External Examination — MCQs
Post-mortem caloricity is not seen in which of the following conditions?
Which feature differentiates antemortem bruises from postmortem bruises?
Which of the following is the most important objective of a medicolegal autopsy?
All of the following helps in determination of time since death, Except
A person died 24 hours ago. Which postmortem change is most likely?
A woman died within 5 years of marriage under suspicious circumstances. Her parents complained that her in-laws used to frequently demand dowry. Under which of the following sections can a magistrate authorize an autopsy of the case?
During autopsy of a fetal death case, what is the correct order of examination to differentiate between live birth and stillbirth?
Certain obligations on the part of a doctor who undertakes a postmortem examination are the following, EXCEPT:
ECV is absolutely contraindicated in all except :
Identify the post mortem lividity of the image: (AIIMS Nov 2018)
External Examination Indian Medical PG Practice Questions and MCQs
Question 1: Post-mortem caloricity is not seen in which of the following conditions?
- A. Pontine haemorrhage
- B. Bacteremia
- C. Status epilepticus
- D. Post-mortem glycogenolysis (Correct Answer)
Explanation: ***Post-mortem glycogenolysis*** - **Post-mortem glycogenolysis** is a **normal biochemical process** that occurs after death, involving the breakdown of glycogen in tissues. - It is **NOT a pre-death pathological condition** and does not cause the body temperature to rise after death. - **Post-mortem caloricity** occurs due to ante-mortem conditions with intense metabolic activity or thermoregulatory dysfunction, not from normal post-mortem biochemical changes. - This is the **correct answer** as it does NOT cause post-mortem caloricity. *Pontine haemorrhage* - **Pontine haemorrhage** causes damage to the **thermoregulatory centers** in the brainstem. - This leads to dysregulation and **uncontrolled heat generation**, resulting in hyperthermia. - The elevated metabolic state can persist briefly after death, causing **post-mortem caloricity**. *Bacteremia* - **Bacteremia** and **sepsis** trigger a massive **inflammatory response** with increased metabolic activity. - The heightened metabolic state generates significant heat before and immediately after death. - This contributes to elevated body temperature observed as **post-mortem caloricity**. *Status epilepticus* - **Status epilepticus** involves **prolonged, intense muscle contractions** and widespread neuronal activity. - This extreme metabolic demand generates substantial heat through continuous muscle activity. - The heat generation can persist briefly post-mortem, leading to **post-mortem caloricity**.
Question 2: Which feature differentiates antemortem bruises from postmortem bruises?
- A. Well-defined margins
- B. Capillary rupture with extravasation of blood
- C. Presence of yellow color (Correct Answer)
- D. Gaping
Explanation: ***Presence of yellow color*** - **Yellow coloration** indicates the breakdown of hemoglobin into **bilirubin** and occurs due to vital reactions in antemortem bruises. - This change is a sign of **healing and metabolism**, which cannot happen in a postmortem state. *Well-defined margins* - The definition of margins in a bruise is not a reliable differentiator, as both antemortem and postmortem bruises can have varying margin characteristics depending on the force and tissue type. - **Well-defined margins** can be seen in both, especially in cases of direct impact or specific tissue types. *Capillary rupture with extravasation of blood* - This is a fundamental characteristic of **all bruises**, whether antemortem or postmortem, as it describes the underlying mechanism of blood leaking from damaged vessels. - The difference lies in the body's reaction to this extravasation, not the initial event itself. *Gaping* - Gaping is typically associated with **lacerations or incisions** where the tissue is separated, rather than just a bruise. - While significant trauma can accompany bruising, gaping is not a defining characteristic that differentiates purely antemortem from postmortem bruises.
Question 3: Which of the following is the most important objective of a medicolegal autopsy?
- A. Manner of death
- B. Cause of death (Correct Answer)
- C. Time since death
- D. All of the options
Explanation: ***Cause of death*** - Ascertaining the **cause of death** is the primary objective of a medicolegal autopsy, as it identifies the disease or injury responsible for physiological derangement leading to death. - This determination is crucial for legal proceedings and public health data, providing the foundational medical reason for the individual's demise. *Manner of death* - While important, the **manner of death** (homicide, suicide, accidental, natural, undetermined) is a classification based on the cause of death and other investigative findings, making it a secondary objective derived from the primary cause. - The manner specifies how the cause of death arose, but the autopsy's direct medical contribution is establishing the cause itself. *Time since death* - Estimating the **time since death** is a significant aspect of a medicolegal autopsy, aiding in establishing timelines for investigations. - However, it is a piece of crucial information that supports the investigation rather than the ultimate objective of understanding why the person died. *All of the options* - Although all mentioned aspects are important components of a comprehensive medicolegal autopsy report, pinpointing the **cause of death** is the singular, most fundamental objective around which other conclusions are built. - The cause of death forms the basis for subsequent legal and public health classifications and without it, other aspects would lack their primary context.
Question 4: All of the following helps in determination of time since death, Except
- A. Algor mortis
- B. Rigor mortis
- C. Pugilistic attitude (Correct Answer)
- D. Livor mortis
Explanation: ***Pugilistic attitude*** - A **pugilistic attitude** is a postmortem change characterized by the posturing of the body into a "boxer-like" stance, caused by the **coagulation of muscle proteins** due to heat from a fire. - While it indicates exposure to high temperatures, it does not reliably help in determining the **time since death**. *Algor mortis* - **Algor mortis** refers to the postmortem cooling of the body. - The rate of cooling can be used to estimate the **time since death**, with various mathematical formulas and environmental factors influencing the calculation. *Rigor mortis* - **Rigor mortis** is the stiffening of muscles after death due to the depletion of **ATP** and the irreversible cross-linking of **actin** and **myosin**. - Its presence, progression, and regression provide valuable clues for estimating the **time since death**. *Livor mortis* - **Livor mortis**, or lividity, is the discoloration of the skin after death due to the **gravitational pooling of blood** in capillaries. - The onset, fixation, and distribution of lividity can help in determining the **time since death** and whether the body has been moved postmortem.
Question 5: A person died 24 hours ago. Which postmortem change is most likely?
- A. Rigor mortis (Correct Answer)
- B. Putrefaction
- C. Cadaveric spasm
- D. Cooling of body
Explanation: ***Rigor mortis*** - Rigor mortis typically begins 2-6 hours after death, becomes fully established at 12-18 hours, and starts resolving by 24-36 hours - At **24 hours post-mortem**, the body is typically in **established rigor** or just beginning to resolve, making this the most characteristic finding - Occurs due to **ATP depletion**, preventing breakdown of actomyosin cross-bridges, leading to muscle stiffness *Putrefaction* - Putrefaction is a later stage of decomposition caused by bacterial activity - Usually becomes evident after **36-48 hours** in temperate climates, appearing as green discoloration of the abdomen - Significant signs (marbling, bloating) are unlikely to be the predominant change at exactly 24 hours *Cadaveric spasm* - Rare phenomenon of **instantaneous stiffening** at the moment of death, usually due to extreme emotional stress or violent death - Does not develop gradually over time and is distinct from rigor mortis - Not typical or expected in routine deaths *Cooling of body (Algor mortis)* - Begins immediately after death and typically reaches ambient temperature by **12-18 hours** depending on environmental factors - While the body would be cooler at 24 hours, cooling is an early change that would have largely completed by this time - Rigor mortis is the more specific and prominent stage at the 24-hour timeframe
Question 6: A woman died within 5 years of marriage under suspicious circumstances. Her parents complained that her in-laws used to frequently demand dowry. Under which of the following sections can a magistrate authorize an autopsy of the case?
- A. Section 302 IPC
- B. Section 174 Cr Pc
- C. Section 304 IPC
- D. Section 176 Cr Pc (Correct Answer)
Explanation: ***Section 176 Cr PC*** - This section empowers a **Magistrate to hold an inquiry into the cause of death** in cases of suspicious circumstances, including deaths within seven years of marriage where dowry harassment is alleged. - The magistrate can **order a post-mortem examination** or even a second post-mortem if there are doubts about the initial findings, making it the appropriate section for **magisterial authorization** of autopsy. - In dowry death cases, Section 176 provides judicial oversight and ensures an independent inquiry beyond police investigation. *Section 174 Cr PC* - This section deals with **police inquiry** and report on suicide and suspicious deaths, empowering the **police officer** (not magistrate) to investigate and order an autopsy. - While Section 174 is used for initial police investigation in suspicious deaths, the question specifically asks about **magistrate authorization**, which falls under Section 176. - Section 174 is the procedural provision for police-initiated investigation, whereas magisterial inquiry requires Section 176. *Section 304 IPC* - This section pertains to **punishment for culpable homicide not amounting to murder**. It is a substantive penal provision, not a procedural law. - It deals with the legal consequence of an act after investigation and trial, not with the investigative procedure for conducting an autopsy. - Charges under Section 304 IPC may result from findings after the autopsy, but it doesn't authorize the autopsy itself. *Section 302 IPC* - This section specifies the **punishment for murder**. Like Section 304 IPC, it is substantive criminal law defining a crime and its penalty. - It would be invoked *after* the investigation reveals evidence of murder, not during the initial phase of ordering an autopsy for a suspicious death. - An autopsy authorized under Cr PC sections might lead to charges under Section 302 IPC, but it doesn't authorize the autopsy procedure.
Question 7: During autopsy of a fetal death case, what is the correct order of examination to differentiate between live birth and stillbirth?
- A. Thorax > head > abdomen
- B. Abdomen > thorax > head
- C. Thorax > abdomen > head
- D. Head > thorax > abdomen (Correct Answer)
Explanation: ### Explanation: Order of Fetal Autopsy The correct sequence for a fetal autopsy to determine live birth is **Head > Thorax > Abdomen**. #### 1. Why "Head First"? The primary goal in determining live birth is to assess the **Hydrostatic (Raygat’s) Test** and the **Stomach-Bowel (Breslau’s) Test**. * If the **thorax** or **abdomen** is opened first, blood from the large vessels (like the superior vena cava or portal vein) can drain downwards due to gravity. * Opening the **head first** allows the blood to drain from the cranial sinuses, effectively **decongesting the thoracic and abdominal organs**. This prevents artificial congestion and ensures that when the lungs and intestines are later tested for air, the results are not confounded by excessive blood volume or accidental trauma to the diaphragm. #### 2. Analysis of Incorrect Options * **Thorax > Head > Abdomen (A & C):** Opening the thorax first is the standard procedure in adult autopsies but is avoided in fetuses. Manipulating the chest before the head can cause blood to pool in the thoracic cavity, potentially obscuring signs of respiration or causing artifacts in the hydrostatic test. * **Abdomen > Thorax > Head (B):** While the abdomen contains the stomach (Breslau’s test), opening it first does not provide the necessary decompression of the venous system that the cranial opening provides. #### 3. High-Yield Clinical Pearls for INI-CET * **Hydrostatic Test:** Based on the principle that lungs that have breathed will float in water. **False positives** occur in putrefaction (gas formation); **False negatives** occur in secondary atelectasis or pneumonia. * **Wredin’s Test:** Presence of air in the **middle ear** indicates the infant lived long enough to perform swallowing/breathing actions. * **Breslau’s Second Life Test:** If the stomach and intestines float, it indicates the child survived long enough to swallow air. * **Spalding’s Sign:** An X-ray finding in *intrauterine* death showing overlapping of cranial bones due to liquefaction of the brain (occurs 4–7 days after death).
Question 8: Certain obligations on the part of a doctor who undertakes a postmortem examination are the following, EXCEPT:
- A. Routinely record all positive findings and important negative ones
- B. He must keep the police informed about the findings (Correct Answer)
- C. The examination should be meticulous and complete
- D. He must preserve viscera and send for toxicology examination in case of poisoning
Explanation: ***He must keep the police informed about the findings*** - This is **NOT a formal obligation** of the doctor conducting a postmortem examination. - The doctor's primary duty is to conduct a thorough, objective examination and prepare a **formal postmortem report** that is submitted to the authority who requisitioned the examination (magistrate/police as per CrPC Section 174). - While findings may eventually reach the police through the official report, there is **no obligation to informally update or keep police informed** during the examination process. - The doctor's role is that of an **independent expert witness** to the court, not an investigative assistant to the police. - Maintaining independence and objectivity requires the doctor to document findings formally rather than providing ongoing informal updates to investigating officers. *Routinely record all positive findings and important negative ones* - This IS a **fundamental obligation** for any doctor performing a postmortem examination. - Both positive findings (pathological changes, injuries) and significant negative findings (absence of expected pathology) must be documented to provide a comprehensive and accurate record. - This meticulous documentation ensures the **integrity, reliability, and legal validity** of the postmortem examination and its conclusions. *The examination should be meticulous and complete* - This IS a **professional, ethical, and legal obligation** for any doctor undertaking a postmortem examination. - A systematic and thorough examination of all body systems is essential to accurately determine the cause of death and identify all relevant findings. - Incomplete examinations can lead to **missed diagnoses and miscarriage of justice** in medico-legal cases. *He must preserve viscera and send for toxicology examination in case of poisoning* - This IS a **crucial obligation** when poisoning is suspected or cannot be ruled out based on the postmortem findings. - Relevant viscera (liver, kidney, stomach contents) and bodily fluids (blood, urine) must be preserved in appropriate containers for subsequent toxicological analysis. - This step is **essential to confirm or exclude toxicological involvement** in the death and is a standard protocol in medico-legal postmortem examinations as per established guidelines.
Question 9: ECV is absolutely contraindicated in all except :
- A. Previous LICS scar (Correct Answer)
- B. Septate uterus
- C. Severe pre-eclampsia
- D. Placenta previa
Explanation: ***Previous LICS scar*** - A **previous lower uterine segment C-section (LICS) scar** is considered a **relative contraindication**, not an absolute contraindication for ECV. - Current guidelines (ACOG, RCOG) indicate that ECV can be attempted in carefully selected women with one prior cesarean delivery, though success rates may be lower. - While there is a theoretical increased risk of **uterine rupture** or **scar dehiscence**, studies have shown this risk remains low (approximately 0.02-0.08%), and many practitioners will offer ECV after thorough counseling and informed consent. - **This is the correct answer** - it is NOT an absolute contraindication. *Septate uterus* - A **septate uterus** (uterine anomaly) is generally considered a **relative contraindication** or significant limiting factor for ECV, though some sources treat it more strictly. - The uterine septum can impair fetal manipulation and reduce success rates significantly, making ECV technically challenging and potentially less likely to succeed. - While not universally classified as "absolute," severe uterine anomalies create substantial barriers to successful version and increase procedural risks, leading many practitioners to avoid ECV in these cases. *Severe pre-eclampsia* - **Severe pre-eclampsia** is an **absolute contraindication** for ECV. - The procedure can exacerbate maternal hypertension, increase risk of **seizures (eclampsia)**, and trigger **placental abruption** or **fetal compromise**. - The physiological stress of ECV is contraindicated in an already unstable maternal-fetal condition. *Placenta previa* - **Placenta previa** is an **absolute contraindication** for ECV. - Any uterine or fetal manipulation carries significant risk of causing **severe hemorrhage** and **placental separation**. - The abnormal placental location makes vaginal delivery contraindicated regardless of presentation, and ECV would serve no clinical purpose while exposing mother and fetus to serious bleeding risks.
Question 10: Identify the post mortem lividity of the image: (AIIMS Nov 2018)
- A. Tattooing
- B. Suggillation (Correct Answer)
- C. Putrefaction
- D. Decomposition
Explanation: ***Suggillation*** - Suggillation refers to the extravasation of blood into the tissues due to crushing pressure or trauma, often seen in cases of severe blunt force injury, leaving **diffuse, purplish discoloration.** - In post-mortem examination, a **suggillation** can be distinguished from common **livor mortis** (lividity) by its darker color and by the fact that it is not blanchable under pressure, indicating **capillary rupture and hemorrhage** rather than just pooling of blood. *Tattooing* - Tattooing involves the insertion of **indelible ink** into the dermis of the skin, creating permanent designs. - Tattoos have distinct, often patterned, appearances and would not resemble the **irregular, deep discoloration** of lividity or hemorrhage. *Putrefaction* - Putrefaction is a later stage of decomposition, characterized by the breakdown of tissues by bacteria, producing **gases, discoloration (greenish-black), and foul odors.** - This process is distinct from the **vascular pooling** or **hemorrhage** that forms suggillation; putrefaction typically starts later (after 24-48 hours) and involves more widespread tissue destruction. *Decomposition* - Decomposition is the broader process of decay of organic matter after death, encompassing various stages like **autolysis, putrefaction, and skeletonization.** - While suggillation occurs post-mortem, it is a specific type of **post-mortem bruising** or lividity, distinct from the generalized tissue breakdown and gaseous changes seen in advanced decomposition.
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