1. In a study of vital statistics for the U.S., the causes for non-natural deaths are enumerated. Which of the following causes is most likely to account for the most deaths per year in the U.S.?
  2. A 17-year-old driver was involved in a motor vehicle accident. He was thrown from the vehicle and sustained extensive blunt trauma with multiple fractures of the left tibia and fibula, left femur, and right humerus. He was in stable condition until three days after admission, when he suddenly became comatose and died. Autopsy is most likely to reveal which of the following gross pathologic findings?
    Multiple cerebral white matter petechiae
  3. A 20-year-old man is combative when police arrive at a house from which the neighbors heard screaming and breaking of glass for the past hour. He suddenly collapses. He is taken to the hospital, requiring resuscitation with defibrillation en route to try and establish a normal cardiac rhythm. On physical examination his vital signs show temperature 40 C, respirations 36/minute, heart rate 110/minute, and blood pressure 175/90 mm Hg. His pupils are dilated. He dies within an hour. Autopsy reveals no signs of major trauma. Which of the following drugs of abuse is most likely to produce these findings?
  4. A 70-year-old man with a medical history of coronary atherosclerosis and congestive heart failure is beaten about the head and robbed. He is unconscious when admitted to the hospital. During his hospital course over the next two weeks he develops bronchopneumonia, sepsis and renal failure. He dies four days later. Which of the following conditions is the most likely underlying cause of death for this man?
    Blunt head trauma
  5. A 30-year-old woman has been the victim of physical abuse by her spouse on multiple occasions, including punching her in the face and abdomen. After the most recent incident, she claims that he attacked her with a knife. Which of the following types of injuries are you most likely to find on physical examination of this woman which suggests that her spouse attacked her with a knife?
    Incised wound
  6. On a trip to the Caribbean, a 29-year-old man takes a scuba diving course. He goes on a wreck dive to a depth of 50 meters (170 feet). His diving partner signals to him that it is time to ascend, but he continues to explore the wreck, noticing some time later than he is running low on air. He panics and ascends to the surface quickly. Within 2 hours he then develops a headache, tightness in his chest, and difficulty breathing. He experiences generalized pain in all extremities. Which of the following injuries is the most likely cause for his findings?
    Nitrogen bubble formation
  7. A medical resident puts down the immediate cause of death as "Prematurity" followed by the underlying cause of death as "Hyaline membrane disease" on a death certificate form. Which of the following statements regarding this death certificate is most appropriate?
    The listed order is not correct
  8. A 66-year old man has an episode of hemoptysis and comes to his physician. A chest x-ray shows a 5 cm mass in the left lung. Fine needle aspiration is performed and cells from the mass are examined microscopically, revealing a non-small cell carcinoma. The man is a non-smoker. Environmental exposure to which of the following agents is most likely to be a risk factor for development of this man's lung cancer?
  9. A 20-year-old man was trapped inside a burning house and suffered 20% total body surface area (TBSA) burns to his arms. Though initially stable, he died 3 weeks later. Which of the following reasons most likely explains his death?
    He had an inhalation injury.
  10. A 9-year-old girl is brought to the emergency department by her aunt. On physical examination there are multiple contusions of varying ages on the head, torso, arms, and thighs. A chest radiograph reveals a healing 6th rib fracture on the left. Her weight is slightly under that expected for age. The child appears listless. Which of the following conditions is the most likely diagnosis?
    Child abuse
  11. A 68-year-old woman is having minor elective eye surgery performed at a free-standing surgi-center. About 5 to 10 patients undergo various procedures each morning. She is next in line for surgery and has just been given pre-operative medications. Five minutes later, the nurse comes into the room where she is lying and discovers that she is not breathing. A crash cart and defibrillator for advanced cardiac life support are not available, so the nurse and doctor use mouth-to-mouth resuscitation and external chest compressions, but to no avail. At autopsy, the patient is found to have about 30% coronary atherosclerosis with 20% narrowing, a 300 gm heart, mild pulmonary emphysema, and minimal hepatic steatosis. A toxicology screen is negative for drugs of abuse and yields only traces of the medications used prior to surgery. Which of the following statements regarding this death is most accurate?
    This is a therapeutic misadventure
  12. A 70-year-old man died suddenly and unexpectedly within 6 hours of admission to the hospital for a high fever that has been present for only 4 hours. At autopsy, there are no significant external findings on examination of the body. However, on opening the cranial cavity, the external surface of the markedly edematous brain shows an extensive yellow-tan exudate obscuring the sulci. Which of the following statements on this man's death certificate is most appropriate?
    Immediate cause of death is "meningitis"
  13. A 50-year-old man has had increasing dyspnea for 12 years, but no chronic cough. On physical examination he is afebrile. A chest radiograph reveals diffuse interstitial fibrosis involving both lungs. These findings are most likely produced by which of the following environmental exposures?
    Inorganic dusts
  14. Therapeutic gamma irradiation is given to a 55-year-old woman for treatment of a breast carcinoma. The treatments occur over 6 weeks. The neoplasm diminishes in size during this time. Which of the following mechanisms of cellular injury is most likely to account for the efficacy of this radiation therapy?
    Free radical formation
  15. A single, round, 9 mm penetrating wound on the forehead extends into the cranial cavity of a 31-year-old man examined at autopsy by the medical examiner. On the skin surface surrounding this wound is a 6 cm diameter area with grey-black stippling. Which of the following mechanisms of injury is most likely to produce these findings?
    Intermediate range gunshot wound
  16. A 72-year-old woman was found dead in the bathtub in her home. She had been visited by her daughter 4 hours earlier and she appeared to be in good health. At autopsy, her brain grossly shows subarachnoid hemorrhage along with bilateral contusions inferiorly on frontal lobes. Which of the following accidental injuries is most likely to be the underlying cause of death?
  17. A 46-year-old man has had increased sputum production and a chronic cough for the past 5 months. On physical examination there are expiratory wheezes heard over the right lung anteriorly. A chest x-ray demonstrates a 6 cm right perihilar mass. Laboratory studies include a sputum cytology, with the report that "Atypical cells are present suggestive of squamous cell carcinoma." Which of the following is most likely to be associated with these findings?
    Exposure to radon gas
  18. A couple returns home from a social event to find that their infant son is dead. The babysitter who was caring for the infant stated that she called emergency medical technicians after she checked on the infant and found him not breathing, and they could not revive the baby. The babysitter states that the child had been well an hour prior to this event. Which of the following findings in the body of the deceased infant documented by the medical examiner would most strongly suggest a non-natural mode of death?
    Retinal hemorrhages
  19. A study is performed using autopsy findings from medical examiner cases of persons who were homeless and who were injection drug users. Toxicologic data is analyzed from these cases. For those persons who were found to have detectable opiates (as heroin) in liver tissue, which of the following conditions is the most likely immediate cause of death?
  20. A 67-year-old man with a 60 pack year history of smoking was diagnosed with glioblastoma (high grade glioma) last year. He was seen by his physician a week ago and was in stable condition. He died suddenly at home last night. The physician must certify the death of this patient. Which of the following statements on the death certificate would be most appropriate to make?
    The underlying cause of death is 'Glioblastoma'
  21. Police officers respond to reports that an unclothed young man is running through the back yards of homes in a suburban neighborhood, climbing over fences and hedges and thrashing through swimming pools. The officers spot him on top of a utility pole. Toxicologic analysis of the man's blood is most likely to show which of the following substances?
  22. Multiple deaths result from a shooting in a classroom at a high school. One of the suspects was reportedly seen earlier in the same classroom on the day of the shooting. What finding on the victims by the medical examiner is most suggestive that the assailant was in the same room, close to the victims as they were shot?
    There is gunpowder stippling (tattooing) on the skin
  23. The 16-year-old driver of a motor vehicle hit a fixed object at a speed of 60 km/hr in a vehicular accident and dies at the scene. This driver's automobile had no functioning airbag and she was not wearing any restraints. She incurs blunt trauma to the abdomen. Which of the following injuries is the most probable immediate serious consequence of this accident?
    Aortic laceration
  24. A 64-year-old woman falls down some stairs at work. She suffers a right hip fracture for which she is hospitalized. She undergoes surgery for placement of a hip prosthesis. She is recuperating from the surgery when she suddenly develops dyspnea and expires in only a few minutes despite resuscitative measures. Autopsy reveals a saddle pulmonary embolus. A 1 cm infiltrating ductal carcinoma is found in the right breast, but there are no metastases. Which of the following statements regarding death certification is most accurate in this patient?
    The mode (manner) of death is accident
  25. A 25-year-old woman is brought to the emergency room in an obtunded condition. She is afebrile. Laboratory studies show a serum sodium of 140 mmol/L, potassium 3.8 mmol/L, chloride 106 mmol/L, CO2 25 mmol/L, glucose 58 mg/dL, creatinine 1.1 mg/dL, AST 2150 U/L, ALT 2876 U/L, lipase 33 U/L, and calcium 9.0 mg/dL. She dies a day later. The microscopic appearance of her liver at autopsy demonstrates extensive necrosis of hepatocytes. Ingestion of which of the following substances is the most likely cause for these findings?
  26. A 26-year-old healthy man visiting Arches National Park in southern Utah leaves the campground heading for double "O" arch some 8 km distant in 40 degree Celsius heat, ignoring the warning sign about carrying plenty of water. He collapses and is brought back to the park headquarters. Which of the following findings on examination by the emergency medical services technician is most likely to suggest that he has a condition unrelated to the hike?
    Dyspnea with wheezing
  27. A 31-year-old man is working on the ungrounded electrical wiring in his house. He has not flipped the switch on the circuit breaker. He accidentally touches the bare black wire of a 110 volt 20 ampere circuit. Which of the following is most likely to be the major life-threatening problem associated with this event?
    Cardiac arrhythmia
  28. A saddle-bronc rider in a rodeo was first crushed into the gate, then thrown from the horse, then stepped on and kicked by the horse, then dropped from the stretcher by the paramedics carrying him out of the arena. He sustained right femoral and left humeral fractures. Two days later he developed respiratory difficulty. Which of the following is the most likely immediate cause for his death?
    Fat embolism
  29. A 13-year-old girl is playing soccer and runs into the post at the goal mouth, striking her left thigh. The coach runs out to determine the extent of the injury and he notes that there is intact skin with no bleeding at the site of injury. There is initially some swelling, and by the end of the day a red-purple color is present beneath the skin. Which of the following terms best describes her leg injury?
  30. An 11-month-old infant is left unattended in a motor vehicle for 2 hours in an unshaded parking lot in summer with the doors shut and the windows of the vehicle rolled up. This infant is at greatest risk for the development of which of the following complications?
  31. A 74-year-old man has been under the care of his physician for 9 years. He suffered an acute myocardial infarction 2 years ago and has since had poor exercise tolerance. His only abnormal laboratory test finding is a fasting blood glucose of 162 mg/dl two weeks ago. In the past his fasting blood glucose has ranged from 140 to 180 mg/dL. The physician is called one evening by his wife, who states that he is being taken to the emergency room, but he dies before the physician arrives. Which of the following statements is most appropriate regarding death certification in this case?
    The underlying cause of death is diabetes mellitus
  32. On a cool Fall day, April 29, 1996, a man walked into the Arrow Cafe in Port Arthur and began shooting with a .223 caliber semiautomatic rifle at all persons in and around the cafe. Many victims were shot as they were running away to exit the building. The assailant continued to fire at passers-by from the building and from stolen automobiles. In the late afternoon, when he was finally apprehended, 35 people were dead. Which of the following types of wounds did the medical examiner find on most of the victims:
    Small 0.6 to 0.7 cm round skin defects
  33. A 55-year-old man has a history of diabetes mellitus, type II. He has the sudden onset of severe chest pain and is admitted to the hospital. Vital signs reveal temperature 36.9 C, pulse 88/minute, respirations 23/minute, and blood pressure 155/110 mm Hg. A chest radiograph reveals widening of the mediastinum. An angiogram reveals a tear of the proximal aorta. He is taken to surgery, and a hemopericardium is evacuated, but then he dies during the operative procedure. Which of the following is the most appropriate as the immediate cause of death given on the death certificate of this man?
    Aortic dissection
  34. A group of neo-nazis sets fire to the house of an immigrant family. Firemen find the bodies of three children trapped inside. Though the coroner cannot find burn injuries to the skin of the children, he is able to prove that the deaths were due to the fire by finding which of the following?
    Tracheal inhalation injury
  35. The body of a 17-year-old adolescent male is found near a dumpster behind the high school he attends. External examination reveals a single 9 mm circular wound on the right temple, with small surrounding lacerations and an abrasion ring. Sooting is found on his right hand. Autopsy reveals that he has widespread malignant lymphoma. The bullet is recovered beneath the scalp on the left side of his head. Which manner of death is most likely for this situation?
  36. The body of a 13-year-old girl is found in her bed at home by Sheriff's deputies, who were called to the scene by a neighbor after he heard screaming sounds. Physical examination of the body reveals no external signs of trauma and no other abnormalities. A complete autopsy reveals no internal trauma or other abnormalities. Which of the following mechanisms of injury best explains these findings?
    Smothering with a pillow
  37. A study is performed analyzing patterns of injury. One type of injury, typically made with a blunt object, can be seen on physical examination and can be dated by the color change that takes place over time. Which of the following terms is most likely to describe this injury?
  38. A 20-year-old man has joined a group of hikers ascending a mountain peak 8000 meters in height. Beginning at the 5000 meter level, he develops a worsening headache and increasing respiratory distress. He decides to press on. He spends a sleepless night while camped at 6000 meters. The next day, he becomes disoriented and cannot stay on the trail. While being attended by other members of the climbing party, he suddenly loses consciousness and cannot be resuscitated. Which of the following pathologic changes is most likely to be present in this man?
    Cerebral edema
  39. A child ingests 50 tablets in a bottle that she found on a table in the house. Two hours later, the child becomes progressively obtunded and then lapses into a coma. The child is taken to a local hospital, where supportive care is given. The child exhibits tachypnea and tachycardia, but is afebrile. Laboratory studies with blood gas analysis show metabolic acidosis. Which of the following substances did this child most likely ingest?
    Acetylsalicylic acid
  40. A 74-year-old man suffers extensive thermal burn injuries in a natural gas explosion and fire while lighting the furnace in the basement of his house. He has 40% total body surface area burns. Which of the following factors is most likely to determine whether skin grafting will be required?
    Thickness of the burn
  41. The "employee of the year" is rewarded with a close-in parking space, but this space is very icy in winter, and she falls getting out of her car. She scrapes her arm on the pavement. She goes to the employee clinic, where the physician's assistant observes only a superficial epidermal injury in which the skin is not completely broken. Which of the following terms is most appropriate for the arm injury to this woman?
  42. While driving a Williams-Renault formula one grand prix racing car in pursuit of the world driving championship at a race run in Italy, the Brazilian driver Ayrton Senna loses control and crashes. He dies moments later. The mode (manner) of death in this case is:
  43. In an Agatha Christie mystery, the plot centers around a homicide that is made to look like a suicide. Though the famous Belgian detective Hercule Poirot eventually solves this mystery, the mode of death should have been obvious by inspection of the deceased's body, because he was alleged to have put the gun to his head and fired. Which of the following clue(s) is most likely to suggest homicide as the manner of death?
    The victim had no sooting of his hand, nor gunshot residue in the entrance wound
  44. What type of object would you expect to have been found at the scene of the death of a woman with the following description of a wound by the medical examiner: "The incised wound of the neck is gaping and exposes the larynx and cervical vertebral column. It measures 5 1/2 inches in length and is found at the level of the superior border of the larynx":
  45. Which of the following cases should be referred to the medical examiner to investigate and certify the death?
    A 22-year-old man dies suddenly and unexpectedly while playing a high school football
  46. A 95-year-old woman falls to the ground after tripping on the carpet in her house. She strikes the back of her head on the floor. She becomes more irritable, with headache and decreasing mentation over the next 3 weeks. Which of the following complications of her injury is she most likely to have developed?
    Subdural hematoma
  47. Which of the following items listed as the immediate cause of death on a death certificate is NOT acceptable?
    Cardiorespiratory arrest.
  48. A baby is born at term and is of normal birth weight, with Apgar scores of 9 and 10 at 1 and 5 minutes. Baby and mother are sent home on the second day following delivery. The baby does fine and is gaining weight and developing normally and is 4 months old. However, one night the mother checks on the baby and finds the infant prone on the bed and not breathing. Paramedics are called, but the infant cannot be resuscitated. Which of the following is the most probable explanation for these findings?
    Sudden infant death syndrome
  49. A 19-year-old man is taken to the emergency room after his mother finds him comatose on the floor of his room at home following a night of partying with his friends at a local club. Pertinent laboratory findings from a blood specimen taken postmortem include ALT of 830 U/L and AST of 1053 U/L, along with a significant amount of acetaminophen. Which of the following pre-existing conditions in the deceased is most likely to have contributed to this injury pattern?
    Chronic ethanol ingestion
  50. A 66-year-old man dies suddenly and unexpectedly. He is found in his home by a neighbor after the man was not seen for over a day. Police find no evidence of foul play. At autopsy, there are no signs of physical injury. The skin of his hands displays cherry red lividity. Which of the following toxins is most likely to be found in this man?
    Carbon monoxide
  51. An elderly man is found dead in his bed at home after paramedics are called by his neighbor, who noticed that the man was out working in his garden as he usually did, but collapsed. When paramedics arrive, the man is noted to have marked salivation with lacrimation. His pupils are pinpoint. He is incontinent of urine. On the way to the hospital he vomits. Which of the following environmental exposures best explains these findings?
  52. A 27-year-old G2P1 woman is in the 39th week of gestation. A screening ultrasound at 19 weeks revealed no abnormalities. She goes into labor and 6 hours later has a routine vaginal delivery of a term male. An intact placenta is delivered 5 minutes later. The infant's Apgar scores are 8 and 9 and 1 and 5 minutes. However, within 10 minutes following delivery, she develops severe dyspnea and cyanosis, followed by seizures and coma. Which of the following is the most likely explanation for this series of events?
    Amniotic fluid embolism
  53. A bomb strikes the embassy of the People's Republic of China one evening in Belgrade. Several persons are killed immediately. By which of the following mechanisms did the victims most likely die from this event?
    Blunt force trauma
  54. A 26-year-old woman is brought to the emergency room of a local hospital by her neighbor. She has 3 to 4 cm long linear incised wounds to the palms of the hands and to the ventral aspect of her wrists. Which of the following explanations offered by the woman for the appearance of these injuries are you most likely to believe?
    My husband attacked me with a knife
  55. A 3-month-old infant is found dead by his mother late one evening. She had put him in bed on his stomach only an hour before, and he had shown no signs of distress. The baby had been doing well prior to that time, feeding well and gaining weight normally. The baby's term birth had followed an uncomplicated pregnancy. Which of the following is the medical examiner most likely to find at autopsy of this infant?
    No abnormalities
  56. A 79-year-old woman is found unconscious in the bedroom by firemen who respond to a report of a house fire by her neighbor. She is taken to a local hospital. She is found to have partial thickness burns involving her head and neck and full thickness burns involving most of her torso and upper extremities. Bronchoscopy reveals no erythema or ulceration of the trachea mucosa. Which of the following features described here suggests the best prognosis?
    The absence of an inhalation injury
  57. A 4-year-old previously healthy child ingests a 100 ml bottle containing a clear liquid he found under the kitchen sink at home. The child is observed to develop central nervous system depression over the next 6 hours. Acidosis is documented on admission to the hospital. Three weeks later, it is noted that the child's visual acuity is markedly decreased. Which of the following chemical substances was most likely present in the liquid ingested by this child?
Card Set
Pathology 1