Asphyxia: vagal inhibition in hanging: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Asphyxia: vagal inhibition in hanging

Sample item

A man is found hanged with a very slight ligature mark that shows a vital reaction on histology, a pale face, no petechiae and no cyanosis. He was previously healthy and there is no cardiac pathology. What is the best explanation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Reflex cardiac arrest from carotid sinus stimulation (vagal inhibition)

Sudden pressure on the carotid sinus or laryngeal nerves can cause reflex vagal bradycardia or asystole in seconds. Death occurs before venous congestion develops, so classical asphyxial signs are minimal or absent. The finding does not exclude hanging as the cause.

Option by option

  • A. Death from cervical spine fracture

    Cervical fracture is uncommon in short-drop suicidal hanging.

  • B. Death occurred before the ligature was applied

    A vital ligature reaction suggests antemortem hanging, so post-mortem suspension is not suggested by these findings alone.

  • C. Reflex cardiac arrest from carotid sinus stimulation (vagal inhibition) (correct)

    Correct. Vagal inhibition causes immediate death with few asphyxial signs.

  • D. Slow asphyxia over many minutes

    Slow asphyxia would produce marked congestion, cyanosis and petechiae.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Forensic Medicine questions

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Reflex cardiac arrest from carotid sinus stimulation (vagal inhibition). Sudden pressure on the carotid sinus or laryngeal nerves can cause reflex vagal bradycardia or asystole in seconds.

Why is "Death from cervical spine fracture" not the answer?

Cervical fracture is uncommon in short-drop suicidal hanging.

Why is "Death occurred before the ligature was applied" not the answer?

A vital ligature reaction suggests antemortem hanging, so post-mortem suspension is not suggested by these findings alone.

Why is "Slow asphyxia over many minutes" not the answer?

Slow asphyxia would produce marked congestion, cyanosis and petechiae.

What concept does this question test?

It tests Asphyxia: vagal inhibition in hanging in Forensic Medicine. Death occurs before venous congestion develops, so classical asphyxial signs are minimal or absent. The finding does not exclude hanging as the cause.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Asphyxia: vagal inhibition in hanging?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.