Examples of

➢ Medical Certificate of Cause of Death (MCCD)

Dept of Forensic Medicine,

MGIMS Sewagram.

1
Case:
➢ A man aged 88 years suffered sudden loss of the use of his
right arm and leg. Following a neurological examination by
you (as the attending doctor) a clinical diagnosis of stroke
(Cerebral thrombosis) was made. He was subsequently
confined to bed for 7 days, and lay there showing few signs
of improvement. Thereafter, he began to cough, became
feverish, and additional sounds could be heard on
auscultation of his chest indicating that he had developed
pneumonia. He died 48 hours later. His medical history
showed that he also suffered from benign prostatic
hyperplasia. 2
MCCD:
Interval
between
onset & Death
I (a) Pneumonia 48 Hours
Immediate Cause
Due to (or as a consequence of )
Antecedent cause (b) -------------……
Due to (or as a consequence of )
UCOD (Underlying (c) Stroke (Cerebral 9 Days
cause of death) thrombosis)
II
Other significant Nil
conditions
3
➢ A man aged 73 years, living on his own, is admitted to
hospital with severe lower abdominal pain. Abdominal
examination revealed a large, tense, fluid-filled swelling. An
enlarged prostate was found on rectal examination. A
diagnosis of urinary retention resulting from benign
prostatic hyperplasia is made. Despite treatment, the man
developed uraemia on 7th day of admission and died
thereafter around 8 days later.

4
MCCD:
Interval
between
onset & Death
I (a) Uraemia
Immediate Cause 8 days
Due to (or as a consequence of )
Antecedent cause (b) Urinary retention
15 days
Due to (or as a consequence of )
UCOD ….. (c) Benign prostatic
Unknown
hyperplasia

II
Other significant
Nil
conditions
5
➢ A 70-year-old man dies from cerebral
haemorrhage 3 days after its onset. This resulted
from secondary hypertension, which he had for the
last year. The hypertension was secondary to
chronic pyelonephritis, which he had for the last 2
years. He had also had a prostatic adenoma for
the last 5 years.
6
Cause of death:

Interval
between
I
Immediate
(a) Cerebral haemorrhage 3 days
Cause Due to (or as a consequence of )
Antecedent (b) Hypertension 1 year
cause
Due to (or as a consequence of )
(c) Chronic pyelonephritis 2 years
Antecedent
cause Due to (or as a consequence of )
UCOD (d) Prostatic adenoma 5 years
II Other
significant
conditions
7
➢ A 60-year-old hypertensive patient was admitted to the
surgical casualty ward with severe abdominal pain and
vomiting. Two weeks before the admission she was
diagnosed as having strangulated femoral hernia with a
bowel perforation. On the day of admission, she underwent
surgery to release the hernia and to resect the intestine,
with an end-to-end anastomosis. Two days after the
surgery she developed signs of peritonitis and she died 2
days after the development of these signs.
8
Cause of death:

Interval
between
I
Immediate
(a) Peritonitis 2 days
Cause Due to (or as a consequence of )
Antecedent (b) --------
cause
Due to (or as a consequence of )
(c) 2 weeks 4
Strangulated femoral
hernia with bowel days
UCOD
perforation

II Other
significant Unknown
Hypertension
conditions
9
➢ A 58-year-old man presented at a clinic with a long history
of haemoptysis and weight loss. The diagnosis was
advanced pulmonary tuberculosis, reactivation type with
cavitations, perhaps of 8 years duration. The patient also
suffered from generalised arteriosclerosis, probably of long
duration. Immediately after the admission, the patient had
an acute and massive pulmonary haemorrhage and died
about 10 hours later.

10
Cause of death:

Interval
between
I
Immediate
(a) Pulmonary hemorrhage 10 hours
Cause Due to (or as a consequence of )
Antecedent (b) --------
cause
Due to (or as a consequence of )

UCOD (c) Advanced pulmonary 8 Years

tuberculosis

II Other
significant Unknown
Generalized arteriosclerosis
conditions
11
34 years old female met an accident while crossing
the road and dashed by a car and had a blunt injury to
abdomen 2 hours back before admission to hospital.
Patient was admitted to the hospital in shock.
Investigations and further management reveled that
patient had hemoperitoneum (around 2 lit blood) due
to laceration of liver with corresponding contusion on
abdomen. Patient died 3 hour after admission.
12
Cause of death:

Interval
between
I Hemorrhagic shock/
Immediate
(a) 5 hrs
hemoperitoneum
Cause Due to (or as a consequence of )
Antecedent (b) Due to Laceration of liver 5 hrs
cause
Due to (or as a consequence of )
5 hrs
UCOD (c) Blunt Injury to abdomen

II Other
significant NIL
conditions

13
➢ A lady aged 23 years was admitted to a hospital at
6 pm. She had H/O suicidal burn at around 4 pm
on the same day- because of pouring of kerosene
and burnt herself. O/E patient had 78% burn
(dermo-epidermal). She developed septicemia
after 3 days of admission and died after 5 days of
sustaining burns.
14
Cause of death:

Interval
between
I
Immediate
(a) Septicemic shock 2 days
Cause Due to (or as a consequence of )
Antecedent (b) ……….
cause

Due to (or as a consequence of )

UCOD (c)
Burn 78% (Dermo- 5 days
epidermal)

II Other
significant NIL
conditions 15
➢ An 83 year-old woman was admitted with a fractured hip
after a fall at home 1 hrs back. Her fracture was fixed
internally by an orthopaedic surgeon on the same day of
admission. Six days post-operatively, while under your
care, she collapsed with severe chest pain and shortness
of breath and died 30 min after. Case was informed to
police. As treating Dr has not given COD, police ordered
PM examination. PM examination revealed a pulmonary
embolus and a deep vein thrombosis in the left leg. Her
medical history also revealed that she suffered from
ischaemic heart disease. Prepare MCCD. 16
Cause of death:

Interval
between
I
Immediate
(a) Pulmonary embolus 30 min
Cause Due to (or as a consequence of )
Antecedent (b) deep vein thrombosis in
-----
cause left leg

Due to (or as a consequence of )

UCOD (c) fracture of hip

6 days

II Other
significant ischemic heart disease
conditions 17
➢ A 50-year-old woman was admitted to the hospital
for vomiting of blood and was diagnosed as having
bleeding oesophageal varices. Investigation
revealed portal hypertension with liver cirrhosis.
The woman had a history of hepatitis B infection.
Three days later, she died. Prepare MCCD.

18
Cause of death:

Interval
between
I
Immediate
(a) Bleeding oesophageal varices 3 days
Cause Due to (or as a consequence of )
Antecedent (b) Portal Hypertension
-----
cause
Due to (or as a consequence of )
Antecedent (c) Liver cirrhosis
cause
Due to (or as a consequence of )
------
UCOD---------- (d) Hepatitis B

II Other
significant Nil
conditions 19
➢ A 50-year-old woman came to the hospital with
complain of breathless ness and fever since last 2
days. She was admitted in the hospital and also
tested for Covid 19, which came positive. After two
days of admission, she developed Pneumonia.
After 09 days of admission, she developed acute
respiratory distress syndrome. She died 2 days
thereafter. Prepare MCCD.
20
Cause of death:

Interval
between
I
Immediate
(a) Acute Respiratory 2 days
Cause distress syndrome
Due to (or as a consequence of )
Antecedent (b) Pneumonia 9 days
cause
Due to (or as a consequence of )

UCOD (c) Covid 19 (Confirmed) 14 days

II Other
significant
conditions 21
➢ A man (66 years old) was diabetic since last 15 years and
had been under insulin control for many years. He
developed ischemic heart disease since last 5 years. He
suddenly developed myocardial infarction and died within 7
hours. Treating doctor considered that there is a
relationship between diabetes and ischemic heart disease
and that the heart condition resulted from the long-standing
diabetes. Now prepare MCCD.
22
Cause of death:

Interval
between
I
Immediate
(a) Myocardial Infarction 7 Hours
Cause Due to (or as a consequence of )
Antecedent (b) Chronic Ischemic heart 5 years
cause disease
Due to (or as a consequence of )

UCOD (c) Diabetes Mellitus 15 Years

II Other
significant
conditions
23
➢ A man (66 years old) was diabetic since last 12 years and
had been under insulin control for many years. He
developed ischemic heart disease since last 5 years. He
suddenly developed myocardial infarction and died within 7
hours. Treating doctor considered that there is NO
relationship between diabetes and ischemic heart disease
and that the heart condition developed independently of
the diabetes. Now prepare MCCD.
24
Cause of death:

Interval
between
I
Immediate
(a) Myocardial Infarction 7 Hours
Cause Due to (or as a consequence of )
Antecedent (b) -----------------
cause
Due to (or as a consequence of )

UCOD (c) Chronic Ischemic heart 5 years

disease

II Other
significant Diabetes Mellitus 12 years.
conditions
25
➢ A 56-year-old man dies from acute myocardial infarction
within three hours of its onset. He did not have any other
illnesses. His ECG and cardiac enzyme levels confirmed
the diagnosis. Prepare MCCD.

26
Cause of death:

Interval
between
I
Immediate
(a) ----------------------
Cause Due to (or as a consequence of )
Antecedent (b) -----------------
cause
Due to (or as a consequence of )

UCOD (c) Myocardial Infarction 3 hours.

II Other
significant
conditions
27
➢ A 56-year old person dies from abscess of the lung after
five days, which resulted from lobar pneumonia of the left
lung which the person had since last two weeks. Prepare
MCCD.

28
Cause of death:

Interval
between
I
Immediate
(a) Abscess of Lung 5 days
Cause Due to (or as a consequence of )
Antecedent (b) -----------------
cause
Due to (or as a consequence of )

UCOD (c) Lobar Pneumonia 2 weeks

II Other
significant
conditions
29
A 36-year-old man with chronic alcoholism for 10 years and a previous history
of duodenal ulcers (for three years) was admitted to the hospital with acute
abdominal pain and high fever. Initial chest x-rays showed free air under both
domes of his diaphragm. He was diagnosed with peritonitis from peptic ulcer
perforation. Emergency exploratory laparotomy on his first day of admission
showed a 2cm duodenal ulcer size on the anterior wall of the first part of the
duodenum. Five days later, the patient had high fever with chills, and his
abdominal ultrasound revealed sub-phrenic abscess under the right
diaphragm. A revision exploratory laparotomy was planned. However the
patient suddenly showed signs of septic shock that night, had a sudden
30
cardiac arrest, and died within two hours of septic shock.
Cause of death:

Interval
between
I
Immediate
(a) Septic shock 2 hours
Cause Due to (or as a consequence of )
Antecedent (b) Right subphrenic abscess 1 day
cause
Due to (or as a consequence of )
Antecedent (c) Perforated duodenal ulcer 5 days
cause
Due to (or as a consequence of )
UCOD---------- (d) Duodenal ulcer 3 years

II Other
significant Chronic alcoholism 10 years
conditions 31
A 10 year old boy with a past medical history of Thalassemia for the past 4
years develops severe anemia leading to high output cardiac failure 2 weeks
ago. Four Days back, he developed cough and dyspnea with a respiratory rate
of 44/minute. Chest xray showed lobar pneumonia. Despite antibiotic coverage
and blood transfusion his condition deteriorated and he died.

32
Cause of death:

Interval
between
I
Immediate
(a) Lobar Pneumonia 4 days
Cause Due to (or as a consequence of )
Antecedent (b) High output cardiac failure 2 weeks
cause
Due to (or as a consequence of )
Antecedent (c) severe anemia 2 weeks
cause
Due to (or as a consequence of )
UCOD---------- (d) Thalassemia 4 years

II Other
significant ---------------- ---
conditions 33
A man aged 66 died the 20th of December 1998. He had a history of non-
insulin dependent diabetes mellitus for 15 years. He had a cholecystectomy in
1992 due to biliary lithiasis. Six months before his death he developed diabetic
glomerulosclerosis and 5 days before he suffered acute renal failure followed
by hyperglyemic coma for 3 days causing respiratory arrest.

34
Cause of death:

Interval
between
I
Immediate
(a) Hyperglicaemic coma 3 days
Cause Due to (or as a consequence of )
Antecedent (b) Acute renal failure 5 days
cause
Due to (or as a consequence of )
Antecedent (c) Diabetic glomerulosclerosis 6 months
cause
Due to (or as a consequence of )
UCOD---------- (d) Non insulin dependent 15 years
diabetes
II Other
significant ---------------- ---
conditions 35
A 73-year old woman with known Alzheimer’s disease for about 15 years had
recurrent bouts of aspiration pneumonia and finally died in a hospital after few
weeks.

36
Cause of death:

Interval
between
I
Immediate
(a) Aspiration pneumonia Weeks
Cause Due to (or as a consequence of )
Antecedent (b) -----------------
cause
Due to (or as a consequence of )

UCOD (c) Alzheimer’s Disease 15 years

II Other
significant
conditions
37
A 92-year-old male was found dead in bed. He had no significant medical
history. Autopsy disclosed minimal coronary disease and generalized atrophic
changes commonly associated with aging. No specific cause of death was
identified. Toxicology was negative.

38
Cause of death:

Interval
between
I
Immediate
(a) ……………….. ……….
Cause Due to (or as a consequence of )
Antecedent (b) ----------------- ……………
cause
Due to (or as a consequence of )

UCOD (c) Undetermined natural Unknown

cause
II Other
significant
conditions
39
A boy aged 18 months died from a bacterial pneumonia caused by
Haemophilus influenzae that he had been suffering for two days. The
pneumonia intervened after measles which he contracted 7 days before death.

40
Cause of death:

Interval
between
I
Immediate
(a) Bacterial pneumonia 2 days.
Cause (Haemophilus influenzae)
Due to (or as a consequence of )
Antecedent (b) ----------------- ……………
cause
Due to (or as a consequence of )

UCOD (c) Measles 1 week

II Other
significant
conditions
41
A woman of 59 died of asphyxia following inhalation of vomitus some hours
after suffering a cerebellar haemorrhage. Three years before she had been
diagnosed to having an adrenal adenoma with aldosteronism, which
manifested itself as hypertension. Congestive heart failure was also present.

42
Cause of death:
Interval
I
Immediate
(a) Asphyxia by vomitus Minutes
Cause Due to (or as a consequence of )
Antecedent (b) Cerebellar hemorrhage Hours
cause Due to (or as a consequence of )
Antecedent (c) Hypertension About 3 years
cause Due to (or as a consequence of )

Antecedent (d) Aldosteronism 3 years plus

cause
3 years plus
UCOD---------- (e) Adrenal adenoma
II Other
Congestive heart failure 3 yrs plus
43
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