Question 1: Which postmortem change is most reliable for estimating time of death during the first 24 hours?
- A. Rigor mortis
- B. Livor mortis
- C. Algor mortis
- D. Putrefaction
Answer
Answer: C. Algor mortis
Explanation: Algor mortis (body cooling) provides the most reliable time-of-death estimation in the first 24 hours when measured rectally with Henssge’s nomogram, which accounts for ambient temperature, body weight, and clothing. Rigor and livor mortis have greater variability due to environmental and physiological factors.
Question 2: What autopsy finding is pathognomonic for death by manual strangulation?
- A> Thyroid cartilage fracture
- B. Petechial hemorrhages
- C. Hyoid bone fracture
- D. Carotid artery intimal tears
Answer
Answer: C. Hyoid bone fracture
Explanation: While petechiae and thyroid cartilage fractures may occur, a hyoid bone fracture (especially in adults) is virtually diagnostic of manual strangulation due to the direct pressure required to break this protected U-shaped bone. The incidence increases with age as the bone ossifies.
Question 3: Which toxicological finding would most strongly suggest chronic arsenic poisoning?
- A. Elevated urine arsenic levels
- B. Mee’s lines in fingernails
- C. Garlic odor in tissues
- D. Basophilic stippling of RBCs
Answer
Answer: B. Mee’s lines in fingernails
Explanation: Mee’s lines (transverse white bands in nails) appear 2-3 months after arsenic exposure due to disrupted keratinization, making them markers of chronic poisoning. Urine arsenic may reflect recent exposure, while garlic odor and basophilic stippling are nonspecific.
Question 4: What is the most definitive autopsy finding in a case of fatal air embolism?
- A> Frothy blood in heart chambers
- B. Crepitus on organ palpation
- C. Air in coronary arteries
- D. Pulmonary edema
Answer
Answer: C. Air in coronary arteries
Explanation: While frothy blood and crepitus may suggest air embolism, the definitive finding is air bubbles in coronary arteries during water immersion of the heart. This confirms systemic air entry, often from trauma to large veins or medical procedures.
Question 5: Which histological finding is characteristic of death from acute carbon monoxide poisoning?
- A> Centrilobular hepatic necrosis
- B. Cherry-red livor mortis
- C. Bright pink skeletal muscles
- D. Pseudopalisading neuronal necrosis
Answer
Answer: B. Cherry-red livor mortis
Explanation: The cherry-red discoloration (from carboxyhemoglobin) in livor mortis is pathognomonic for CO poisoning. While muscles may appear pink, this is less specific. Hepatic necrosis and neuronal patterns occur in other poisonings.
Question 6: What autopsy finding would differentiate antemortem from postmortem burns?
- A. Skin splitting
- B. Carbon deposition in airways
- C. Pugilistic posture
- D. Epidermal peeling
Answer
Answer: B. Carbon deposition in airways
Explanation: Soot in the tracheobronchial tree confirms breathing during the fire (antemortem burn). Pugilistic posture and skin changes occur postmortem due to heat effects, while epidermal peeling happens in both scenarios.
Question 7: Which finding is most specific for fatal anaphylaxis at autopsy?
- A. Pulmonary edema
- B. Laryngeal edema
- C. Mast cell tryptase >20 ng/mL
- D. Eosinophilic infiltrates
Answer
Answer: C. Mast cell tryptase >20 ng/mL
Explanation: Elevated serum tryptase (released by degranulating mast cells) is the most specific marker. Laryngeal edema and pulmonary congestion occur in other conditions, while eosinophils may be absent in acute anaphylaxis.
Question 8: What is the earliest microscopic change in myocardial infarction?
- A> Wavy fiber change
- B. Coagulation necrosis
- C. Neutrophilic infiltrate
- D. Fibroblast proliferation
Answer
Answer: A. Wavy fiber change
Explanation: Wavy fibers (stretched, buckled myocytes) appear within 30-60 minutes of infarction due to passive stretching by adjacent viable tissue. Coagulation necrosis develops after 4-12 hours, followed by inflammation (12-24h) and fibrosis (days-weeks).
Question 9: Which finding would confirm a diagnosis of traumatic asphyxia?
- A. Rib fractures
- B. Petechiae above the level of compression
- C. Cyanosis of the face
- D. Pulmonary contusions
Answer
Answer: B. Petechiae above the level of compression
Explanation: The classic sign of traumatic asphyxia (e.g., from crush injuries) is intense facial/conjunctival petechiae above the compression point, caused by sudden backpressure in the superior vena cava system. Cyanosis and rib fractures are nonspecific.
Question 10: What is the most reliable method to diagnose drowning at autopsy?
- A. Froth in airways
- B. Diatom testing in bone marrow
- C. Lung weight >1000g
- D. Middle ear hemorrhages
Answer
Answer: B. Diatom testing in bone marrow
Explanation: While frothy fluid and heavy lungs are suggestive, diatom analysis is the gold standard. These microscopic algae from water penetrate the circulation during drowning and can be detected in distant organs like bone marrow, confirming antemortem water aspiration.