Postmortem pathology MCQs

Postmortem pathology MCQs 1. You are a busy consultant pathologist in a post-mortem room currently performing the identification checks with the anatomic pathology technician.

The deceased belongs to a Muslim family who are eager to have the postmortem exam completed as soon as possible so they can expedite the burial in keeping with their religious beliefs. You note a discrepancy with the police ID band and the details on the coroner’s permission to examine form. What is the next most appropriate action?

A. Proceed with the post-mortem examination. Submit provisional cause of death and ask the Coroner to correlate the identification.

B. Proceed with the post-mortem examination ensuring toxicology and histology is taken. Submit provisional cause of death and ask the Coroner to clarify the identification.

C. Proceed with the post-mortem examination ensuring toxicology and histology is taken. Submit provisional cause of death and ask the Police to clarify the identification.

D. Refuse to proceed with the post-mortem examination E. Alert the medical examiner

2. You have completed a post-mortem examination for the Coroner and submitted the Postmortem Cause of Death form. The cause of death was due to myocardial infarction secondary to coronary artery thrombosis. You receive a call from the Bereavement oMice who say the wife of the deceased would like to speak about the circumstances of the death. She believes she is responsible for his death as she did not give him his evening meal on time even though he mentioned he was having pangs of hunger. The bereavement staM tell you that she is very distressed and feels that knowing more about the findings may help her cope.

Which of the following is the most appropriate response?

A. Invite the patient for a discussion to better elicit her understanding of the situation B. Tell the bereavement oMicer to only mention that she is not responsible for the death and disclose no further information C. Advise the bereavement oMicer to speak with the Coroner’s OMice D. Refuse to disclose the information and do not elaborate further

3. Which of the following deaths would not require referral to the Coroner?

A. A 75-year-old gentleman with a long history of interstitial lung disease who used to work as a construction worker B. Man who dies at home due to disseminated metastatic prostate cancer and his regular GP is away on holiday for the next 3 weeks C. An 18-year-old gentleman who died shortly after returning home from a night club D. A 55-year-old man recently diagnosed with chronic lymphocytic leukaemia found dead at home

4. You have performed a post-mortem histology on a 50 year old gentleman who showed no gross internal examination findings. Histology samples from the heart reveal contraction band necrosis and you list the cause of death as myocardial infarction and submit the cause of death form and the PM report. A few days later you obtain a request from family members for the tissue blocks taken so they can be buried along with the body. Which of the following is the most appropriate responses?

A. Have the blocks ready to collect from the bereavement oMice at the family’s convenience B. Do not release the blocks to the family. Ask the family to speak with the Coroner’s OMice C. Do not release the blocks to the family. Instead speak with the funeral director and have them collect the blocks when collecting the body.

D. Do not release the blocks to the family. Inform the family that as the tissue has been processed in a hospital lab consent must be obtained from the laboratory manager

5. Examination of the base of the brain shows the following findings. What do these findings indicate?

A. Increased intracranial pressure B. Haemorrhagic stroke C. Embolic disease D. Lacunar infarcts

6. You are performing a postmortem examination of a 70-year-old man who was the passenger in a road traMic collision. Resuscitation was attempted but unsuccessful. An image of the patient’s brain is shown below. You are able to displace the material using the blunt side of the blade. What was the likely cause of this finding?

A. Tearing of the bridging veins B. Rupture of the middle meningeal artery C. Ruptured berry aneurysm D. Hypertension

7. You are performing a post-mortem examination on a 40-year-old man who had a history of psychosis, memory deficits and involuntary jerking movements. His father who died at 50 had similar symptoms. Which of the following structures in the normal brain image below would you expect to be abnormal?

A B C D E

A. A B. B C. C D. D E. E

8. You are reviewing the postmortem histology from the heart. The findings are as depicted in the photomicrograph below. What can be said about the likely age of the infarct?

A. Less than 4 hours old B. 4- 24 hours old C. 1 day to 1 week old D. >1 week old E. >4 weeks old

9. You are performing a postmortem examination on a 25-year-old athlete who died suddenly. On examination of the heart you see the features below. What is the next appropriate step prior to closing the body?

A. Obtain blood for toxicology B. Obtain vitreous humour C. Obtain a sample of spleen D. Obtain a sample of lung

10. You are performing the post-mortem examination on a 65-year-old gentleman with a history of myocardial infarction. Examination of the lungs shows pulmonary oedema. Examination of the bowel shows findings as depicted in the photograph below. What gross findings would be expected on examination of the heart?

A. Normal heart B. Ventricular septal defect C. Haemopericardium D. Saccular left ventricle E. Left ventricular outflow tract obstruction

11. You are performing a post-mortem examination on a 65-year-old female. On examining the heart, you notice the heart appears noticeably large and exhibits a deep blue-purple colour as depicted in the image below. On opening of the pericardium, you see a large haematoma encasing the heart and an area of ventricular perforation. What histological findings would be expected from the heart adjacent to the perforation?

A. Normal heart histology B. Contraction band necrosis and coagulation necrosis C. Neutrophilic infiltration of myocardium D. Early fibrosis E. Well-established fibrosis

12. You are performing the post-mortem examination of a 75-year-old gentleman who was a lifelong smoker. He died suddenly at home. External examination shows cachexia and tar staining of the nails. You discover a large tumour in the lung with multiple enlarged hilar lymph nodes and similar nodules in the brain.

Examination of the heart reveals findings as depicted in the photograph below.

The vegetations are present on one side of the valve. How would you best classify this disease process?

A. Infective endocarditis B. Marantic endocarditis C. Libman-Sacks endocarditis D. Rheumatic heart disease

13. You are performing a post-mortem examination of an 25-year-old man who collapsed during a friend’s birthday party. His friends report that before his death he seemed to have a lot of energy and seemed jittery. External examination reveals a collapsed nasal bridge. Which of the following are expected on postmortem examination?

A. Saddle embolism B. Splitting of the aortic media C. Lobar pneumonia D. Twisted bowel E. Splenic rupture

14. You are performing a post-mortem examination of an otherwise fit and healthy young man who suddenly became ill and died at home. Examination of the lung shows changes as depicted in the photograph below. These changes are most likely caused by which of the following organisms?

A. Staphylococcus aureus B. Haemophilus influenza C. Streptococcus pneumoniae D. Klebsiella pneumonia E. Pseudomonas aeruginosa

15. You are performing a post-mortem examination on a 65-year-old gentleman who used to work as a mason. He has a history of ischemic heart disease for which he took regular medications. Examination of the lungs shows nodularities in the upper lobes. Histology shows nodules of whirled collagen and fibroblasts as shown in the photomicrograph below. Which of the following is the most likely explanation?

A. Silicosis B. Asbestosis C. Rheumatoid nodules D. Medication induced fibrosis

16.

You are performing the post-mortem examination on an 85 year old gentleman. Internal examination of the lungs shows findings as depicted in the image below. What can be deduced about the deceased relating to this pathological finding?

A. He was a smoker B. He was immunocompromised C. He was a roofer D. He was taking antibiotics

17. You are performing a post-mortem examination of a 55-year-old gentleman. You see enlarged airspaces diMusely involving the upper, middle and lower zones of both lungs as depicted in the image below. What other findings would you expect to find elsewhere in the postmortem examination?

A. Splenic infarcts B. Hepatic nodularity C. Red and swollen calf D. Tricuspid valve vegetations E. Dissection of the aortic media

18. You have been requested by the Coroner to perform an external examination on a 22-year-old female who committed suicide via hanging. She was found by her mother who says she had been home alone all day. The police attended the scene and reported no suspicious circumstances. Which of the following findings would be unexpected in this scenario?

A. Posterior lividity B. Oblique ligature mark C. Protrusion of the tongue

D. Facial petechiae

19. A 45-year-old man was recovered from a local river after being spotted by passersby on the adjacent footpath. An ambulance crew was called, and CPR was attempted but unsuccessful. He had a history of alcohol dependence and dilated cardiomyopathy. He had no other medical history. Internal examination reveals moderate atheroma of the left anterior descending and right coronary arteries. There are mild fatty liver changes. The stomach is free of contents and shows appearances as shown in the photograph below. The remainder of the examination including the lungs showed no significant findings. What is the likely cause of death?

A. Submersion B. Immersion C. Haemorrhagic shock D. Septic shock

20. You obtained histology and toxicology from the lungs of a 30-year-old deceased man who died after he fell oM a ladder at work. Polarisable material is seen with focal foreign body giant cell reaction as per the photomicrograph below. What conclusion can be deduced about the patient from these findings?

A. Patient was a cocaine user B. Patient was a heroin user C. Patient was a sandblaster D. Patient worked with aluminium

21. You perform the postmortem examination on a 63-year-old female with a history of alcohol dependence. She had no history of any other medical conditions.

Blood tests from a recent over 60s health check at her GPs oMice were normal including cholesterol and HbA1c. Her relatives are sure that the death was related to alcohol consumption. Identification of which of the following substances would confirm the relatives suspicions?

A. Lactate B. Beta-hydroxybutyrate C. Thiamine D. Glucose

22. You are a trainee who has just joined the consultant pathologist in reporting postmortem lung histology on a 40-year-old female patient. The consultant asks you based on the finding observed in the photomicrograph below what can be deduced about the deceased?

A. She was an IV drug user B. She has vegetations on the tricuspid valve C. She had a swollen and painful calf D. She was pregnant E. She was immunocompromised