Autopsy and Forensic Pathology
Core concepts
Understand the purposes of pediatric autopsy: cause of death, identification of heritable disease, quality assurance, and family counseling. Know the techniques-external and internal examination, organ weights and measurements, radiography, and ancillary studies (microbiology, genetics, toxicology). Recognize sudden unexpected infant death categories, including SIDS and its diagnostic criteria, and the importance of scene investigation and death-scene reenactment.
Forensic issues include non-accidental trauma (child abuse), with patterns such as metaphyseal corner fractures, retinal hemorrhage, and patterned injuries. Understand the role of the pathologist in documenting and distinguishing accidental from inflicted injury, and the importance of chain of custody.
Traps
Examiners test SIDS as a diagnosis of exclusion-it requires a complete autopsy, scene review, and history. Another trap: attributing retinal hemorrhage solely to abuse without considering other causes. Do not overinterpret postmortem changes as injury.
Worked example / rule of thumb
An infant found unresponsive with no autopsy findings, a safe sleep environment, and negative ancillary studies: SIDS. Rule of thumb: "No SIDS diagnosis without scene, history, and autopsy; abuse = pattern + age + explanation mismatch."
Laboratory Management and Quality Assurance
Core concepts
Understand quality systems: preanalytic, analytic, and postanalytic error sources; internal quality control vs external proficiency testing; and the role of accreditation. Know performance metrics-turnaround time, critical value reporting, and delta checks. Grasp statistical process control (Levey-Jennings charts, Westgard rules) and how shifts and trends are detected.
Pediatric-specific management issues include small-volume testing, point-of-care testing, and reference-interval validation across age groups. Understand competency assessment, document control, and root-cause analysis for adverse events. Know the principles of laboratory safety and biosafety.
Traps
Examiners test Westgard rule interpretation-e.g., 1-3s as a rejection rule vs 2-2s as a warning/rejection depending on context. Another trap: confusing quality control (internal) with proficiency testing (external). Also, do not assume a single out-of-range control mandates patient result rejection without investigating the rule violated.
Worked example / rule of thumb
Two consecutive control values exceed 2 SD on the same side: apply the 2-2s rule and investigate before reporting. Rule of thumb: "Most errors are preanalytic; detect shifts with control charts and confirm with defined rules."