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minna528
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Cardiovascular system deaths are _____% of the total unexpected natural deaths
53%
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Respiratory system deaths are ____% of total unexpected natural deaths
18%
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Central nervous system deaths are ___% of total unexpected natrual deaths
12%
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Sudden and unexpected natural death in adults may account for up to ___% of the autospy caseload at the MEs office
50%
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Is toxicology analysis required in all cases?
yes it is! Need to determine died of a particular disease as apposed to died with a particular disease
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Sudden death
- Occurs within minutes of onset of symptoms
- often dead
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unexpected death
May occur in individual with significant natural disease but the death was not expected at that time
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What are the three most common systems involved in sudden unexpected natural death
- 1. cardiovascular system
- 2. respiratory system
- 3. central nervous system
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With atherosclerotic cardiovascular disease there is often _____history
No history of previously diagnosed coronary disease
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in Atherosclerotic coronary artery disease symptoms may be:
- indigestion or abdominal pain
- back, shoulder or neck pain
- antacid tablets commonly found at the scene
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ASCAD common findings
- Most common is at least 1 coronary artery with at least 75% stenosis
- Thrombosis in lumen of artery (less than 15%)
- May or may not have: myocardial tissue damage- myocardial fibrosis, acute myocardial necrosis
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T/F The finding of severe atherosclerotic coronary artery disease rules out death due to other causes
Faaaalse
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Cause of death of ASCAD
Cause- cardiac arrhythmia due to severe atherosclerotic coronary artery disease or atherosclerotic cardiovascular disease.
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ASCAD mechanism of death
- cardiac arrhythmia
- ventricular fibrilllation
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Atherosclerotic disease of the aorta
- destruction of aortic wall due to atherosclerosis
- aorta may rupture- into body cavity or into pericardial cavity
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In disease of the aorta: aortic dissection findings include blood from the lumen gains access to the wall of aorta through an ____
blood separates the layers of the aortic call for a distance
blood may rupture out at a site________________
intimal tear
distant from the tear of the intimal surface
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Hypertensive cardiovascular disease
Hypertrophy of muscle of heart due to increased work-load
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Hypertensive cardiovascular disease usually accompanied by:
atherosclerotic coronary artery disease
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In hypertensive cardiovascular disease the weight of the heart is increased above ____
350gm
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In hypertensive cardiovascular disease:
- myocytes may have enlarged nuclei
- may be associated changes in the kidney
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The mechanism of death for hypertensive cardiovascular disease:
acute cardiac arrhythmia
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What is the primary disease of the heart muscle?
- cardiomyopathies:
- hypertrophic cardiomyopathy
- myocarditis
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Hypertrophic cardiomyopathy/asymmetric septal hypertrophy
Enlarged heart with septrum thickness more than left ventricular free wall
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Histology of hypertrophic cardiomyopathy often shows:
Disarray and haphazard arrangemtn of myoctes in the septum
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Victims of hypertrophic cardiomyopathy are often_______ dying suddenly during or immediately after______
young athletes
physical exertion
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T/F 50% of cases of hypertrophic cardiomyopathy may be attributed to a genetic defect
True
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Myocarditis
- inflammation of the heart
- often viral
- may have history of flu-like symptoms
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Myocarditis microscopic exam reveals:
inflammatory cells and myocyte necrosis
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What is the most common form of sudden respiratory death?
Pulmonary thromboembolism
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Pulmonary thromboembolism
Clots arise from deep venous thrombosis in lower extremities, dislodge and travel to pulmonary artery and into the lungs
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Thrombosis may be due to blood stasis in the lower extremities due to:
immobility, bed rest, obesity
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If ____% of the pulmonary vasculature is suddenly blocked, the heart can not pump blood through the lungs leading to _____
60%
cardiovascular collapse
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Pneumonia
- Invasion of lung tissue by oraganism ( viral, bacteria)
- usally an underlying disorder (trauma-brain injury, alcohol or drug use)
- Signs/symptoms may have been ignored or treated with over the counter products
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Autopsy findings of pneumonia
- lung has areas of consolidation (areas filled with inflammatory cells instead of air)
- microscopic exam: aveoli filled with inflammatory cells
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Epiglottitis
- Bacterial of viral inflammation of epiglottis
- marked welling (edema) of epiglottis leads to mechanical obstruction of the airway
- rapid death
- Immediate intubation of tracheostomy is required
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Asthma
- may present at status asthaticus or sudden collapse
- exposure to allergen
- Obstruction of airways by muscular constriction and mucus production such that air can get into but not out of the lung
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Autopsy findings in asthma
- over inflated, billowy lungs
- clear mucus plugging the bronchi
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Microscopic analysis of asthma
- increased muscle in walls of airways
- increased mucus producing cells
- mucus in lumen
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Seizure disorder
uncoordinated abnormal electrical discharge from neurons; disorder of function
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Seizure disorder is analogous to:
cardiac arrhthmia
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Epilepsy
recurrent seizure disorder
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Mechanism of death in seizure disorder
Cardiac arrhythmia
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Idiopathic epilepsy
- brain appears normal in autopsy
- maner of death natural
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Post traumatic epilepsy
- abnorma discharge starts in area of injury
- manner of death is accident or homicide
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Bite marks on tongue found in less that ___% of seizure deaths
25%
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Toxicology results for seizure deaths often find
Subtherapeutic levels of anticonvulsant medication
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Ruptured blood vessels of brain cause:
subarachnoid hemorrhage
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Vascular malformation-congenital
- tangle of small arteries and veins
- may cause headache or seizure disorder
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Berry aneurysm
- sudden onset of severe headache (worst headache i've ever had)
- sudden collapse
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Berry aneurysm due to
- Congenital malformation of media of blood vessel at points of bifurcation
- -vessels at base of brain (circle of willis)
- causes subarachnoid hemorrhage at base of the brain
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Berry aneurysm may be associated with:
- Episodes of increased blood pressure
- -drugs, emotional, hypertension
- straining
- physical activity
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