Quiz 2: Hospital Autopsy Decline & Pediatric & Elder Abuse

What are some reasons for the decline of hospital autopsies?

Better medical understanding of diseases, improved pre-mortem diagnosis, fewer in-hospital pathologists, high hospital costs, and public perception influenced by media.

What is considered the gold standard for diagnosis in medicine?

Autopsy

What opportunities do autopsies provide for hospitals?

Recognizing missed diagnoses, improving medical practice, teaching, and learning.

What are indicators for conducting a hospital autopsy?

Natural death with no suspicious circumstances, patient with multiple medical problems, genetic syndromes, and legal reasons.

Define a Natural Death and give an example.

Death attributed to an illness or internal malfunction, not influenced by external forces. Example: death from complications of influenza.

What are the six classes of discrepancies in clinical vs. autopsy diagnosis according to Goldman et al. 1983?

Class I: Major discrepancies affecting management; Class II: Major discrepancies not affecting survival; Class III: Minor discrepancies affecting prognosis; Class IV: Minor occult discrepancies; Class V: Non-discrepant diagnoses; Class VI: Non-classifiable cases.

What is a Class I discrepancy?

Major discrepancies in diagnoses that, if known before death, could have changed management and prolonged survival.

Give an example of a Class I discrepancy.

Pulmonary infarction treated as pneumonia.

What is a Class II discrepancy?

Major discrepancies whose detection before death would not have changed survival, even with correct treatment.

Give an example of a Class II discrepancy.

Biventricular cardiac insufficiency due to severe aortic stenosis with missed pulmonary emboli.

What is the role of a Diener in an autopsy?

An autopsy assistant responsible for handling, moving, and cleaning the corpse, and sometimes performing evisceration.

What responsibilities does a Pathologist Assistant have?

Gross examination, preparing tissue samples, performing frozen sectioning, and training pathology residents.

What does a Resident do during an autopsy?

A pathologist in training who performs most cases under supervision and whose reports are signed by an attending pathologist.

What are the steps in an autopsy timeline?

Autopsy permit review, chart review, gross examination, internal exam, microscopic exam, and report writing.

What is the significance of the PAD (Preliminary Anatomic Diagnosis)?

It includes preliminary gross findings released within 24 hours of the autopsy but can change upon further examination.

What is the most common cause of death in the western world?

Coronary artery disease (Atherosclerosis).

What are examples of Class I causes of death?

Heart attack with rupture and stroke with hemorrhage.

What constitutes a Class II cause of death?

Conditions that probably killed the patient, where advanced disease is present but no immediate structural change inconsistent with life.

What is the role of a Pathologist during an autopsy?

Performs cutting, writes the autopsy report, and integrates all findings into the final diagnosis.

What is the purpose of the gross examination in an autopsy?

To document physical characteristics of the body and evidence of medical interventions, as well as to assess external signs of disease.

What is the significance of the microscopic exam in autopsies?

It involves reviewing glass slides prepared from tissue sections to identify cellular abnormalities and confirm diagnoses.

What is the importance of the autopsy permit?

It ensures legal permission for the autopsy, requiring signatures from next of kin.

What is the role of the attending pathologist in an autopsy?

Supervises the resident and signs off on the final autopsy report.

What factors can affect the standardization of organ examination during an autopsy?

Age, sex, ethnicity, height, weight, and other medical conditions.

What is Class III in the context of causes of death?

A situation where lethal potential is present, requiring a good history and exclusion of other causes.

What characterizes Class IV causes of death?

No lethal structural findings or alternative explanations; often seen in sudden death cases like epilepsy.

What does Class VI indicate regarding causes of death?

No autopsy findings or toxicology results, with no evidence of unnatural death.

What is coronary artery disease?

The most common cause of natural death in the western world, characterized by the narrowing of coronary arteries, leading to insufficient blood supply to the heart muscle.

What is a myocardial infarction?

A heart attack caused by sudden obstruction of a coronary artery, resulting in decreased blood and oxygen to the heart muscle.

How does hypertension contribute to heart issues?

It causes the heart to work harder, thickening the heart muscle and increasing oxygen demand, which can lead to death if not met.

What is an aortic dissection?

A complication of high blood pressure and atherosclerosis, where blood tracks between layers of the aorta, potentially leading to severe bleeding.

What is an aortic aneurysm?

A dilation of the aorta's wall that can rupture and cause rapid death, often related to long-standing high blood pressure and atherosclerosis.

What are the two types of strokes?

Ischemic stroke, caused by blood clots, and hemorrhagic stroke, caused by ruptured blood vessels.

What is the second most common cause of death in the western world?

Cancer, which includes various types such as carcinoma, sarcoma, melanoma, and lymphoma.

What is pulmonary embolism?

A blood clot in the lung vessels that can block blood flow and is often caused by factors like cancer, obesity, or immobility.

What are the differences between Type I and Type II diabetes?

Type I is characterized by the pancreas's inability to produce insulin, while Type II involves insulin resistance in cells.

What is hypoglycemia?

A condition resulting from low blood sugar that can lead to brain damage.

What is diabetic ketoacidosis?

A serious condition resulting from high glucose levels leading to acidosis, dehydration, and brain swelling.

How does chronic drug and alcohol abuse affect health?

It can lead to conditions like cancer, heart disease, and liver disease, with overdose considered accidental death.

What is emphysema?

A lung condition caused by cigarette smoke that damages lung tissue, leading to larger holes in the lung.

What is SUID?

Sudden Undetermined Infant Death, a diagnosis of exclusion for unexplained infant deaths.

What is the most common manner of death in children aged 1-18?

Accidents, with drowning being a leading cause for children under 1 year old.

What are the differences between fetal, perinatal, and neonatal death?

Fetal death occurs before birth, perinatal death occurs around the time of birth, and neonatal death occurs within the first month after birth.

What is neonaticide?

Homicide of a newborn within the first 24 hours, often by a family member.

What is filicide?

The act of a parent killing their child, typically acknowledged with prenatal care.

What are common causes of natural pediatric death?

Infections, congenital abnormalities, and metabolic disorders.

What are common causes of accidental pediatric death?

Choking, drowning, and other age-related accidents.

What factors can lead to suicidal death in children?

Behavioral changes, social media influences, and issues related to discipline or identity.

What is asphyxia?

A lack of oxygen caused by factors such as airway occlusion, cessation of oxygen in the atmosphere, or lack of blood flow to the brain.

What are common causes of asphyxia in children?

Drowning, choking, strangulation, hanging, wedging, overlay, and suffocation during breastfeeding.

What age group is most likely to drown in bathtubs?

Children under 1 year old.

What percentage of preschool-age children drown in backyard or community pools?

60-90%.

What is a shallow water blackout?

A loss of consciousness due to lack of oxygen while swimming in shallow water.

What are the signs of neglect in elder abuse?

Contractures, malnutrition, dehydration, and decubitus ulcers.

What are common sites for decubitus ulcers?

Sacrum, greater trochanters (hips), and ischial tuberosities.

What is the most common thermal injury in children?

Scalding.

What findings at autopsy indicate carbon monoxide poisoning?

Cherry red lividity and elevated carbon monoxide levels in blood.

What are common causes of animal bites in children?

Dog bites, which can lead to disfigurement and infection.

What is the typical scenario for dog bite fatalities?

A large breed family dog attacks an infant.

What is excited delirium syndrome?

An acute disturbance in consciousness and cognition characterized by violent behavior and high pain tolerance.

What are common symptoms of excited delirium?

Violent behavior, rapid breathing, profuse sweating, and elevated body temperature.

What can cause excited delirium?

Stimulant drug intoxication, psychiatric disease, and metabolic disorders.

What are the autopsy findings in cases of excited delirium?

Minor abrasions and contusions, with no significant findings to explain death.

What is the definition of elder abuse?

An act or omission that results in harm or threatened harm to the health or welfare of an elderly person.

What types of injuries indicate physical abuse in the elderly?

Contusions, lacerations, fractures, and inappropriate use of restraints.

What is the significance of injuries to certain body areas in elder abuse cases?

Injuries to areas like the axilla, buttocks, and genitalia are more likely to be inflicted rather than accidental.

What is the most common cause of decubitus ulcers?

Pressure over bony prominences in individuals with altered consciousness or impaired motor activity.

What is the risk associated with insect bites and stings?

Death is uncommon but can occur due to toxic envenomation or anaphylaxis.

What is the typical autopsy finding for carbon monoxide poisoning?

Cherry red lividity and elevated carbon monoxide levels in blood.

What is the definition of in-custody deaths?

Any death occurring in the custody of law enforcement or similar institutions.

What is the role of toxicology in excited delirium cases?

Toxicology may be positive for drug intoxication, helping to explain the cause of death.

What is the most common source of animal bites leading to fatalities?

Dog bites, particularly from large breeds attacking infants.

What is the expected finding in autopsy for insect sting-related deaths?

Minimal findings, but may include a swollen airway in severe cases.

What are the common household items that can cause toxicities in children?

Medications, recreational drugs, household cleaners, and laundry detergent pods.