Practice Test Geeks(ABFM) American Board of Forensic Medicine Certification Practice Test
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Toxicology and Cause of Death Analysis Flashcards

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  1. A skeleton is submitted for toxicology. Which tissue offers the best opportunity to detect heavy metal poisoning decades after death?

    Answer: Cortical bone

    Cortical bone retains heavy metals such as lead, arsenic, and mercury for decades to centuries, making it the preferred tissue for historical toxicological analysis of skeletal remains.

  2. Organophosphate pesticide poisoning is confirmed by demonstrating:

    Answer: Depressed cholinesterase activity in blood

    Organophosphates irreversibly inhibit both acetylcholinesterase (RBC) and pseudocholinesterase (plasma), so depressed activity in both confirms exposure.

  3. During a mass fatality incident involving possible cyanide release, which rapid bedside test result is most consistent with cyanide toxicity?

    Answer: Low venous oxygen saturation with high arterial PaO2 and high lactate

    Cyanide blocks cytochrome c oxidase, preventing cellular oxygen utilization; venous blood remains highly oxygenated while arterial O2 is normal, combined with severe lactic acidosis.

  4. A 'body packer' dies in custody. Autopsy reveals ruptured cocaine-filled latex packets in the GI tract. The cause of death is best attributed to:

    Answer: Acute cocaine toxicity from massive absorption after rupture

    Rupture of cocaine packets results in rapid massive absorption, producing fatal cocaine toxicity characterized by cardiovascular collapse, arrhythmia, and hyperthermia.

  5. Which postmortem finding most specifically indicates chronic alcohol use rather than acute intoxication at time of death?

    Answer: Fatty change of the liver (hepatic steatosis) on histology

    Hepatic steatosis (fatty liver) is a histologic marker of chronic alcohol use, whereas elevated blood and vitreous ethanol only confirm recent ingestion.

  6. A toxicology report returns a blood fentanyl level of 8 ng/mL. The medical examiner must also consider which variable before attributing death solely to fentanyl?

    Answer: Presence of other CNS depressants, tolerance status, and postmortem redistribution

    Fentanyl lethality must be contextualized by co-ingested depressants that potentiate toxicity, degree of opioid tolerance, and the extent of postmortem redistribution from patch or tissue depots.

  7. In a child death investigation with suspicion of salt poisoning (hypernatremic homicide), which specimen and threshold best confirms the diagnosis?

    Answer: Vitreous humor sodium >155 mEq/L with no medical explanation for hypernatremia

    Vitreous sodium above 155 mEq/L, resistant to postmortem changes and without a physiological explanation, is the accepted forensic threshold for diagnosing fatal hypernatremia.