WORKSHOP 2

Exercises in Filling out the

Death Certificate
Instructions for Workshop
•Read through each case then fill-in the ‘Cause of Death’
portion of the Medical Certificate provided on this slide.
•After editing this file with your answers, upload it on or
before the deadline.
•I will post the answers after the deadline.
•This is not graded, however your participations in the
workshops will be considered in computing your grades.
SAMPLE CASES
Sample 1 - Medical Case Study

A 75 year-old male had a 10-year history of chronic bronchitis

associated with smoking two packets of cigarettes a day for
more than 40 years. When seen 3 months prior to his terminal
episode, he had significantly reduced FEV1 and FVC with no
response to bronchodilators. He awoke one evening with
shortness of breath. He was taken to the emergency room
where he was found to have an acute exacerbation for
obstructive airway disease. He was admitted to the hospital. At
the patient’s request, no mechanical ventilation was employed,
and he died 12 hours later in respiratory arrest.
 
Sample 1 - Medical Case Study__
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and Interval between
over Death Onset and Death

I. Immediate cause: a.

Antecedent cause: b.

Underlying cause: c.

II. Other significant conditions contributing to

death:
Sample 1 - Medical Case Study ANSWER
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)
19b. CAUSES OF DEATH (if the deceased is aged 8 days and over Interval Between Onset and Death
I. Immediate cause : a. ACUTE EXACERBATION OF CHRONIC
12 HOURS
OBSTRUCTIVE AIRWAYS DISEASE

Antecedent cause : b. CHRONIC BRONCHITIS 10 YEARS

Underlying cause : c. NICOTINE DEPENDENCE MORE THAN 40 YEARS

II. Other significant conditions contributing to death:  

Sample 2 - Pediatric Case Study

A 5 year old malnourished girl was admitted to the ward with

loose stools and vomiting of 4 days duration. On examination,
the child was severely dehydrated and had a high fever.
Further, she was unconscious at the time of admission.
Despite remedial treatment, the patient’s condition did not
improve and she expired within 2 hours after admission. She
was a diagnosed patient with a Ventricular Septal Defect.
Sample 2 - Pediatric Case Study __
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and Interval between
over Death Onset and Death

I. Immediate cause: a.

Antecedent cause: b.

Underlying cause: c.

II. Other significant conditions contributing to

death:
 Sample 2 - Pediatric Case Study ANSWER
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and over Interval Between Onset and Death

I. Immediate cause : a. SEVERE DEHYDRATION HOURS

ACUTE GASTROENTERITIS
Antecedent cause : b. DUE TO MALNUTRITION 4 DAYS

VENTRICULAR SEPTAL
5 YEARS
Underlying cause : c. DEFECT

II. Other significant conditions contributing to death: RS5 YEARS

EXERCISES
Case Study 1 (Medical)
A 75 year old female had a 15 year history of noninsulin-dependent diabetes
mellitus, a 13 year history of mild hypertension treated with thiazide
diuretics, and an uncomplicated myocardial infarction 6 years prior to the
present illness. She was found disoriented in her apartment and brought to
the hospital. On admission, she was noted to be unresponsive without focal
neurological signs, and severely dehydrated with a blood pressure of 90/60.
Initial laboratory tests disclosed severe hyperglycemia, hyper-osmolarity,
azotemia, and mild ketosis without acidosis. A diagnosis of hyperosmolar
nonketotic coma was made.
 
The patient was vigorously treated with fluids, electrolytes, insulin, and
broad spectrum antibiotics, although no source for infection was
documented. Within 72 hours, the patient’s hyperosmolar, hyperglycemic
state was resolved. However, she remained anuric with progressive
azotemia. Attempts at renal dialysis were unsuccessful admission and the
patient dies on the 8th day from admission in severe renal failure.
Case Study 1 (Medical)
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and Interval between
over Death Onset and Death

I. Immediate cause: a. Severe renal failure hours

Hyperosmolar nonketotic coma 8days

Antecedent cause: b.

Uncontrolled Diabetes type 2 6years

Underlying cause: c.

II. Other significant conditions contributing to Myocardial infarction, Hypertension

death:
Case Study 2 (Gynaecological and
Obstetric)
A 24 year old married, nulliparous woman was admitted with severe right
sided abdominal pain of 6 hours duration. She collapsed in the outpatient
department. She looked severely anemic and was resuscitated in the
emergency department. Intravenous fluid replacement was started and
blood was ordered. The history from her husband showed that she had
amenorrhoea for 11 weeks. She had never contacted a health care
professional to confirm a pregnancy.

Ultra sound scan confirmed the clinical suspicion of a ruptured ectopic

pregnancy and she was prepared for surgery. But before the surgery was
performed to arrest internal bleeding, she died of hypovolemic shock after
2 hours of admission.
Case Study 2 (Gynaecological and
Obstetric)
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and Interval between
over Death Onset and Death

I. Immediate a. Hypovolemic shock Few min

cause:

Ruptured ectopic pregnancy 6hrs

Antecedent cause: b.

Underlying cause: c.

II. Other significant conditions contributing to death:

19c. Maternal Condition (if the deceased is female aged 15-49 years old)

__a. pregnant __b. pregnant __c. less than 42 __d. 42 days to 1 __e. None of the
not in labor in labor days after delivery year after delivery choices
Case Study 3 (Surgical)
A 42 year old woman complained about a chronic ulcer in her right foot which she
had for the last 3 months. She also complained of fever and sero-sanguinous
discharge from the ulcer during the last week. Her past medical history also
showed diabetes mellitus type 2 for 8 years.
 
Necrotizing fasciitis was a diagnosis for the admission. Emergency debridement
was performed on the first day of arrival with high doses antibiotics given to her.
Three days later, she still had high fevers, plain film of right foot showed
osteomyelitis fragments of metatarsal bones with air shadow in foot showed
osteomyelitis fragments of metatarsal bones with air shadow in foot tissues. A
second wound exploration revealed abscesses adjacent metatarsal bone which
was drained immediately. One day after the latest operation, she had septic
shock and sudden cardiac arrest with unsuccessful resuscitation.
Case Study 3 (Surgical)__
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and Interval between
over Death Onset and Death

I. Immediate cause: a. Septic Shock 1 day

Necrotizing fasciitis with abscess if the right foot 1 week

Antecedent cause: b.

Chronic ulcer, right foot 3 months

Underlying cause: c.

II. Other significant conditions contributing to Diabetes Mellitus Type 2

death:
Case Study 4 (Cancer)

A 68 year old man was admitted to the hospital with right lower
quadrant pain of one month duration. He complained of recent loss of
body weight, loss of appetite and malaise over the same period of time.
On examination, he looked ill and wasted. Examination of the abdomen
showed that he had an enlarged liver 4 cm below the costal margin.
Needle biopsy of the liver showed hepato-cellular carcinoma so the
patient was started on chemotherapy. He was regularly followed up
during the therapy at the clinic. One month after the initial diagnosis,
reduction of his liver functions were observed. Since he had developed
deep vein thrombosis of his left thigh he was readmitted to the hospital.
Five days after the admission, he developed severe pulmonary
embolism and died within 30 minutes of onset.
Case Study 4 (Cancer) __
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and Interval between
over Death Onset and Death

I. Immediate cause: a. Sever pulmonary embolism 30 mins

Deep vein thrombosis 5 days

Antecedent cause: b.

Primary hepatocellular carcinoma 1 month

Underlying cause: c.

II. Other significant conditions contributing to

death:
Case Study 5 (Pediatric)

This 11 year old boy was brought to the emergency

treatment unit with uncontrollable fits. All attempts to
resuscitate the patient at the facility failed as the child
has aspirated large amount of his gastric contents at
the time of admission. The patient expired within a few
minutes after admission. He was a diagnosed case of
grand mal epilepsy for the last 2 years with poor
compliance.
Case Study 5 (Pediatric)
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish items 14-19a at the back)

19b. CAUSES OF DEATH (if the deceased is aged 8 days and Interval between
over Death Onset and Death

I. Immediate cause: a. Asphyxia by vomitus Few minutes

Aspiration of gastric content 2 years

Antecedent cause: b.

Grand mal epilepsy

Underlying cause: c.

II. Other significant conditions contributing to

death:
Case Study 6 (Perinatal Death Case)
A 27 year old woman was admitted to the hospital at 37th week of
gestation with severe abdominal pain. During her antenatal visits, she
has had hypertension. On admission, her blood pressure was 150/100
mmHg and she had slight vaginal bleeding with normal fetal heart
sounds. Fetal heart sounds were continuously monitored and they
became sluggish and irregular indicating fetal distress. Subsequently
the mother was hypotensive with tachycardia. Presumptive diagnosis of
abruptio placenta was suspected and the mother was brought to the
operating room for emergency caesarean section. The baby was
stillborn and the mother was transferred to intensive care unit following
surgery. She recovered and was sent home 10 days following surgery.
Perinatal Case: Group __
MEDICAL CERTIFICATE
FOR CHILDREN AGED 0 TO 7 DAYS
14. AGE OF MOTHER: 15. METHOD OF DELIVERY (Normal, spontaneous vertex, if 16. LENGTH OF
27 others, specify) emergency caesarean section PREGNANCY (in completed weeks)
37weeks of gestation
17. TYPE OF BIRTH (Single, Twin, Triplet, etc.) 18. IF MULTIPLE BIRTH, CHILD WAS (First, Second, Third, etc.)
single

19a. CAUSES OF DEATH

Intrauterine hypoxia
a. Main disease/condition of fetus

Fetal distress
b. Other diseases/conditions of fetus

Abruptio placenta
c. Main maternal disease/condition affecting fetus

Maternal hypertension
d. Other maternal diseases/ conditions affecting fetus

e. Other relevant conditions

Congratulations for finishing the workshop!

END OF WORKSHOP