Postmortem changes -Immediate

Postmortem changes -Immediate

Q. 1 All  are  tests  for  stoppage  of   circulation EXCEPT:
 A Magnus test
 B Winslow’s test
 C Icard’s test
 D Diaphanous test
Q. 1 All  are  tests  for  stoppage  of   circulation EXCEPT:
 A Magnus test
 B Winslow’s test
 C Icard’s test
 D Diaphanous test
Ans. B

Explanation:

Tests of circulation: (1) Magnus test (ligature test): Fingers fail to show congestion & swelling to a ligature applied at their base. (2) Diaphanous test (transillumination test):  Failure to show redness in the web-space between the fingers on transillumination from behind. (3) I card’s test: Fluorescein dye on being injected at a given site in a dead body fail to produce yellowish-green discolouration in a dead body. Tests of respiration: Winslow’s test– No movement of reflection of light shone on mirror, or surface of water in bowl, kept on the chest.


Q. 2

True about suspended animation:

 A

Common phenomenon in yogic person

 B

Can be voluntary

 C

Similar to molecular death

 D

a and b

Q. 2

True about suspended animation:

 A

Common phenomenon in yogic person

 B

Can be voluntary

 C

Similar to molecular death

 D

a and b

Ans. D

Explanation:

A i.e. Common phenomenon in yogic person; B i.e. Can be voluntary


Q. 3

Surest sign of brain stem death

 A

Absent Doll’s eye reflex

 B

Fixed dilated pupil not reacting to light

 C

Cheyne Stokes breathing

 D

Decerebrate posture

Q. 3

Surest sign of brain stem death

 A

Absent Doll’s eye reflex

 B

Fixed dilated pupil not reacting to light

 C

Cheyne Stokes breathing

 D

Decerebrate posture

Ans. B

Explanation:

B i.e. Fixed dilated pupil not responding to light

Cooling of body & rigor mortis is a sign of molecular or cellular death. 

– Somatic (systemic, clinical or brain) death is cessation of spontaneous breathing, circulation and brain activity (as indicated by flat isoelectric EEG, deep unconsciousness with no response to external stimuli or internal need). Surest sign of brain stem death is fixed dilated pupil not constricting (responding) to light.Q

Quiz In Between


Q. 4

Definition of suspended animation is :

 A

It is a condition of apparent death when no signs of life are discovered as the functions are interrupted for sometimes or are reduced to minimum

 B

Sign of death are irreversible

 C

Only signs of brain death are present

 D

None

Q. 4

Definition of suspended animation is :

 A

It is a condition of apparent death when no signs of life are discovered as the functions are interrupted for sometimes or are reduced to minimum

 B

Sign of death are irreversible

 C

Only signs of brain death are present

 D

None

Ans. A

Explanation:

A i.e. It is a condition of apparent death when no signs of life are discovered as the functions are interrupted for sometimes or are reduced to minimum


Q. 5

Criteria for Brainstem death includes:

 A

Positive Doll’s eye Reflex

 B

Absent pupillary light reflex and delated pupils

 C

Pinpoint pupils

 D

Positive vestibulo-ocular reflex

Q. 5

Criteria for Brainstem death includes:

 A

Positive Doll’s eye Reflex

 B

Absent pupillary light reflex and delated pupils

 C

Pinpoint pupils

 D

Positive vestibulo-ocular reflex

Ans. B

Explanation:

Answer is B (Absent pupillary light reflex and delated pupils):

Brainstem death is defined by the absence of all brainstem mediated cranial nerve reflexes.

Pupillary Light Reflex is a brainstem mediated cranial nerve reflex that is absent in brainstem death. The pupils are usually midsized but may be dilated (should not however be small).

Occulo-cephalic (Doll’s eye) reflex and Vestibulo-ocular (Caloric) reflex are both brainstem mediated cranial nerve reflexs that should be absent in Brainstem death.

Criteria for Brain Death/Brainstem death

The definition of Brain stem death requires simultaneous demonstration that the patient has irreversibly lost the capacity of consciousness (Coma) and the capacity to breathe (Apnoea) both of which are dependent on intact brainstem.
Clinical assessment of the integrity of Brainstem has two components including assessment of the integrity of brainstem mediated cranial nerve reflexes and the Apnea test.

Deep Unresponsive Coma

Patients with brain death show the deepest coma possible with total unresponsiveness to all stimuli.

  • No spontaneous movement
  • No response to external stimuli (Verbal/ Deep pain)

Absence of all Brainstem Cranial Reflexes

All reflexes mediated by cranial nerve must be absent

  • Absent Pupillary Light reflex (CN II, III)

(Pupils are usually midsized but may be enlarged but they should not be small)

  • Absent Corneal Reflex (CN V, VII)
  • Absent Vestibulocochlear Reflex (CN III, IV, VI, VIII) (No eye movement in response to caloric irrigation of ears)
  • Absent Oculocephalic Reflex

(Absent Doll’s eye reflex) Eyes will move with the head

(No occular movements on rapid turning of head).

  • Absent Gag Reflex (CNIX, X)
  • Absent Tracheal Cough Reflex (CNX)
  • Absent Central Motor Response to Pain (CN V, VII) (No response to deep somatic stimulation).

Complete Aponea in pressure of hypercarbia (Absence of Brainstem Respiratory Reflex)

  • No respiratory effort in response to hypercarbia needs to be demonstrated to show that aponea is due to brainstem (medullary) damage
  • Absent respiratory movement during disconnection from the ventilator with the PaCO2 > 60 mm Hg is required for the test to be valid

Cranial nerve reflexes in Brain Stem Death testing:

Reflex

Cranial nerves

Notes

Pupillary light reflex

HAI

Use bright light source (not ophthalmoscope) in a dimmed environment. Look for both

direct and consensual reaction.

 

 

Important reflex that interrogates at level of midbrain

Corneal reflex

V, VII

Stroke cornea with gauze, whilst gently holding eyes open; avoid trauma to cornea.

 

 

The various nuclei of V are found throughout the whole length of the brainstem, whilst

that of VII (facial nerve) is in the upper medulla.

Central response to

V, VII

Apply deep pressure stimulation centrally (e.g. supra-orbital ridge) and peripherally

deep somatic

 

(e.g. nail bed). Look for central motor response in the distribution of the facial nerve.

stimulation

 

Peripheral stimulation may illicit peripheral spinal reflexes.

Cold caloric

III, IV, VI, VIII

Check patency of external auditory canal with auroscope. Flex head to 30° (or apply

vestibulo-ocular

 

30° head up tilt if cervical spine injury is suspected). Slowly irrigate canal with 5OrriL

reflex

 

ice-cold water over 60s. Observe for nystagmus for a further 30s. Contra-indicated in

trauma-related otorrhea.

 

 

The nuclei of III and IV lie withjin the midbrain, whilst those of VI and VIII are in the

medulla.

Oculocephalic reflex

VIII, Ill, VI

Rapid lateral movement of the head normally results in eye deviation to the

(Doll’s eye reflex)

 

contralateral side, testing brainstem gaze mechanism.

 

 

In brainstem death eyes remain in a fixed position within the orbit.

Gag reflex

IX, X

Stimulate uvula under direct vision with throat spatula, observing for contraction of

soft palate.

 

 

The nuclei of IX and X lie in the medulla.

Tracheal cough reflex

X

Expose patient to umblicus. Stimulate trachea to level of carina by introduction of

sterile suction catheter down endotracheal tube. Observe for cough response


Q. 6

Brain death is defined as loss of:           

March 2005

 A

Withdrawl reflex

 B

Brain stem functions

 C

Cortical functions

 D

Spinal reflex

Q. 6

Brain death is defined as loss of:           

March 2005

 A

Withdrawl reflex

 B

Brain stem functions

 C

Cortical functions

 D

Spinal reflex

Ans. B

Explanation:

Ans. B: Brain stem functions

Brain death should be suspected in any patient rendered deeply comatose and apneic from a profound or diffuse brain insult.

The cardinal diagnostic criteria for brain death are: (1) profound coma with total unresponsiveness, (2) apnea despite induced hypercapnia, (3) absence of all reflexes subserved by the brainstem and cranial nerves, (4) presence of a structural brain lesion sufficient to produce the clinical findings, and (5) irreversibility

Areflexia of those reflexes subserved by the cranial nerves must be present for brain death to be determined. There can be no pupillary light reflexes, vestibulo-ocular reflexes, corneal reflexes, gag reflexes, or cough reflexes.

Quiz In Between


Q. 7

True about suspended animation: 

PGI 10

 A

Common phenomenon

 B

Can be voluntary

 C

Similar to molecular death

 D

None

Q. 7

True about suspended animation: 

PGI 10

 A

Common phenomenon

 B

Can be voluntary

 C

Similar to molecular death

 D

None

Ans. B

Explanation:

Ans. Can be voluntary


Q. 8

Which of the following is false regarding suspended animation‑

 A

Can be produced voluntarily

 B

Patient can be resuscitated

 C

It is state of apparent death

 D

It usually lasts for 6 hours

Q. 8

Which of the following is false regarding suspended animation‑

 A

Can be produced voluntarily

 B

Patient can be resuscitated

 C

It is state of apparent death

 D

It usually lasts for 6 hours

Ans. D

Explanation:

Ans. is ‘d’ i.e., It usually lasts for 6 hrs

Suspended animation (sudden death)

It is apparent death, i.e. signs of life are not found as the functions are interrupted for some time or are reduced to minimum. The person is not dead i.e. there is no somatic death, brain death or molecular (cellular) death. Life continues and resuscitation is successful in such cases. The condition lasts from few seconds to 1/2 an hour or more. It may be found in :

  1. Electrocution
  2. After anaesthesia
  3. Cerebral concussion
  4. Yogis (voluntary)
  5. Drowning
  6. Shock
  7. Narcotic poisoning
  8. Cholera
  9. Sunstroke
  10. Newborn infants

Q. 9

Suspended animation is seen in following except‑

 A

Sun stroke

 B

Cerebral concussion

 C

Cholera

 D

Delerium tremens

Q. 9

Suspended animation is seen in following except‑

 A

Sun stroke

 B

Cerebral concussion

 C

Cholera

 D

Delerium tremens

Ans. D

Explanation:

Ans. is ‘d’ i.e., Delirium tremens

Suspended animation may be seen in electrocution, drowning, cholera, after anesthesia, shock, sunstroke, cerebral concussion, narcotic poisoning, new born infants and yogis/voluntary.

Quiz In Between


Q. 10

Which of the following is not a diagnostic criteria for declaring brainstem death?

 A

Absence of brainstem reflexes

 B

A positive apnea test

 C

Lack of cerebromotor response to pain in all extremities

 D

Absence of stretch reflex from all extremities is essential

Q. 10

Which of the following is not a diagnostic criteria for declaring brainstem death?

 A

Absence of brainstem reflexes

 B

A positive apnea test

 C

Lack of cerebromotor response to pain in all extremities

 D

Absence of stretch reflex from all extremities is essential

Ans. D

Explanation:

Ans. d. Absence of stretch reflex from all extremities is essential


Q. 11

All are signs of somatic death except ‑

 A

Cessation of respiration

 B

Cessation of heart

 C

Non-responding muscles

 D

No response to external stimuli

Q. 11

All are signs of somatic death except ‑

 A

Cessation of respiration

 B

Cessation of heart

 C

Non-responding muscles

 D

No response to external stimuli

Ans. C

Explanation:

  Ans. is ‘c’ i.e., Non-responding muscles

  • Death denotes death of human being (46 IPC). It is defined as cessation of life or cesation to exist. Death is of two types (1) somatic death (systemic death or clinical death) and (2) molecular death (cellular death).

Somatic death (systemic death or clinical death)

  • It is the complete and irreversible stoppage of the circulation, respiration and brain functions (bishop’s tripod of life). Somatic death is associated with immediate signs of death :‑
  1. Permanent and complete cessation of function of brain and flat electric EEG with no response to external stimuli; i.e. brain death.
  2. Permanent and complete cessation of function of heart and flat ECG.
  3. Permanent and complete cessation of function of lungs.
  • Somatic death is due to stopped aerobic processes. However, anaerobic enzymatic processes are still continuing, hence (i) muscles still respond to mechanical, electrical and thermal stimuli, (ii) pupils still respond to miotics and mydriatics.

Molecular death (cellular death)

  • It occurs after somatic death. It refers to death of all individual cells. It occurs when even anaerobic processes stop, due to non availability of ATP. At this stage :
  1. Muscles do not respond to stimuli.
  2. Pupils do not respond to stimuli or drugs.
  3. There are early signs and late signs of death :
  • Early signs : Changes in skin and eye, cooling of the body, post-mortem lividity, changes in muscles (e.g. primary relaxation, rigor mortis).
  • Late signs : Decomposition (putrefaction), adipocere fromation and mummification.

4.  Molecular death of various organs occur at different intervals after somatic death :

  1. Nervous tissue —> After 5 minutes.
  2. Liver —> After 15 minutes.
  3. Heart —> After 45 minutes.
  4. Kidney —> After 1 hours.
  5. Muscles —> After 3 hours.
  6. Cornea —> After 6 hours.
  7. Blood After 6 hours.

Quiz In Between



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