By referring to the attached autopsy, I

By referring to the attached autopsy, I need ti answer the following questions: 1. What would you certify as the cause of death on a death certificate? (Please adopt the format of the death certificate (i.e. Part I, Part II) when presenting your cause of death.); 2. What do you think the manner of death might be?; 3. What additional information do you require before you are confident that you know the cause of death? 4. Has the autopsy assisted in the determination of the cause of death and, if so, how? AUTOSPY: RECENT INJURIES Scanty abrasions are present on the front of both knees. OLD OR HEALING INJURIES Nil significant. NTERNAL EXAMINATION Cardiovascular System: Heart (480g): is enlarged. Pericardial sac: the pericardium contains a large amount of fresh blood and blood clot, approximately 350mls. Atria: normal; contain no thrombus. Right ventricle: normal in configuration and thickness. Left ventricle: dilated and in addition, shows moderate symmetrical hypertrophy. An acute yellowish transmural infarct is present on the upper aspect of the posterior wall. Through this there is a ragged spontaneous rupture. Valves: normal. Coronary arteries: have a normal distribution with left sided dominance. The coronary ostia occupy a normal anatomical position and are widely patent. The left main coronary artery is widely patent. The left anterior descending coronary artery proximally shows moderate narrowing due to atheroma but more distally is widely patent. The right coronary artery is small and shows moderate f ocal atheroma. The left circumflex coronary artery is widely patent, however the posterior descending artery is almost totally occluded at its origin due to concentric atheroma. There is no indentifiable thrombosis. Aorta: shows moderate atheroma. Carotid arteries: widely patent with no significant atheroma. Venae cavae: normal. Renal arteries: widely patent with no significant atheroma. Pulmonary vessels: no thrombo-emboli. Other vessels: unremarkable. Mediastinum: normal. Respiratory System: Hyoid bone and laryngeal cartilages: intact. Larynx: normal. Soft tissues of neck: uninjured and healthy. Trachea and main bronchi: unobstructed and free from disease. Pleural cavities: no adhesions or free fluid. Lungs (right 1,150g; left 740g): both lungs are markedly congested and oedematous but otherwise unremarkable. There is no evidence of pneumonia, neoplasia or aspiration of gastric contents. Hilar lymph nodes: unremarkable. Digestive System: Tongue: no trauma. Mouth: unremarkable. Tonsils: normal. Pharynx: normal. Oesophagus: normal. Peritoneal cavity: unremarkable; no excess of fluid and no adhesions. Stomach: healthy mucosa and wall. Stomach contents: scanty bile stained fluid only. Duodenum: normal. Small intestine: normal. Large intestine: normal. Contents of bowel: normal; no bleeding. Appendix: present. Rectum: normal. Liver (2,100g): normal externally, however, on sectioning shows mild passive venous congestion. Gall bladder: contains clear bile. There are no gall stones. Bile ducts: healthy and unobstructed. Pancreas: unremarkable. Genito-urinary System: Kidneys (right 210g; left 220g): the capsules strip with ease revealing fine cortical scarring . Ureters: unremarkable. Bladder: empty. Internal genitalia: the prostate shows moderate nodular enlargement. Gonads: unremarkable. External genitalia: unremarkable. The penis is not circumcised. Lymphatic System: Spleen (360g): healthy externally and on section. Cervical lymph nodes: unremarkable. Mediastinal lymph nodes: unremarkable. Mesenteric lymph nodes: unremarkable. Para-aortic lymph nodes: unremarkable. Peripheral lymph nodes: unremarkable. Thymus: not recognisable. Vertebral bone marrow: not examined. Endocrine System: Parathyroids: unremarkable. Thyroid: unremarkable. Adrenals: unremarkable. Pituitary: unremarkable. Cranium and Nervous System: Scalp: not injured. Skull: no fracture. Middle ears: exposed but not opened. No apparent abnormality. Air sinuses: not opened. Meninges: no epidural, subdural or subarachnoid haemorrhage. Cranial vessels: have a normal anatomical distribution with no aneurysmal dilatation and no significant atheroma. Brain (1,400g): no contusions. No significant uncal or tonsillar herniation. Serial coronal sections of the cerebral hemispheres at 1 cm intervals reveal no old or recent pathological changes. The cerebellum and brain stem appear unremarkable. Spinal cord: not examined. Peripheral nerves: where exposed during routine dissection, unremarkable. Musculo-skeletal System: Spinal column: no visible fractures. Limb girdles: no visible fractures. Long limb bones: no fracture evident externally or on palpation. Hands and feet: no fractures evident externally or on palpation. Ribs/sternum: the right 3rd t hrough to 8th ribs and the left 2nd through to 6th ribs are fractured anteriorly with no evidence of intravital bruising. General condition of skeleton: normal for age. Muscles: where exposed during routine dissection, unremarkable. SAMPLES A range of routine tissue samples have been retained for histology. No other organs retained. TOXICOLOGY No specimens were taken.

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