Postmortem changes – Early

Postmortem changes – Early

Q. 1

In which of the following conditions postmortem lividity is unlikely to develop?

 A

Drowning in well

 B

Postmortem submersion

 C

Drowning in a fast flowing river

 D

Drowning in chlorinated swimming pool.

Q. 1

In which of the following conditions postmortem lividity is unlikely to develop?

 A

Drowning in well

 B

Postmortem submersion

 C

Drowning in a fast flowing river

 D

Drowning in chlorinated swimming pool.

Ans. C

Explanation:

If the body is lying in moving water, due to constant movement of the body postmortem lividity may not develop.
 
Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 137-9

Q. 2

Which among the following is not known to cause delay in algor mortis?

 A

Pontine hemorrhage

 B

Asphyxial death

 C

Septicemia

 D

Burns

Q. 2

Which among the following is not known to cause delay in algor mortis?

 A

Pontine hemorrhage

 B

Asphyxial death

 C

Septicemia

 D

Burns

Ans. D

Explanation:

Algor mortis is the cooling of body after death.

Pontine hemorrhage, tetanus, asphyxial death, septicemia, sunstroke etc are causes for post mortem caloricity.

In case of burns, there is a loss of heat due to evaporation of fluids from the raw surface and hence causes ↑ algor mortis.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page – 124


Q. 3

Which of the following is TRUE about cadaveric lividity?

 A

It occurs only in the dependent parts

 B

It occurs only upto 3-4 hours after death

 C

It occurs due to dilatation of arterioles

 D

All these

Q. 3

Which of the following is TRUE about cadaveric lividity?

 A

It occurs only in the dependent parts

 B

It occurs only upto 3-4 hours after death

 C

It occurs due to dilatation of arterioles

 D

All these

Ans. A

Explanation:

Cadaveric lividity is the bluish-purple or purplish-red discolouration which appears under the skin in the most superficial layers of the dermis (rete mucosum) of the dependent parts of the body after death, due to capillo-venous distention.
It is well developed within four hours and reaches a maximum between 6 to 12 hours and persists until putrefaction sets in.
 
Ref: Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 136-137.

Quiz In Between


Q. 4

Post mortem lividity persists till :

 A

24 hours

 B

18 hours

 C

2-3 days

 D

Merges with putrefactive changes

Q. 4

Post mortem lividity persists till :

 A

24 hours

 B

18 hours

 C

2-3 days

 D

Merges with putrefactive changes

Ans. D

Explanation:

D i.e. Merges with putrefactive changes

–  Postmortem lividity also k/a suggilation, vabices, hypostasis, staining, darkening of death is an early sign of death & commences within an hour of death.Q

–  Fixed in about 4 – 6 hoursQ; reaches maximum between 6-12 hoursQ and persists until putrefaction sets in.Q Lividity does not develop in drowning in running water & areas of contact flattening.Q

When lividity first develops (i.e. before fixing), on applying firm pressure it disappears & releasing pressure it reappears (Difference from bruise).


Q. 5

A dead body is having cadaveric lividity of bluish green colour. The most likely cause of death is by poisoning due to

 A

Hydrocyanic acid

 B

Hydrogen sulphide

 C

Oleander

 D

Sodium nitrite

Q. 5

A dead body is having cadaveric lividity of bluish green colour. The most likely cause of death is by poisoning due to

 A

Hydrocyanic acid

 B

Hydrogen sulphide

 C

Oleander

 D

Sodium nitrite

Ans. B

Explanation:

B i.e. Hydrogen sulphide


Q. 6

Dark brown P.M. lividity is seen in:

 A

Aniline

 B

CO

 C

Phosphorous

 D

Hydrocyanide

Q. 6

Dark brown P.M. lividity is seen in:

 A

Aniline

 B

CO

 C

Phosphorous

 D

Hydrocyanide

Ans. C

Explanation:

c i.e. Phosphrous

Quiz In Between


Q. 7

Which of the following is not a postmortem change:

NEET 15

 A

Algor mortis

 B

Rigor mortis

 C

Atria mortis

 D

Livor mortis

Q. 7

Which of the following is not a postmortem change:

NEET 15

 A

Algor mortis

 B

Rigor mortis

 C

Atria mortis

 D

Livor mortis

Ans. C

Explanation:

Ans. Atria mortis


Q. 8

Postmortem lividity is useful to access:      

TN 06

 A

Time since death

 B

To know the weapon used

 C

Position of the body after death

 D

A and C

Q. 8

Postmortem lividity is useful to access:      

TN 06

 A

Time since death

 B

To know the weapon used

 C

Position of the body after death

 D

A and C

Ans. D

Explanation:

Ans. A and C


Q. 9

Best medium to estimate time since death:

Maharashtra 09

 A

Blood

 B

Vitreous humor

 C

CSF

 D

Pericardial fluid

Q. 9

Best medium to estimate time since death:

Maharashtra 09

 A

Blood

 B

Vitreous humor

 C

CSF

 D

Pericardial fluid

Ans. B

Explanation:

Ans. Vitreous humor

Quiz In Between


Q. 10

Color of postmortem lividity in hypothermic deaths:

NEET 13

 A

Purple

 B

Deep red

 C

Cherry red

 D

Bright pink

Q. 10

Color of postmortem lividity in hypothermic deaths:

NEET 13

 A

Purple

 B

Deep red

 C

Cherry red

 D

Bright pink

Ans. D

Explanation:

Ans. Bright pink


Q. 11

A dead body is having cadaveric lividity of bluish green color. The most likely cause of death is by poisoning due to:   

AIIMS 06; DNB 10; NEET 13

 A

Hydrocyanic acid

 B

Hydrogen sulfide

 C

Oleander

 D

Sodium nitrite

Q. 11

A dead body is having cadaveric lividity of bluish green color. The most likely cause of death is by poisoning due to:   

AIIMS 06; DNB 10; NEET 13

 A

Hydrocyanic acid

 B

Hydrogen sulfide

 C

Oleander

 D

Sodium nitrite

Ans. B

Explanation:

Ans. Hydrogen sulfide


Q. 12

What is the proof of eyes being open for few hours after death ‑

 A

Kevokian sign

 B

Tache noir

 C

Both of the above

 D

None of the above

Q. 12

What is the proof of eyes being open for few hours after death ‑

 A

Kevokian sign

 B

Tache noir

 C

Both of the above

 D

None of the above

Ans. B

Explanation:

Ans. is ‘b’ i.e., Tache noir

If the eye lids are open for a few hours after death, a film of cell debris and mucous forms two yellow triangles on the sclera on either side of the iris , which become brown and then black called tache noir withing 3 – 4 hours.

Quiz In Between


Q. 13

Algor mortis is ‑

 A

Rise of body temperature after death

 B

Cooling of body

 C

Persistent body spasm

 D

None

Q. 13

Algor mortis is ‑

 A

Rise of body temperature after death

 B

Cooling of body

 C

Persistent body spasm

 D

None

Ans. B

Explanation:

Ans. is ‘b’ i.e., Cooling of body

ALGOR MORTIS

After death, dead body behaves like an inert substance and therefore, if atmospheric temperature is low, body loses its heat by conduction, covection, radiation and evoporation, so as to attain the atmospheric temperature, i.e. the body cools. No cooling of dead body occurs if atmospheric temperature is higher than that of body.

Cooling of body starts 1/2 to 1 hour after death. There are varying opinions about rate of cooling of dead body:

i) Most widely accepted view is that the rate of cooling in india (tropical countries) is 0.5-0.7° C/hour, so that body attains atmospheric temperature in 16-20 hours after death. In temperate climate, the rate of fall is about 1.5° C/hour.

ii) As per another view, cooling is faster in initial period, when the temprature difference between body and atmosphere is maximum ‑

  1. First 30-45 minutes —> No temperature fall (isothermic phase).
  2. First 1-6 hours —4 1.5-2° C/hour.
  3. 6-12 hours       0.9-1.2° C/hour.
  4. After 12 hours —> 0.4-0.6° C/hour.

iii) Rate of cooling is related to difference in temperature and its surroundings (environment). In the first 2 hours average rate fall of temperature is roughly half this difference. In next 2 hours the temperature fall is at half this rate and in subsequent 2 hours, at quarter this rate.

iv) Most common site for recording temperature is the rectum. Thermameter is inserted in rectum around 8-10 cm for 2 minutes. Other sites for recording temperture are nose, ear (external auditory meatus), vagina and under liver.

Medicolegal importance of algor mortis –

i) It is a sign of death.

ii) Time since death may be determined and and algor mortis is the most important indicator to determine the time since death during first 24 hours.


Q. 14

Post mortem lividity in a case of poisoning caused by inhalation of fumes for a few minutes in a person working in gold mining is represented in the picture below .It is seen in a case of ? 

 A

CO poisoning.

 B

HCN poisoning.

 C

H2S poisoning.

 D

Phosphorus poisoning.

Q. 14

Post mortem lividity in a case of poisoning caused by inhalation of fumes for a few minutes in a person working in gold mining is represented in the picture below .It is seen in a case of ? 

 A

CO poisoning.

 B

HCN poisoning.

 C

H2S poisoning.

 D

Phosphorus poisoning.

Ans. B

Explanation:

Ans:B.)HCN poisoning.

The poisoning case shown in the picture above represents HCN poisoning as lividity shown is bright red(pinkish red) staining.

HCN poisoning

  • Acute hydrogen cyanide poisoning can result from inhalation of fumes from burning polymer products that use nitrile in their production, such as polyurethane, or vinyl.
    • Cyanides are used in many industries and thus are available to potential poisoners.
      • The main industries that use cyanides are:Mining of gold and Silver,Electroplating industry,pesticide industry
  • Cyanide poisoning is a form of histotoxic hypoxia because the cells of an organism are unable to create ATP, primarily through the inhibition of the mitochondrial enzyme cytochrome c oxidase.
  • Autopsy Findings
    • Hypostasis is said to be brick-red, due to excess oxyhaemoglobin (because the tissue are prevented from using oxygen) and to the presence of cyanmethaemoglobin.
    • There may be a smell of cyanide about the body, and a distinct odor of bitter almonds about the viscera especially in the skull cavity and the brain.
    • Internally the tissues may also be bright pink caused by the oxyhaemoglobin that cannot be utilized by the tissues – which is probably more common than the presence of cyanmethaemoglobin.
    • The stomach lining may be badly damaged and can present a blackened, eroded surface, by altered blood staining the stripped mucosa.The oesophagus may be damage, especially the mucosa of the lower third.
  CO poisoning Cyanide poisoning
Effect on ability of RBCs to transfer Oxygen Yes,it impairs No
Effect on mitochondria Effect not as much as Cyanide poisoning Complete and sustained blockade of cellular respiration inducing severe lactic acidosis
Type of Hypoxia Hypemic hypoxia is caused by the reduction of the oxygen carrying capacity of the blood.  

Histotoxic hypoxia because the cells of an organism are unable to create ATP, primarily through the inhibition of the mitochondrial enzyme cytochrome c oxidase.

Amount of exposure required Requires hours of exposure  Occurs within seconds or minutes of exposure
Post-mortem lividity Colour Cherry red Pinkish red
Treatment Oxygen Oxygen with Antidote like amyl nitrite,intravenous sodium nitrite, intravenous sodium thiosulfate and Hydroxocobalamin

Q. 15

Measurement of which electrolyte in this fluid as marked by an arrow shown in the  photograph below to evaluate time since death ? 

 A

Sodium.

 B

Potassium.

 C

Chloride.

 D

Proteins.

Q. 15

Measurement of which electrolyte in this fluid as marked by an arrow shown in the  photograph below to evaluate time since death ? 

 A

Sodium.

 B

Potassium.

 C

Chloride.

 D

Proteins.

Ans. B

Explanation:

Ans:B.)Potassium

The fluid shown in the picture above represents Vitreous humor.

Vitreous humour

  • It is a transparent, colorless, gelatinous mass that fills the space in the eye between the lens and the retina.
  • Produced by cells in the non-pigmented portion of the ciliary body.
  • Biochemical Properties:
    • It is composed mostly of phagocytes, which remove unwanted cellular debris in the visual field, and hyalocytes.
    • The vitreous humour contains no blood vessels, and 98–99% of its volume is water .
    • In addition to water, the vitreous consists of salts, sugars, vitrosin (a type of collagen), a network of collagen type II fibrils with glycosaminoglycan, hyaluronan, opticin, and a wide array of proteins.
    • It has a refractive index of 1.336.
  • Clinical Significance:
    • Unlike the fluid in the frontal parts of the eye (aqueous humour) which is continuously replenished, the gel in the vitreous chamber is stagnant. Therefore, if blood, cells or other byproducts of inflammation get into the vitreous, they will remain there unless removed surgically.These are known as floaters.
    • The metabolic exchange and equilibration between systemic circulation and vitreous humour is so slow that vitreous humour is sometimes the fluid of choice for postmortem analysis of glucose levels or substances which would be more rapidly diffused, degraded, excreted or metabolized from the general circulation.
      • Vitreous humor is strongly recommended as a body fluid for determination of ethanol in postmortem toxicology to help establish whether the deceased had consumed ethanol before death.
  • Forensic Significance:
    • After death, the vitreous resists putrifaction longer than other body fluids. The vitreous potassium concentration rises so predictably within the hours, days and weeks after death, that vitreous potassium levels are frequently used to estimate the time-of-death


Quiz In Between


Q. 16

Post mortem lividity as shown in the photograph below is due to which poisoning ? 

 A

Carbon monoxide.

 B

Hydrogen sulphide.

 C

Nitrites.

 D

Phosphorus.

Q. 16

Post mortem lividity as shown in the photograph below is due to which poisoning ? 

 A

Carbon monoxide.

 B

Hydrogen sulphide.

 C

Nitrites.

 D

Phosphorus.

Ans. A

Explanation:

Ans:A.)Carbon Monoxide

Post mortem lividity shows Bright red cherry discolouration of Skin.

Postmortem lividity

  • Livor mortis (postmortem lividity / hypostasis / suggillation)is the fourth stage and one of the signs of death.
  • Purple coloration of dependent parts, except in areas of contact pressure, appearing within 30 minutes to 2 hours after death, as a result of gravitational movement of deoxygenated blood within the vessels.

Colour of post mortem lividity (hypostasis)

  • Normal – Bluish pink which later turns into bluish purple
  • Carbon monoxide – Bright cherry red
  • Cyanide – Pink
  • Phosphorous – Dark brown
  • Nitrates – Reddish brown
  • Chlorates – Chocolate brown
  • Hydrogen sulphide – Bluish Green
  • Aniline – Deep blue
  • Opiates – Black

Postmortem findings of CO-poisoning

  • Fine froth at mouth and nose.
  • Bright cherry red discolouration of skin, mucous membranes, nail-beds, blood, tissues and internal organs as shown in the picture aboveCyanide poisoning and exposure to cold causes similar redness.
  • Blood is fluidish thin, hyperemia (congestion) is general, and serous effusion are common.
  • Skin blisters or red patches due to hypoxia in areas that contact the ground or appositional skin e.g. axilla, inner thigh, buttock, calves, knee.
  • Lungs show congestion with pink fluid blood, followed by pulmonary edema and bronchopulmonary consolidation.
    Pleural and pericardial anoxic haemorrhage, tiny focal necroses in myocardium are late changes (5 days).
  • Bilateral symmetrical necrosis and cavitation of basal ganglia (esp globus pallidus and putamen)
  • Spectroscopic examination, Hoppe – Seyler’s test (10% NaOH), kunkel’s (tannic acid) test and adding water (15 ml) in 2 drops of blood can detect CO.

Q. 17

Tache noire de salenortica is a postmortem finding is related to 

 A

Eye

 B

Muscle 

 C

Hair

 D

Semen

Q. 17

Tache noire de salenortica is a postmortem finding is related to 

 A

Eye

 B

Muscle 

 C

Hair

 D

Semen

Ans. A

Explanation:

  • Brownish discolouration of the sclera due to cellular debris and dust-Tache noire

Q. 18

Which of the following shows Kevorkian sign?

 A

Retina

 B

Sclera

 C

Vitreous

 D
Q. 18

Which of the following shows Kevorkian sign?

 A

Retina

 B

Sclera

 C

Vitreous

 D
Ans. A

Explanation:

Fragmentation or segmentation (trucking or shunting) of the blood columns (Kevorkian sign) appears in the retinal blood vessels within minutes after death and persists for about an hour.

Quiz In Between



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