. Ovary 5. Correct Answer: 3. Question 69: Rate of cooling helps in determining 1. Time of death 2. Manner of death 3. Place of death 4. Cause of death 5. Correct Answer: 1. Question 70: After post-mortem autopsy body is handed over to 1. The authority who had conducted inquest in that case

2. Police Station near by 3. Coroner 4. Magistrate 5. Correct Answer: 1. Question 71: Post mortem lividity is unlikely to develop in a case of 1. Drowning in well 2. Drowning in fast flowing river 3. Postmortem submersion 4. Drowning in swimming pool 5. Correct Answer: 2. Question 72: Immediate rigidity of a group of muscle without passing into stage of primary relaxation 1. Cadaveric spasm 2. Cadaveric rigidity 3. Both 4. None 5. Correct Answer: 1. Question 73: The rate of cooling down of dead bodies in tropical climate is 1. 0.20 C / hr 2. 0.50C / hr 3. 1.0 C / hr 4. 1.50 C / hr 5. Correct Answer: 2. Question 74: Barberio,s test is done for 1. Blood 2. Urine 3. Saliva 4. Semen 5. Correct Answer: 4. Question 75: Mummification is due to 1. Putrefaction 2. Desication 3. Saponification 4. Necrosis 5.

Correct Answer: 2. Question 76: One of the following is true of antemortem abrasion 1. Bright red in colour 2. Exudation of serum is more 3. Intravital reaction is seen 4. All of the above 5. Correct Answer: 1. Question 77: Post mortem lividity is unlikely to develop in a case of 1. Drowning in well 2. Drowning in fast flowing river 3. Post mortem submersion 4. Drowning in clorinated swimming pool 5. Correct Answer: 2. Question 78: The hydrostatic test need not be performed in case of 1. Infanticide 2. Spongy or crepitant 3. Lungs or Liver like in consistency 4. None 5. Correct Answer: 2. Question 79: All the following are related to legal responsibility of an insane person except 1. Mc Naughten's rule 2. Durham's rule 3. Rule of nine 4. Curren's rule 5. Correct Answer: 3. Question 80: At autopsy, a body was found to have fine froth from the nose and mouth which increased on compression of the chest. Which of the following is the most likely cause of death 1. Opioid poisoning 2. Hanging 3. Drowning 4. Cyanide poisoning 5. Correct Answer: 3.

Question 81: Maggots are seen on the dead body after 1. One day 2. 2 to 3 days 3. 3-4 days 4. One week 5. Correct Answer: 2. Question 82: Tentative cuts are seen in a case of 1. Homicide 2. Suicide 3. Accident 4. Drowning 5. Correct Answer: 2. Question 83: Antemortem blister differs from postmortem blister by 1. Presence of Albumin & Chloride in blister fluid 2. Gas in blister 3. Dry hard surface of the floor of blister 4. Absence of hyperemia around the blister 5. Correct Answer: 1. Question 84: Which of the following is not a feature of brain death 1. Complete apnea 2. Absent pupillary reflex 3. Absent deep tendon reflex 4. Heart rate unresponsive to atropine 5. Correct Answer: 3. Question 85: More than 5% carboxyhaemoglobin is indicative of 1. Ante mortem burns 2. Drowning 3. HCN poisoning 4. Suffocation 5. Correct Answer: 1. Question 86: Mummification refers to 1. Hardening of muscles after death

2. Colliquative putrifaction 3. Saponification ofsubcutaneous fat 4. Dessication of a dead body 5. Correct Answer: 4. Question 87: Endotracheal intubations prior to gastric lavage is done in cases of poisoning 1. To prevent aspiration 2. Due to fear of cardiac arrest 3. For ventilatory support 4. For easy passage of gastric tube 5. Correct Answer: 3. Question 88: Mummification occurs when 1. High atmospheric temperature is present 2. Dry Air condition 3. Wind is present 4. All of the above 5. Correct Answer: 4. Question 89: Post mortem caloricity is seen with 1. Strychnine poisoning 2. Lead poisoning 3. Mercury poisoning 4. Phosphorus poisoning 5. Correct Answer: 1. Question 90: . Number of hours since death is calculated by multiplying the fall in rectal temperature with 1. 0.33 2. 0.67 3. 1.0 4. 1.33 5. Correct Answer: 2. Question 91: Which of the following combination is correct 1. Deferroxamine - lead 2. Penicillamine - Copper 3. Dimercaprol - Iron

4. EDTA - Arsenic 5. Correct Answer: 2. Question 92: A patient has been allegedly bitten by cobra snake. The venom in such a bite would be 1. Musculotoxic 2. Vasculotoxic 3. Cardiotoxic 4. Neurotoxic 5. Correct Answer: 4. Question 93: In starvation, the post mortem appearance of gall bladder is 1. Atrophied 2. Distended 3. Show stones 4. Normal 5. Correct Answer: 2. Question 94: In burnt bones, the following can be detected 1. Arsenic 2. Lead 3. Organophosphorus 4. Mercury 5. Correct Answer: 1. Question 95: Cafe Coronary is due to 1. Myocardial infarction 2. Asphyxia 3. Strangulation 4. Drowning 5. Correct Answer: 2. Question 96: Honey combing is seen in liver in cases of 1. Cirrhosis 2. Rupture 3. Putrefaction 4. Hydatid disease 5. Correct Answer: 3.

Question 97: Vibices are 1. Arborescent markings 2. Lichenberg flowers 3. Marbling 4. Hypostasis in subcutaneous area 5. Correct Answer: 1. Question 98: Changes in retinal vessels soon after death include 1. Fragmentation of Blood column 2. Haemorrhage into vitreous 3. Collapse of vessels 4. None of the above 5. Correct Answer: 1. Question 99: Suspended animation occurs after 1. Electrocution 2. Cyanide poisoning 3. Burns 4. Drowning 5. Correct Answer: 1. Question 100: Putrefaction starts in 1. Liver 2. Lung 3. Heart 4. Brain 5. Correct Answer: 1.

2) Post mortem lividity is useful to access a. Time since death b. To know the weapon used c. Position of the body after death d. None of the above

Answer : (c ) Position of the body after death