ABFM Case Analysis & Practical Application 2 — Questions and Answers
Question 1: A 34-year-old male is found dead in a locked apartment with a single gunshot wound to the right temple. The weapon is in his right hand and there is gunshot residue on his right palm. Which finding would most strongly suggest homicide rather than suicide?
- Contact wound with muzzle contusion ring
- Hesitation wounds on the left wrist
- Bullet trajectory traveling upward through the skull
- Wound location inconsistent with decedent's reach (Correct answer)
Correct answer: Wound location inconsistent with decedent's reach
A wound location that the decedent could not have self-inflicted based on anatomical reach analysis is the strongest indicator of homicide in gunshot cases.
Question 2: During autopsy of a drowning victim, which internal finding would most support wet drowning (true drowning) over post-mortem submersion?
- Pulmonary edema with frothy fluid in airways
- Cutis anserina (gooseflesh) on the skin
- Washerwoman hands and feet
- Diatoms in lung tissue matching the submersion water (Correct answer)
Correct answer: Diatoms in lung tissue matching the submersion water
Diatoms recovered from lung tissue that match the specific water source confirm active inhalation during drowning, distinguishing true drowning from post-mortem submersion.
Question 3: A forensic pathologist is asked to estimate time of death for a body found outdoors in summer heat. Livor mortis is fixed, rigor mortis is fully resolved, and putrefaction is advanced. Which method is most appropriate?
- Rectal temperature using the Henssge nomogram
- Vitreous potassium level measurement
- Forensic entomology (blow fly succession) (Correct answer)
- Sodium/potassium ratio in cerebrospinal fluid
Correct answer: Forensic entomology (blow fly succession)
In advanced decomposition, forensic entomology using insect succession patterns is the most reliable method for estimating postmortem interval when temperature-based methods are no longer valid.
Question 4: A 6-year-old child presents with multiple bruises in various stages of healing on the torso, bilateral retinal hemorrhages, and subdural hematoma without a history of significant trauma. What is the most likely forensic diagnosis?
- Accidental fall from furniture
- Abusive head trauma (shaken baby syndrome) (Correct answer)
- Osteogenesis imperfecta
- Idiopathic thrombocytopenic purpura
Correct answer: Abusive head trauma (shaken baby syndrome)
The triad of subdural hematoma, retinal hemorrhages, and bruising in different stages with inconsistent history is the classic presentation of abusive head trauma.
Question 5: A forensic expert is evaluating a strangulation death. The neck shows horizontal ligature marks below the thyroid cartilage with upward deviation of the furrow edges. This pattern is most consistent with:
- Homicidal ligature strangulation (Correct answer)
- Suicidal hanging with a typical suspension point
- Atypical hanging with incomplete suspension
- Manual strangulation followed by ligature application
Correct answer: Homicidal ligature strangulation
Horizontal or downward-slanting ligature marks with upward edge deviation are characteristic of homicidal ligature strangulation, unlike the oblique upward furrow seen in hanging.
Question 6: In a mass disaster with fragmented remains, what is the primary reason DNA kinship analysis is preferred over dental comparison when reference ante-mortem dental records are unavailable?
- DNA is always recovered intact from fire victims
- Kinship analysis can identify individuals without prior personal records (Correct answer)
- Dental comparison requires at least 12 matching points
- DNA testing is faster than radiographic comparison
Correct answer: Kinship analysis can identify individuals without prior personal records
DNA kinship analysis using family reference samples can establish identity without the victim's own ante-mortem records, making it invaluable when records are unavailable.
Question 7: A toxicology report shows a blood ethanol concentration of 0.35 g/dL in a decedent found dead in bed. Vitreous ethanol is 0.28 g/dL. What does the vitreous-blood discrepancy most likely indicate?
- Post-mortem ethanol production by putrefaction bacteria in blood (Correct answer)
- Antemortem alcohol consumption followed by absorption still in progress
- Laboratory error requiring repeat testing
- Isopropanol contamination of the blood sample
Correct answer: Post-mortem ethanol production by putrefaction bacteria in blood
A higher blood ethanol than vitreous ethanol post-mortem suggests microbial fermentation in blood elevating the blood level, since vitreous is more protected from bacterial decomposition.
ABFM Case Analysis & Practical Application 2
A 34-year-old male is found dead in a locked apartment with a single gunshot wound to the right temple.
The weapon is in his right hand and there is gunshot residue on his right palm.
Which finding would most strongly suggest homicide rather than suicide?