‫بيانات المبلغ‬ ‫‪:‬بيانات المتوفى‬

‫‪:‬‬ ‫االسم الكامل ‪-‬‬

‫تاريخ و محل ‪-‬‬
‫السم ‪-‬‬ ‫النوع ‪-‬‬
‫القامة‬
‫البطاقة ‪-‬‬
‫محل القيد بالسجل ‪-‬‬ ‫الديانة ‪-‬‬
‫علقته بالمتوفى ‪-‬‬
‫المدنى‬ ‫الجنسية ‪-‬‬
‫عنوان محل القامة ‪-‬‬
‫جهة الوفاة ‪-‬‬ ‫السن ‪-‬‬
‫مكان الوفاة ‪-‬‬ ‫الحالة العائلية ‪-‬‬
‫تاريخ الوفاة ‪-‬‬ ‫العنوان ‪-‬‬
‫البطاقة ‪-‬‬
 ‫‪:‬شهادة الوفاة الطبية‬
‫(‪ )I‬أ‪ :‬السبب المباشر للوفاة ‪:‬‬
‫ب‪ :‬أحوال مرضية أو إصابية إن وجدت نشأ عنها السبب المباشر‬
‫‪:‬للوفاة‬
‫‪:‬ج‪ :‬المرض أو الصابة الصلية‬
‫(‪ )II‬أحوال مرضية إن وجدت ساعدت على حدوث الوفاة و ليس‬
‫لها علقة بالمرض الصلى‪:‬‬
‫إسم الطبيب‬
‫التوقيع‬
‫التاريخ‬
pulmonary embolism:
sever chest pain
hemoptysis
tachycardia
tachypnea
hypotension
and cyanosis.
 An elderly pedestrian was hit from the back
by a car, she sustained bruises of Rt. Leg
.she confined to bed and died after 10 days.
Autopsy showed a massive pulmonary
embolism with thrombosis of the veins of Rt.
Leg.

‫ انحذاف رئوي‬-‫)أ‬2(
‫ جلطة بأوردة الساق‬-‫ب‬
‫ رقاد طويل بالفراش‬-‫ج‬
‫) ل يوجد‬2(
During a quarrel a man has received a
strong blow on the lower part of the
abdomen, he was carried home, next
day he died. on examination the urinary
bladder was found ruptured , inflamed ,
there was general peritonitis.
‫ التهاب بريتوني حاد‬-‫)أ‬2(
‫ انفجار المثانة البولية‬-‫ب‬
‫ ضربة أسفل البطن‬-‫ج‬
‫) ل يوجد‬2(
When an old man who has been
depressed, was not seen for a few days,
his neighbors call for the police. On
breaking his apartment door, he was
found lying on bed and a revolver was
clenched in his Rt. hand .On
examination a gunshot wound was
found on his Rt. Temple.
‫ طلق ناري انتحاري بالرأس‬-‫)أ‬2(
‫ ل يوجد‬-‫ب‬
‫ ل يوجد‬-‫ج‬
A middle-aged woman, who was suffering from
bronchial asthma, was found dead at home dressed
in underclothes. On examination there were discoid
bruises about 1 Cm in diameter and semilunar
abrasions on the front & sides of the neck, internal
examination showed massive contusions of the
neck soft tissue and a fracture of the hyoid bone.

‫ اسفكسيا الخنق باليد‬-‫)أ‬2(

‫ ل يوجد‬-‫ب‬
‫ ل يوجد‬-‫ج‬
‫) الربو الشعبي‬2(
A pregnant female tried to end her
pregnancy. She introduced a douching
nozzle and gushed a large amount of soap
into the uterus. She died suddenly after she
felt a sever chest pain, hemoptysis,
tachycardia, tachypnea, hypotension and
cyanosis.
‫ انحذاف رئوي‬-‫)أ‬2(
‫ محاولة اجهاض‬-‫ب‬
‫ ل يوجد‬-‫ج‬
‫) ل يوجد‬2(
A haemophilic child was playing with fellows
when he was struck on the Lt. temple by a
stick ,he staggered and fell momentarily
concussed , but got to his feet. Next
morning, he was found unconscious,
feverish, there was rigidity on the muscles of
the back of the neck, signs of lateralization
.on his way to hospital he died.
‫ انضغاط بالمخ‬-‫)أ‬2(
)2( ‫هيموفيليا‬
‫ نزيف بالمخ‬-‫ب‬
‫ اصابة بالرأس‬-‫ج‬
 During playing of one baby by a belt he
tied it around his neck .He became
cyanosed, unconscious, his mother tried
to save him by removing the belt but she
failed, and the baby died.
‫ اسفكسيا الخنق بالحبل‬-‫)أ‬2(
‫ ل يوجد‬-‫ب‬
‫ ل يوجد‬-‫ج‬
)2( ‫ل يوجد‬
 During a war an alarm was sounded, people
hurried to the ground floor. a woman fell on
the stairway and people ran over her crushing
her chest & abdomen. On examination, face
& neck were deeply cyanosed with numerous
petechiae over head, neck and shoulders.
‫ اسفكسيا اصابية‬-‫)أ‬2(
‫ ل يوجد‬-‫ب‬
‫ ل يوجد‬-‫ج‬
‫) ل يوجد‬2(
During playing of one baby by a coin, he
aspirated it on his trachea, he become
cyanosed, unconscious. He received treatment
in emergency room but he died. during autopsy,
we found deep blue hypostasis , the right side of
the heart , great vessels were congested, also,
the lung was congested.
‫ اسفكسيا الشرق‬-‫)أ‬2(
‫ ل يوجد‬-‫ب‬
‫ ل يوجد‬-‫ج‬
‫) ل يوجد‬2(
A 20 year old man collapsed during
football practice on a hot humid day
)atmospheric temp. 45( on admission to
hospital, he was comatose, B/P=70/20,
body temperature was 42⁰c with mild
sweating, he developed seizures, died.

‫ ضربة شمس‬-‫)أ‬3(
‫ ل يوجد‬-‫ب‬
‫ ل يوجد‬-‫ج‬
An alcoholic fell on a bare electric wire
and died. No external signs were
found.

‫ صعق كهربي‬-‫)أ‬3(
‫ ل يوجد‬-‫ب‬
‫ ل يوجد‬-‫ج‬
‫) تعاطي الكحول‬2(
A 30 year farmer with bilharzial
splenomegaly & chronic anaemia
was severely shocked after a severe
attack of haematemesis & melena &
died on arrival to hospital.

‫ قيئ دموي‬-‫)أ‬3(
‫ انفجار دوالي المرئ‬-‫• ب‬
‫ تليف كبدي بلهارسي‬-‫• ج‬
‫) انيميا‬2( •
A diabetic man who had been on a
therapy for angina suddenly suffered
from chest pain radiating to the left
arm, dyspnea & sweating. He died on
his way to the hospital

‫ احتشاء بعضلة القلب‬-‫)أ‬3(

‫ قصور في الشرايين التاجية‬-‫• ب‬
‫ تصلب الشرايين‬-‫• ج‬
‫) مرض البول السكري‬2( •
An alcohol addict man was found dead in a
smoke filled room. He had sustained
moderate burns on his right hand. On
examination, skin was red in color, alcohol
level was 100 mg %, and
carboxyhemoglobin level was 80%.

‫ تسمم بغاز أول أكسيد الكربون‬-‫)أ‬3(

‫ ل يوجد‬-‫• ب‬
‫ ل يوجد‬-‫• ج‬
‫) تعاطي الكحول‬2( •
An eight years old boy was knocked
down the road by a speeding motor
vehicle and died on the spot. On
examination bleeding from the ears
was observed.

‫ كسر بقاع الجمجمة‬-‫)أ‬3(

‫ اصابة بالرأس‬-‫ب‬
‫ ل يوجد‬-‫ج‬
1(A middle aged man was driving along a
road , where the car curved and crashed into
a tree, he was found dead at the wheel ,
autopsy revealed fracture ribs , hemothorax,
rupture of the thoracic aorta ,also coronary
arteries were moderately atherosclerotic.

‫ اصابة بالصدر‬-‫)أ‬2(
‫ ارتطام بعجلة القيادة‬-‫ب‬
‫ حادث سيارة‬-‫ج‬
‫) تصلب الشرايين التاجية‬2(