Thanatology: sudden death in young athletes: 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 · Thanatology: sudden death in young athletes

Sample item

A 17-year-old collapses and dies during a sprint. The heart is otherwise normal, but the left coronary artery arises from the right aortic sinus and passes between the aorta and the pulmonary trunk. What is the most likely mechanism of death?

AVentricular fibrillation from a blow to the chestBExertional myocardial ischaemia with arrhythmia from compression of the anomalous arteryCDynamic outflow obstruction from septal hypertrophyDRupture of the aortic root

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

The answer and the reasoning

B. Exertional myocardial ischaemia with arrhythmia from compression of the anomalous artery

An anomalous left coronary artery arising from the right sinus is squeezed between the great vessels during exertion, causing ischaemia and fatal arrhythmia. The heart may look normal otherwise. It is a recognised cause of sudden death in young athletes.

Option by option

A. Ventricular fibrillation from a blow to the chest
A blow to the chest is commotio cordis and no such blow is described.
B. Exertional myocardial ischaemia with arrhythmia from compression of the anomalous artery (correct)
Correct. Compression of the anomalous artery between the great vessels during exertion causes ischaemia.
C. Dynamic outflow obstruction from septal hypertrophy
Outflow obstruction belongs to hypertrophic cardiomyopathy, which this heart does not show.
D. Rupture of the aortic root
Aortic root rupture is not suggested by a structurally normal aorta.

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 B, Exertional myocardial ischaemia with arrhythmia from compression of the anomalous artery. An anomalous left coronary artery arising from the right sinus is squeezed between the great vessels during exertion, causing ischaemia and fatal arrhythmia.

Why is "Ventricular fibrillation from a blow to the chest" not the answer?

A blow to the chest is commotio cordis and no such blow is described.

Why is "Dynamic outflow obstruction from septal hypertrophy" not the answer?

Outflow obstruction belongs to hypertrophic cardiomyopathy, which this heart does not show.

Why is "Rupture of the aortic root" not the answer?

Aortic root rupture is not suggested by a structurally normal aorta.

What concept does this question test?

It tests Thanatology: sudden death in young athletes in Forensic Medicine. The heart may look normal otherwise. It is a recognised cause of sudden death in young athletes.

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 Thanatology: sudden death in young athletes?

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.