a = new Array(287);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. This is last on the list. Though specific events may be spectacular and grab attention, they have a negligible effect on population over time. The revenge engendered by such acts tends to increase the loss of life, and the cycle of violence continues."
a[2] = f + "(B) Incorrect. Alcohol-related deaths exceed 20,000 per year. This includes acute overdoses (over 600 per year, the most common form of fatal drug overdose) and the effects of chronic alcohol abuse, including chronic liver disease."
a[3] = f + "(C) Incorrect. There are over 4000 deaths related to drowning each year."
a[4] = f + "(D) Incorrect. Falls account for over 18,000 deaths per year. The elderly are  mainly affected in their homes."
a[5] = f + "(E) Incorrect. Fires account for over 3000 deaths per year."
a[5.1] = f + "(F) Incorrect. Pedestrians hit by motor vehicles lead to over 5000 deaths per year. Death related to motor vehicles account for over 45,000 deaths per year."
a[5.2] = f + "(G) CORRECT. Poisonings acount for over 28,000 deaths per year, and over 18,000 of these are accidental. Overall, accidents are the fifth leading cause of death in the U.S., with over 100,000 deaths per year. The world is unsafe more from unintended human actions than from intentional actions such as wars. The list of chemicals in use and/or potentially released into the environment grows by over a hundred each year."
a[6] = f + "(A) CORRECT. He has fat embolism syndrome. This is a complication of multiple long bone fractures. It is uncommon but unpredicatable in occurrence. Extensive blunt force trauma to soft tissues and burn injuries may also cause fat embolism."
a[7] = f + "(B) Incorrect. He had no pulmonary symptoms; also, the time frame is too short for most pulmonary thromboemboli, which come from deep venous thromboses."
a[8] = f + "(C) Incorrect. An epidural hematoma develops into a medical emergency much more quickly, typically within an hour or so from the time of a blow to the head."
a[9] = f + "(D) Incorrect. A hemopericardium would have appeared very soon after traumatic injury to the heart. The cardiac tamponade that resultsd quickly reduces cardiac output."
a[10] = f + "(E) Incorrect. The pneumothoraces would appear quickly following chest injury and be associated with severe dyspnea."
a[11] = f + "(A) Incorrect. Some combativeness is possible as the blood ethanol rises, but most persons become obtunded with increasing levels of ethanol, and cardiac irregularities and hyperthermia are not features of ethanol overdose."
a[12] = f + "(B) Incorrect. Heroin overdoses will produce obtundation and respiratory failure that may respond to administration of naloxone."
a[13] = f + "(C) CORRECT. Cocaine overdoses are associated with a state of 'excited delirium' which can be accompanied by hyperthermia. Cocaine is powerful vasoconstrictor and has a variety of vascular effects.  Many complications come from the cardiac complications that include arterial vasoconstriction with ischemic myocardial injury and arrhythmias."
a[14] = f + "(D) Incorrect. Methamphetamine can cause cardiac toxicity appearing similar to cocaine, but not the syndrome of excited delerium."
a[15] = f + "(E) Incorrect. Marijuana has a mild sedative or tranquilizer effect and no major health risks."
a[16] = f + "(A) CORRECT. No matter what the course of the patient and no matter how long it takes, the underlying cause of death is still the disease or event that started the chain of events leading to death. The manner of death in this case is homicide."
a[17] = f + "(B) Incorrect. Though pneumonia complicated his course and contributed to his demise, it is not the underlying event."
a[18] = f + "(C) Incorrect. He may have had pre-existing coronary artery disease, but the traumatic event triggered the chain of events leading to his death."
a[19] = f + "(D) Incorrect. His renal failure was a complications of the consequence of his hospital course and is not the underlying cause of death."
a[20] = f + "(E) Incorrect. Sepsis complicated his hospital course, but was not the underlying cause that started the chain of events leading to death."
a[21] = f + "(A) Incorrect. A contusion is a bruise made in soft tissue by a blunt object. The skin is not broken."
a[22] = f + "(B) CORRECT. The sharp edge of a knife produces an incision (just as a surgical scalpel blade is used to make a surgical incision)."
a[23] = f + "(C) Incorrect. An abrasion is produced by a scraping injury, as when a motorcycle rider falls and scrapes along the pavement."
a[24] = f + "(D) Incorrect. A laceration is a tearing injury of the skin from a blunt object."
a[25] = f + "(E) Incorrect. A puncture is a deep wound made by a sharp, pointed instrument."
a[26] = f + "(A) Incorrect. DIC may complicate his recovery if there is significant tissue necrosis, sepsis, or shock as a consequence, but it is not involved in the immediate events following the dive."
a[27] = f + "(B) Incorrect. Though diving gear can include equipment to help avoid heat loss, this was not the major consequence of this dive."
a[28] = f + "(C) Incorrect. Free radicals can be generated with severe hypoxia, but this is not the key event in the diving accident."
a[29] = f + "(D) Incorrect. Apoptosis is a process of single cell death that is not seen as an immediate illness."
a[30] = f + "(E) CORRECT. He has the 'bends' from too rapid decompression. The nitrogen bubbles form in blood and tissues to produce the various symptoms."
a[31] = f + "(A) Incorrect. This case has a natural mode of death."
a[32] = f + "(B) Incorrect. Hyaline membrane disease can only occur in a liveborn."
a[33] = f + "(C) CORRECT. The resident has the immediate and underlying causes of death listed backwards. This destroys the resident's credibility unless an amended death certificate is issued."
a[34] = f + "(D) Incorrect. SIDS cases have no major gross or microscopic findings."
a[35] = f + "(E) Incorrect. A congenital infection, if it had been present, would then be listed as the underlying cause of death."
a[36] = f + "(A) CORRECT. Exposure to radon gas is considered the second most common cause for lung cancer--a distant second to smoking. Radon gas seeps up from the ground and is trapped in dwellings, where it is inspired and may lead to mutational events that underlie neoplasia."
a[37] = f + "(B) Incorrect. Inhaled silica is a risk for pulmonary fibrosis. The risk for lung cancer is slightly increased."
a[38] = f + "(C) Incorrect. Inhaled molds can produce 'farmer's lung' which is a form of extrinsic allergic alveolitis."
a[39] = f + "(D) Incorrect. A large amount of coal dust can produce a pneumoconiosis, but small amounts of carbon pigment produce anthracosis, which is innocuous."
a[40] = f + "(E) Incorrect. Ozone in polluted air such as smog is an airway irritant but not a significant risk for lung cancer."
a[41] = f + "(A) Incorrect. Even if they were full-thickness, only 20% TBSA burns are not usually considered life-threatening to someone this age."
a[42] = f + "(B) CORRECT. The extent of his burns was not great, but a fire in a closed space is often accompanied by inhalation of hot gases that lead to inhalation injury and respiratory airway injury that can lead to pneumonia and sepsis."
a[43] = f + "(C) Incorrect. The burns were not extensive for a 20-year-old; he would be expected to survive."
a[44] = f + "(D) Incorrect. The complications of hypoxia would have been manifested earlier in his course."
a[45] = f + "(E) Incorrect. A 20-year-old is unlikely to have underlying heart disease."
a[46] = f + "(A) Incorrect. Injuries with multiple contusions are not a key feature seen in children with mental retardation."
a[47] = f + "(B) Incorrect. Scurvy is not common, though it could produce soft tissue hemorrhages. Contusions should not be present."
a[48] = f + "(C) CORRECT. Any time you see contusions of varying ages in multiple body regions, whether in an adult or a child, suspect possible abuse and see if the explanation makes sense. Rib fractures are unlikely to result from normal play by children."
a[49] = f + "(D) Incorrect. Meningococcemia is an acute fulminant febrile infectious process with purpuric skin lesions of the same age."
a[50] = f + "(E) Incorrect. A single fall would not account for contusions of varying ages."
a[51] = f + "(A) Incorrect. There are enough findings in this case to indicate an accidental mode (manner) of death."
a[52] = f + "(B) Incorrect. The degree of coronary atherosclerosis and the size of the heart is not enough to account for a sudden death."
a[53] = f + "(C) Incorrect. The patient's prior medical condition(s) should have been determined prior to the procedure. However, the autopsy findings do not suggest an existing condition serious enough to account for the death"
a[54] = f + "(D) CORRECT. This is an 'oops' which should not have happened. Clearly, there was not close enough monitoring of the patient or adequate facilities to deal with a potential complication of this nature. You don't expect to have the complication of death with such minor surgery, and if the patient were unstable, then this elective surgery should not have been performed."
a[55] = f + "(E) Incorrect. There are no findings in this case that suggest chronic alcoholism."
a[56] = f + "(A) Incorrect. A purulent meningitis is unlikely to be the result of head trauma when the patient dies suddenly and unexpectedly."
a[57] = f + "(B) Incorrect. A purulent meningitis is typically a natural event and not the result of an accident. There would have had to be penetrating trauma involving the skull."
a[58] = f + "(C) CORRECT. The description fits best with an acute bacterial meningitis. Such patients can succumb quickly from cerebral edema."
a[59] = f + "(D) Incorrect. Tuberculosis rarely produces an acute meningitis; it is usually chronic."
a[60] = f + "(E) Incorrect. A 'stroke' is typically a focal thromboembolic event or hemorrhage."
a[61] = f + "(A) CORRECT. These inorganic dusts, typically silicates containing silica, are trapped in the lungs and then ingested by macrophages. The macrophages then release cytokines that result in fibrogenesis. The length and extent of exposure determine the degree of pulmonary fibrosis."
a[62] = f + "(B) Incorrect. NOx compounds are acutely injurious to the lung, though not markedly so, or we would be more willing to do something about smog in large cities."
a[63] = f + "(C) Incorrect. Organic particulate materials that are inhaled are best known to produce hypersensitivity pneumonitis, typical of 'farmer's lung'."
a[64] = f + "(D) Incorrect. Lung damage from smoking is primarily due to loss of alveoli (emphysema)."
a[65] = f + "(E) Incorrect. Radon gas that may collect in houses is now considered to be a risk for lung cancer."
a[66] = f + "(A) Incorrect. Exposure to radiant energy increases the risk for mutations to occur, but this is a long-term, unpredictable effect."
a[67] = f + "(B) Incorrect. Gamma irradiation is not converted to heat."
a[68] = f + "(C) Incorrect. NK cell lysis is a feature of innate immunity and may play a role in tumor surveillance. Radiation therapy, however, tends to reduce immune function if the irradiated field includes tissues of the immune system, such as bone marrow and lymph nodes.."
a[69] = f + "(D) CORRECT. The goal of therapeutic radiation is selective destruction of neoplastic cells, in which formation of free radicals within the tumor has the greatest effect."
a[70] = f + "(E) Incorrect. There are long-term vascular changes in radiated tissues, but the doses are divided and spread over time to avoid significant immediate tissue damage."
a[71] = f + "(A) Incorrect. Blunt force does not typically produce a round penetrating wound; blunt force does not account for the stippling."
a[72] = f + "(B) CORRECT. The stippling from gunpowder is typical for an intermediate range (not contact and not long range)."
a[73] = f + "(C) Incorrect. A sharp instrument leading to a penetrating injury does not account for the stippling."
a[74] = f + "(D) Incorrect. A contact range gunshot wound typically has lacerations and typically does not have stippling."
a[75] = f + "(E) Incorrect. A long range gunshot wound does not account for the stippling. Also, it is unlikely that a long range shotgun pellet could penetrate the skull."
a[76] = f + "(A) Incorrect. Drowning may be associated with hemorrhage in mastoid sinuses, but not cerebral contusions."
a[77] = f + "(B) Incorrect. Electrocution does not produce contusions."
a[78] = f + "(C) Incorrect. There may be petechial hemorrhages with strangulation, but not contusions."
a[79] = f + "(D) Incorrect. Hyperthermia does not produce contusions."
a[80] = f + "(E) CORRECT. She probably had a fall backwards to produce a contrecoup injury pattern."
a[81] = f + "(A) Incorrect. Bronchogenic carcinomas are not greatly increased in frequency in persons with just exposure to silica."
a[82] = f + "(B) Incorrect. The extrinsic allergic alveolitis associated with inhalation of bird dust typically does not cause extensive chronic lung disease, and the risk for cancer is not increased."
a[83] = f + "(C) Incorrect. Cystic fibrosis leads to chronic obstructive lung disease, but the risk for carcinoma is not significantly increased."
a[84] = f + "(D) Incorrect. AIDS is not associated with an increased risk for pulmonary carcinomas."
a[85] = f + "(E) CORRECT. Radon gas, which may collect in dwellings, is a risk for bronchogenic carcinomas. The exposure occurs over many years."
a[86] = f + "(A) Incorrect. Icterus suggests possible liver disease."
a[87] = f + "(B) Incorrect. Such a color suggests the contusion occurred days before. A single contusion is not good evidence for extensive abuse leading to death."
a[88] = f + "(C) Incorrect. Cyanosis suggests cardiac or pulmonary disease."
a[89] = f + "(D) CORRECT. The retinal hemorrhages strongly suggest the 'shaken baby' syndrome. The findings in this case more strongly suggest sudden infant death syndrome (SIDS)"
a[90] = f + "(E) Incorrect. Edema suggests natural disease."
a[91] = f + "(A) Incorrect. Although overdoses are an important cause for mortality with intravenous drug abuse, they are not the greatest risk."
a[92] = f + "(B) Incorrect. Heroin-induced nephropathy is not extremely common."
a[93] = f + "(C) Incorrect. Ilicit drugs used intravenously are unlikely to result directly in marrow failure."
a[94] = f + "(D) CORRECT. Infection with HIV and viral hepatitis, as well as bacteria producing endocarditis and meningitis, represents a significant and serious risk to persons using drugs intravenously."
a[95] = f + "(E) Incorrect. The amount of talc used to dilute the injected drugs is not great enough (usually) over time to lead to significant pulmonary fibrosis."
a[96] = f + "(A) Incorrect. Such a statement provides no useful information and should be avoided."
a[97] = f + "(B) Incorrect. Neoplasia is a natural process defining a natural mode of death."
a[98] = f + "(C) Incorrect. There is no definable separate immediate or intermediate cause of death in this case."
a[99] = f + "(D) Incorrect. Smoking had nothing to do with his death, since brain cancers are not linked to smoking."
a[100] = f + "(E) CORRECT. In fact, all you would have to do is put only the one word on the first line of the death certificate."
a[101] = f + "(A) Incorrect. This drug is a tranquilizer."
a[102] = f + "(B) Incorrect. This drug has a tranquilizing effect."
a[103] = f + "(C) Incorrect. Although 'excited delerium' is one manifestation of cocaine use, persons so affected usually stay in one place."
a[104] = f + "(D) CORRECT. The more bizarre the history, the more likely that PCP (a schizophrenomimetic drug) is involved."
a[105] = f + "(E) Incorrect. Ethanol is usually a depressant, though in some persons disinhibition will occur with violent or aggressive behavior."
a[106] = f + "(A) Incorrect. The appearance of the entrance wound does not always correlate with the caliber of the weapon used."
a[107] = f + "(B) Incorrect. The presence of an exit wound depends upon multiple factors including the caliber of the weapon and the type of bullet."
a[108] = f + "(C) Incorrect. Entrance wounds by an assailant can be anywhere."
a[109] = f + "(D) CORRECT. The presence of the powder stippling is consistent with an intermediate range from inches to feet away. The assailant would have to be close for this to occur."
a[110] = f + "(E) Incorrect. Exit wounds vary in size, depending upon the type of bullet and path of bullet."
a[111] = f + "(A) Incorrect. Skin abrasions are typical of blunt force injuries, but are not generally life-threatening."
a[112] = f + "(B) Incorrect. Contusions are typical of blunt force injury, but in the abdominal wall are not generally life-threatening."
a[113] = f + "(C) Incorrect. Rupture of a viscus may occur with blunt injury, but is not common and is not as life-threatening as aortic laceration."
a[114] = f + "(D) Incorrect. Rib fractures would be common in this setting and could lead to a pneumothorax with lung pucture, but would not be as life-threatening as aortic laceration."
a[115] = f + "(E) CORRECT. The deceleration injury can produce tearing of the aorta, which is extremely serious, because a large amount of blood can be lost into the chest in a short period of time."
a[116] = f + "(A) Incorrect. This statement provides no useful information and only describes what would be expected in any death."
a[117] = f + "(B) Incorrect. Pulmonary embolism is a recognized complication of hospitalization."
a[118] = f + "(C) CORRECT. The chain of events started with the fall; technically, this is an industrial accident because the injury occurred at work. Remember that the underlying cause of death is the condition that started the chain of events leading to death, no matter how long that took."
a[119] = f + "(D) Incorrect. The breast cancer is localized and played no role in the events leading to her death.."
a[120] = f + "(E) Incorrect. Pulmonary embolism is the last event in the chain of events, not the precipitating cause."
a[121] = f + "(A) CORRECT. The liver enzymes are markedly elevated and there is extensive hepatocellular necrosis microscopically, typical for acetaminophen toxicity."
a[122] = f + "(B) Incorrect. Ethanol poisoning acutely has no significant hepatic histologic finding. Chronic alcoholism can produce findings that can range from steatosis (fatty change) to micronodular cirrhosis."
a[123] = f + "(C) Incorrect. Lead poisoning mainly affects the nervous system acutely."
a[124] = f + "(D) Incorrect. Methanol poisoning acutely affects the central nervous system and the eye."
a[125] = f + "(E) Incorrect. Vitamin A toxicity can lead to findings suggesting a brain tumor."
a[126] = f + "(A) Incorrect. Arrhythmias can be a consequence of hyperthermia with 'heat stroke'."
a[127] = f + "(B) Incorrect. In the heat, his body will be losing a lot of water, and eventually his intravascular volume will drop."
a[128] = f + "(C) Incorrect. Vasodilation will be significant because of the heat."
a[129] = f + "(D) CORRECT. Respiratory difficulty with dyspnea is an unlikely direct consequence of hyperthermia. Wheezing would suggest bronchoconstriction, as with acute asthma."
a[130] = f + "(E) Incorrect. He will probably suffer this problem first."
a[131] = f + "(A) Incorrect. The focal burns with entrance and exit sites for the current are typically quite small."
a[132] = f + "(B) Incorrect. Pulmonary edema takes time to develop."
a[133] = f + "(C) Incorrect. The body does not gain that much heat with electrical injury."
a[134] = f + "(D) CORRECT. The electrical current interferes with the cardiac conduction system, particularly if the path the current takes is across the chest."
a[135] = f + "(E) Incorrect. Any thrombosis would be very focal along the path of the current."
a[136] = f + "(A) Incorrect. Vasculitis typically develops with immunologically mediated diseases, not trauma."
a[137] = f + "(B) Incorrect. This is possible, but usually venous thrombosis with immobilization following trauma takes longer to develop."
a[138] = f + "(C) Incorrect. With aspiration, he probably would have had respiratory problems to begin with, or developed a pneumonia somewhat later in the course."
a[139] = f + "(D) CORRECT. Trauma with long bone fractures can lead to fat embolism. Respiratory difficulties typically occur 1 to 3 days following the initial injury."
a[140] = f + "(E) Incorrect. Problems with the contusion would appear soon after the traumatic events."
a[141] = f + "(A) Incorrect. The skin is irregularly broken when a laceration occurs."
a[142] = f + "(B) Incorrect. A puncture wound is a penetrating injury that is deeper than it is broad, and is made by a pointed object."
a[143] = f + "(C) Incorrect. An abrasion is an irregular scraping injury."
a[144] = f + "(D) Incorrect. An incised wound has sharp edges because it is made by a sharp object such as a knife."
a[145] = f + "(E) CORRECT. Contusions are quite common injuries. The blunt force injury does not break the skin, but disrupts small blood vessels in the soft tissues beneath the epidermis, with leakage of red blood cells from the capillaries into the surrounding soft tissues."
a[146] = f + "(A) Incorrect. There will be plenty of air in the closed car."
a[147] = f + "(B) Incorrect. SIDS by definition means there is no identifiable cause of death."
a[148] = f + "(C) CORRECT. Children, older persons, and pets left unattended in autos are at risk for hyperthermia (because they can't open the windows or get out in response to rising temperatures). Considerable heat will build up in a closed space inside the auto, even if the outside temperature is not high."
a[149] = f + "(D) Incorrect. The time frame is not great enough for serum glucose to fall significantly."
a[150] = f + "(E) Incorrect. Retinopathy is most often a consequence of an inherited condition or from oxygen toxicity."
a[151] = f + "(A) CORRECT. Remember to list the underlying cause of death, which is the disease that led to the chain of events culminating in death. With the history that you know, then you have enough information to establish a natural cause of death."
a[152] = f + "(B) Incorrect. This is clearly a natural death with a documented medical history sufficient to establish cause of death."
a[153] = f + "(C) Incorrect. The acute MI is in the chain of events resulting from the underlying cause of death, not an unrelated condition."
a[154] = f + "(D) Incorrect. NEVER list 'cardiac arrest' or 'cardiorespiratory arrest' as an immediate cause of death. Such statements provide no useful information."
a[155] = f + "(E) Incorrect. Since you are his regular physician, then you should take responsibility for filling out the death certificate. The patient's physician should fill out the death certificate."
a[156] = f + "(A) Incorrect. Wad marks around large wounds are made by a shotgun fired at intermediate range."
a[157] = f + "(B) Incorrect. Sooting and lacerations are more typical of contact range gunshot wounds."
a[158] = f + "(C) CORRECT. The victims were at a distance and exhibited distant, or indeterminate, range gunshot entrance wounds."
a[159] = f + "(D) Incorrect. Powder stippling is a feature of intermediate range entrance wounds."
a[160] = f + "(E) Incorrect. Deformed bullets passing through body and striking bone, or which may have struck an intermediate target, may produce elongated wounds."
a[161] = f + "(A) Incorrect. This statement should never be put on the death certificate."
a[162] = f + "(B) Incorrect. This could be put as the underlying cause of death."
a[163] = f + "(C) CORRECT. Aortic dissections arise in persons who have atherosclerosis and hypertension. The blood can dissect into the pericardial cavity, into the pleural cavities, or around great vessels."
a[164] = f + "(D) Incorrect. This could be a contributing cause of death, since it is a risk factor for aortic dissection and made the dissection more likely to occur."
a[165] = f + "(E) Incorrect. The operative procedure was intended to treat the condition that caused death. Not all procedures are effective."
a[166] = f + "(A) Incorrect. Sepsis following burn injuries occurs days to weeks following the injury."
a[167] = f + "(B) Incorrect. Fat embolism syndrome takes about a week to produce cerebral symptoms."
a[168] = f + "(C) Incorrect. Marked edema can be a complication of underlying cardiac, hepatic, or renal disease in survivors of burn injuries."
a[169] = f + "(D) Incorrect. Such petechiae are a non-specific finding of hypoxia from many causes."
a[170] = f + "(E) CORRECT. Persons trapped in enclosed spaces during a fire often succumb to inhalation of the gases and smoke."
a[171] = f + "(A) Incorrect. With the location of the entrance wound, an accident is unlikely."
a[172] = f + "(B) Incorrect. The location of the entrance wound and the sooting on the victim's hand are against a homicide."
a[173] = f + "(C) CORRECT. The findings suggest that the victim fired the weapon, and the external wound is consistent with contact range."
a[174] = f + "(D) Incorrect. Though the lymphoma may well have caused his death in the near future, the bullet wound is the cause of death."
a[175] = f + "(E) Incorrect. There is enough physical evidence in this case to make a determination of the mode of death."
a[176] = f + "(A) Incorrect. There should be physical signs such as contusions on the neck, and underlying soft tissues may show hemorrhage, and there may be hyoid bone fractures."
a[177] = f + "(B) Incorrect. CO poisoning can be marked by cherry red lividity (and the screaming is not consistent, because CO poisoning leads to obtundation)."
a[178] = f + "(C) Incorrect. Forcible rape is unlikely to cause death, though the victim may be strangled."
a[179] = f + "(D) CORRECT. There are few, if any, physical findings with smothering, particularly in an infant or child or very old adult who cannot fight back."
a[180] = f + "(E) Incorrect. A blow to the head would leave a contusion."
a[181] = f + "(A) Incorrect. Lacerations tend to be irregular and without good patterns."
a[182] = f + "(B) Incorrect. Patterned abrasions with toolmarks are helpful in determining the instrument that made them."
a[183] = f + "(C) Incorrect. Punctures are indicative only of a sharp, pointed instrument."
a[184] = f + "(D) CORRECT. The contusion changes color as the blood extravasated into the tissues is broken down and resorbed."
a[185] = f + "(E) Incorrect. An incised wound has some features that are helpful in identifying the sharp instrument, but only very generally."
a[186] = f + "(A) Incorrect. He will have pulmonary edema as part of altitude sickness, but the time course is not long enough for the edema to be complicated by pneumonia"
a[187] = f + "(B) CORRECT. He has altitude sickness. He should have descended to a lower elevation at the first sign of trouble."
a[188] = f + "(C) Incorrect. Air embolism is a rare event that may occur with decompression injury, as from diving."
a[189] = f + "(D) Incorrect. A subdural hematoma occurs as a result of trauma with head injury."
a[190] = f + "(E) Incorrect. His risk for coronary artery disease is nil, given that he is a climber able to make it up that far."
a[191] = f + "(A) Incorrect. Sodium hypochlorite is contained within household bleach."
a[192] = f + "(B) Incorrect. Lead poisoning leads to anemia, peripheral neuropathy, nephritis, and long term neurologic damage in children."
a[193] = f + "(C) Incorrect. Methanol is metabolized by the hepatic enzyme alcohol dehydrogenase to the toxic metabolites formic acid and formaldehyde which are toxic to retina and brain stem."
a[194] = f + "(D) CORRECT. Aspirin ingestion can lead to metabolic acidosis. The tachypnea is a physiologic compensation with respiratory alkalosis."
a[195] = f + "(E) Incorrect. Chronic mercury poisoning mainly affects the central nervous system: parlysis, blindness, hearing loss, psychosis."
a[196] = f + "(A) Incorrect. Older persons are less likely to recover from burn injuries, regardless of whether skin grafting is done."
a[197] = f + "(B) Incorrect. The extent of total body surface area involved has a great prognostic significance, but does not determine if skin grafting is required."
a[198] = f + "(C) Incorrect. An inhalation injury (hot gases injuring the upper respiratory tract, is a major complication, but does not determine whether skin grafting is necessary."
a[199] = f + "(D) Incorrect. Infections of the skin and the respiratory tract are common complications of burn injuries, and may compromise either regenerating or grafted skin."
a[200] = f + "(E) CORRECT. A partial thickness burn leaves the lower epidermis or skin adnexal structures intact, from which re-epithelialization may occur without grafting. A full thickness burn leaves no epidermal regenerative capacity, and skin grafting to that area is necessary."
a[201] = f + "(A) CORRECT. Abrasions are quite common injuries. There is a scraping of the epidermis. Sometimes the pattern of the abrasion can indicate how it occurred."
a[202] = f + "(B) Incorrect. A laceration will break the skin in an irregular pattern."
a[203] = f + "(C) Incorrect. A puncture is made with a sharp object that breaks the skin over a small area, but the wound may be quite deep."
a[204] = f + "(D) Incorrect. An incised wound is made with a sharp object such as a knife."
a[205] = f + "(E) Incorrect. A contusion, or 'bruise', leads to extravasation of blood into soft tissues below the skin."
a[206] = f + "(A) Incorrect. This is a non-natural death due to accident, not a disease process."
a[207] = f + "(B) CORRECT. This is an obvious accident, because the result was not intended. Though a great deal has been done to make the sport safer, a human occupying a high speed projectile is an inherently unsafe situation. Incredibly, though, an Italian court initially indicted Frank Williams, implying he was to blame and it was not an accident."
a[208] = f + "(C) Incorrect. Incorrect. The driver was in the race on his own volition. It is highly unlikely that someone purposely damaged the car, particularly with a large team and multiple checkpoints."
a[209] = f + "(D) Incorrect. The driver was trying to win the championship."
a[210] = f + "(E) Incorrect. It is unlikely that investigation would not reveal evidence to solve this case."
a[211] = f + "(A) Incorrect. This would be more indicative of a contact wound, which would more likely be seen with suicide."
a[212] = f + "(B) Incorrect. Don't you just hate it when mystery stories actually revolve around such obscure clues."
a[213] = f + "(C) CORRECT. If the gun were in the victim's hand, there should be sooting, and a contact or close contact gunshot wound should have gunshot residue in the entrance wound."
a[214] = f + "(D) Incorrect. Depending upon the caliber of the weapon, the type of bullet fired, and what tissues are traversed, a bullet may not always exit from the body."
a[215] = f + "(E) Incorrect. A suicide or a homicide may have either a single bullet or multiple bullets."
a[216] = f + "(A) Incorrect. An entrance wound from a bullet fired from a rifle (usually at more than contact range) typically has the appearance of a round hole."
a[217] = f + "(B) Incorrect. Electrical entrance wounds are usually quite small."
a[218] = f + "(C) Incorrect. A shovel can produce contusions as a blunt object, or lacerations, but is typically not sharp enough to produce an incised wound."
a[219] = f + "(D) Incorrect. A brick as a blunt object would produce contusions, and possibly lacerations or abrasions."
a[220] = f + "(E) CORRECT. Incised wounds are typically made by a sharp object such as a knife. This description is taken from the autopsy report of Nicole Brown Simpson and describes the fatal injury."
a[221] = f + "(A) Incorrect. The bypass surgery is for a natural disease--atherosclerosis, and death is a known complication of such surgery."
a[222] = f + "(B) Incorrect. Alzheimer disease is a natural condition and bronchopneumonia a common immediate cause of death for neurologic disease."
a[223] = f + "(C) CORRECT. Such sudden and unexpected deaths need to be investigated to rule out a non-natural manner of death."
a[224] = f + "(D) Incorrect. Sexually transmitted diseases are considered natural events."
a[225] = f + "(E) Incorrect. This is a remote, but possible complication of surgery for a disease condition."
a[226] = f + "(A) Incorrect. Such hemorrhage is not common in adults, but may occur when blood from a ruptured intracranial aneurysm dissects into the ventricular system, and this is an acute event."
a[227] = f + "(B) CORRECT. The cerebral atrophy in older adults exposes the bridging veins beneath the dura to injury from trauma, with tearing and hematoma formation. A subdural bleed can form and organize over a long period of time."
a[228] = f + "(C) Incorrect. Rhinocerebral mucormycosis most often complicates diabetic ketoacidosis."
a[229] = f + "(D) Incorrect. Such a laceration is uncommon, but is an acute event."
a[230] = f + "(E) Incorrect. Epidural hematomas, from middle meningeal artery bleeding, may have a 'lucid' phase of a few hours, but are acute events."
a[231] = f + "(A) CORRECT. NEVER put this term on the first line, as it is meaningless for the purposes of certifying the death. A disease condition should be listed."
a[232] = f + "(B) Incorrect. This is a common immediate cause of death and describes a disease process."
a[233] = f + "(C) Incorrect. This is a common immediate cause of death and describes a disease process."
a[234] = f + "(D) Incorrect. This can be an immediate cause of death for a baby born prematurely."
a[235] = f + "(E) Incorrect. This can be an immediate cause of death for an immunocompromised person."
a[236] = f + "(A) Incorrect. Group B streptococcal infections can present suddenly, but typically at or no more than a few days after birth."
a[237] = f + "(B) Incorrect. Congenital conditions are typically manifest in the neonatal period, which is why SIDS is defined at more than 1 month of age."
a[238] = f + "(C) Incorrect. Vitamin C deficiency could lead to anemia and poor wound healing, but not likely demise so acutely."
a[239] = f + "(D) CORRECT. SIDS is sudden, and there are no anatomic findings. Of course, suffocation could be made to look like SIDS, so it would be necessary to interview persons present at the time of death."
a[240] = f + "(E) Incorrect. Inborn errors of metabolism can present after birth, but the infants typically have a protracted course of illness."
a[241] = f + "(A) Incorrect. Diabetes mellitus does not predispose to greater injury to the liver from acetaminophen toxicity."
a[242] = f + "(B) CORRECT. Chronic ethanolism depletes glutathione and induces cytochrome p450, which increases the potential for toxic liver injury from acetaminophen ingestion, via production of N-acetyl-p-benzoquinone imine (NAPQI)."
a[243] = f + "(C) Incorrect. Nicotine does not potentiate toxic liver injury from acetaminophen."
a[244] = f + "(D) Incorrect. Blunt injury to the abdomen can produce liver lacerations and hemoperitoneum, but not liver enzyme elevations to the degree seen here."
a[245] = f + "(E) Incorrect. Depression can be a risk for suicidal ingestion of drugs such as acetaminophen, but most cases of acetaminophen toxicity are accidental. If he were depressed, it is unlikely he would have been partying all night."
a[246] = f + "(A) Incorrect. Chronic arsenic poisoning can lead to squamous cell carcinoma of the skin."
a[247] = f + "(B) CORRECT. Carbon monoxide binds to hemoglobin over 200 times more avidly than oxygen, so even small amounts in the environment can lead to fatal poisoning. A blood sample must be taken to determine the CO level. Poorly vented or unvented heating devices within the home are most often the cause."
a[248] = f + "(C) Incorrect. Lead poisoning can produce acute 'lead coli' with abdominal pain, renal failure, and CNS effects."
a[249] = f + "(D) Incorrect. Methyl salicylate is 'oil of Wintergreen' and similar to acetyl salicylic acid (aspirin) can lead to metabolic acidosis."
a[250] = f + "(E) Incorrect. Organophosphate insecticides are acute neurotoxins from inhibition of acetylcholinesterase."
a[251] = f + "(A) Incorrect. Inhalation of radon gas has no immediate effects. The long-term effect is the contribution to the development of lung cancer."
a[252] = f + "(B) Incorrect. Asbestos exposure can contribute to the development of interstitial lung disease, and it increases the risk for lung cancer in smokers."
a[253] = f + "(C) Incorrect. Ozone is found in increasing amounts in cities as a pollutant, but it has no serious effects. It contributes to respiratory distress in persons with lung disease."
a[254] = f + "(D) CORRECT. Organophosphate poisoning can be very subtle, with findings of 'SLUDGE' standing for salivation, lacrimation, urinary incontinence, defecation, gastrointestinal changes, emesis, and miosis. Organophosphates inhibit acetylcholinesterase to produce the cholinergic findings."
a[255] = f + "(E) Incorrect. Lead exposure produces neuropathy and obtundation, as well as anemia."
a[256] = f + "(A) Incorrect. DIC can be an obstetrical complication, but usually occurs following some disaster, such as infection, bleeding, or retained dead fetus."
a[257] = f + "(B) Incorrect. A choriocarcinoma is unlikely to be present with a normal term birth, and choriocarcinoma arising following a normal pregnancy is rare. Neoplasms don't cause death this quickly."
a[258] = f + "(C) Incorrect. This would be unusual at her age, though she could have hypotension and shock with marked blood loss that could cause ischemic injury."
a[259] = f + "(D) CORRECT. This is a rare, but serious, complication seen in term births. The amniotic fluid gains access to uterine veins at the time of delivery and is conducted to the lungs."
a[260] = f + "(E) Incorrect. If she had suffered a pulmonary embolism, she would have to survive a day or two to develop an infarction."
a[261] = f + "(A) Incorrect. Though there can be dust and debris from a blast, there is no lack of oxygen and no significant amount of toxic gases."
a[262] = f + "(B) CORRECT. 'Precision bombing' is an oxymoron which, when combined with a chronic inability of most politicians to think things through, leads to disasters. Blast injuries, like many physical force injuries, produce extensive contusions with multiple organ injuries."
a[263] = f + "(C) Incorrect. Of course, this defines death but says nothing about causation."
a[264] = f + "(D) Incorrect. Blasts such as this one are designed to produce injury at a distance."
a[265] = f + "(E) Incorrect. Though it may be acceptible in the media to say that someone 'died of fright' this rarely happens. Underlying diseases, however, may put survivors at risk."
a[266] = f + "(A) Incorrect. Animal bites are more likely to produce irregular lacerations or punctures."
a[267] = f + "(B) Incorrect. Falls typically produce blunt injuries with contusions or abrasions."
a[268] = f + "(C) CORRECT. These wounds are very suggestive of 'defensive' wounds by the victim of an assailant with a sharp weapon such as a knife that produces incised wounds."
a[269] = f + "(D) Incorrect. With both hands? Abused persons, however, may offer improbable explanations."
a[270] = f + "(E) Incorrect. With both hands? Abused persons, however, may offer improbable explanations."
a[271] = f + "(A) Incorrect. HMD of the newborn occurs with prematurity, typically for births less than 34 weeks gestation, because of the lack of surfactant with pulmonary immaturity."
a[272] = f + "(B) Incorrect. CMV can be a congenital infection, but the manifestations, which are often the result of brain involvement, should be apparent at birth."
a[273] = f + "(C) Incorrect. This form of congenital heart disease leads to cyanosis that should be evident from birth."
a[274] = f + "(D) Incorrect. An adrenal neuroblastoma is a pediatric neoplasm that can be congenital or appear in childhood. It is unlikely to lead to sudden death."
a[275] = f + "(E) CORRECT. The events suggest sudden infant death syndrome (SIDS). The exact cause is not known, and there are no significant gross or microscopic autopsy findings, though in many cases there is a history of a recent respiratory infection. One theory holds that infants developing SIDS have abnormalities of serotonergic neural pathways involving arousal centers in the medulla oblongata of the brain stem. A respiratory tract stressor may put vulnerable infants at risk."
a[276] = f + "(A) Incorrect. She has extensive partial thickness burns, and involvement of the head and neck region is worse."
a[277] = f + "(B) Incorrect. The lower extremities are not as critical as other areas such as the head and neck, in terms of burn involvement."
a[278] = f + "(C) CORRECT. Older persons are at greater risk for morbidity and mortality from burns. The extent of her burns is great, and the presence of burns on her head and neck is more ominous. However, she does not have an inhalation injury as determined at bronchoscopy."
a[279] = f + "(D) Incorrect. Older persons are less able to withstand burn injuries and recover from them."
a[280] = f + "(E) Incorrect. These are extensive burns, particularly for an older person."
a[281] = f + "(A) Incorrect. Cyanide produces very rapid poisoning through disruption of cellular metabolism via the cytochrome p450 pathway."
a[282] = f + "(B) Incorrect. Mercury poisoning produces nervous system injury that occurs over a long period of time."
a[283] = f + "(C) Incorrect. Ethanol is the antidote for methanol poisoning, since it competes for detoxification by alcohol dehydrogenase."
a[284] = f + "(D) Incorrect. Organophosphate insecticides act very quickly."
a[285] = f + "(E) CORRECT. Methanol is metabolized by the same enzymatic pathway as ethanol, but the toxic metabolites formaldehyde and acetaldehyde are produced which damage the CNS and the retina."