Asphyxial deaths: cold-water submersion in children: 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 · Asphyxial deaths: cold-water submersion in children

Sample item

A 4-year-old is pulled from a frozen pond after being under the ice for about 25 minutes. She has no pulse and her pupils are fixed and dilated. Why should resuscitation be continued and not abandoned?

AFixed dilated pupils in drowned children always recover with warmingBCold water stimulates spontaneous breathing after submersionCProfound hypothermia protects the brain, so recovery is possibleDIce prevents water entering the lungs, so there is no hypoxia

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

The answer and the reasoning

C. Profound hypothermia protects the brain, so recovery is possible

Rapid cooling in icy water lowers cerebral metabolism and oxygen demand, so some children survive intact after prolonged submersion. Resuscitation should therefore continue until the child is rewarmed, and death is declared only when the core temperature is near normal. Fixed pupils are unreliable in a cold patient.

Option by option

A. Fixed dilated pupils in drowned children always recover with warming
Pupil signs are unreliable in hypothermia, but they do not always recover.
B. Cold water stimulates spontaneous breathing after submersion
Cold water does not cause the heart or breathing to restart.
C. Profound hypothermia protects the brain, so recovery is possible (correct)
Correct. Hypothermia reduces brain oxygen needs and extends the survival time.
D. Ice prevents water entering the lungs, so there is no hypoxia
Water still enters the airway and hypoxia still occurs in cold-water drowning.

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.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Profound hypothermia protects the brain, so recovery is possible. Rapid cooling in icy water lowers cerebral metabolism and oxygen demand, so some children survive intact after prolonged submersion.

Why is "Fixed dilated pupils in drowned children always recover with warming" not the answer?

Pupil signs are unreliable in hypothermia, but they do not always recover.

Why is "Cold water stimulates spontaneous breathing after submersion" not the answer?

Cold water does not cause the heart or breathing to restart.

Why is "Ice prevents water entering the lungs, so there is no hypoxia" not the answer?

Water still enters the airway and hypoxia still occurs in cold-water drowning.

What concept does this question test?

It tests Asphyxial deaths: cold-water submersion in children in Forensic Medicine. Resuscitation should therefore continue until the child is rewarmed, and death is declared only when the core temperature is near normal. Fixed pupils are unreliable in a cold patient.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Asphyxial deaths: cold-water submersion in children?

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.