BURNS

Question 1

1. The affinity of carbon monoxide for hemoglobin is
   A. 2-5 times greater than oxygen
   B. 20-50 times greater than oxygen
   C. 200-250 times greater than oxygen
   D. 2000-2500 times greater than oxygen

Answer 1

C. 200-250 times greater than oxygen

Another important contributor to early mortality in burns is carbon monoxide (CO) poisoning resulting from smoke inhalation. The affinity of CO for hemoglobin is approximately 200–250 times more than that of oxygen, which decreases the levels of normal oxygenated hemoglobin and can quickly lead to anoxia and death. Unexpected neurologic symptoms should raise the level of suspicion, and an arterial carboxyhemoglobin level must be obtained because pulse oximetry is falsely elevated. (See Schwartz 9th ed., p 198.)

Question 2

2. A 100-kg patient with a 50% TBSA full thickness burn receives 10 L of 0.9% NaCl solution in transit to the hospital. His laboratory values 6 hours after the injury are likely to reflect which of the following:
   A. Acidosis
   B. Alkalosis
   C. Hypoxia
   D. Dilutional anemia

Answer 2

A. Acidosis

The most commonly used formula, the Parkland or Baxter formula, consists of 3 to 4 ml/kg per percent burned of Lactated Ringer’s, of which half is given during the first 8 hours postburn, and the remaining half over the subsequent 16 hours. Given these large volumes of intravenous resuscitation fluid, Lactated Ringer’s solution is preferred, because 0.9% NaCl results in hypernatremia and more importantly a hyperchloremic acidosis. (See Schwartz 9th ed., p 200.)

Question 3

3. The topical antimicrobial agent mafenide acetate is most likely to cause which of the following complications:
   A. Methemoglobinemia
   B. Neutropenia
   C. Metabolic acidosis
   D. Nephrotoxicity

Answer 3

C. Metabolic acidosis

Mafenide acetate, either in cream or solution form, is an effective topical antimicrobial. It is effective even in the presence of eschar and can be used in both treating and preventing wound infections, and the solution form is an excellent antimicrobial for fresh skin grafts. The use of mafenide acetate may be limited by pain with application to partial-thickness burns. Mafenide is absorbed systemically and a major side effect is metabolic acidosis resulting from carbonic anhydrase inhibition. (See Schwartz 9th ed., p 202.)

Question 4

1. Which of the following patients should be immediately referred to a burn center?
   A. A 20-year-old with a 12% partial thickness burn
   B. A 30-year-old with a major liver injury and a 15% partial thickness burn
   C. A 2% TBSA partial thickness burn to the anterior leg, crossing the knee
   D. A 10-year-old with a 7% partial thickness burn

Answer 4

B. A 30-year-old with a major liver injury and a 15% partial thickness burn

All patients with a partial thickness burn >10% TBSA should be transferred to a burn center. A patient with a burn and other major trauma can be treated and stabilized in the trauma center first. Burns that involve the entire joint should be transferred to a burn center, but a small burn to the anterior surface of the knee would not necessarily mandate transfer. Children should be transferred if there are no personnel able to care for them, but for a child with a 7% TBSA burn, this would not be mandatory. (See Schwartz 9th ed., p 198; See Table 8-1.)

Question 5

2. Which of the following should prompt immediate, elective intubation in a patient with a major burn?
   A. Subjective dyspnea
   B. Singed nasal hair
   C. Perioral burns
   D. Oxygen saturation 96%

Answer 5

A. Subjective dyspnea

Perioral burns and singed nasal hairs are signs that the oral cavity and pharynx should be further evaluated for mucosal injury, but in themselves these physical findings do not indicate an upper airway injury. Signs of impending respiratory compromise may include a hoarse voice, wheezing, or stridor; subjective dyspnea is a particularly concerning symptom, and should trigger prompt elective endotracheal intubation. (See Schwartz 9th ed., p 197.)

Question 6

3. Which of the following is indicated in a 46-year-old patient with a 22% TBSA partial thickness burn?
   A. Prophylactic 1st generation cephalosporin
   B. Prophylactic clindamycin
   C. Tetanus booster
   D. Tetanus toxoid

Answer 6

C. Tetanus booster

Patients with acute burn injuries should never receive prophylactic antibiotics. This intervention has been clearly demonstrated to promote development of fungal infections and resistant organisms and was abandoned in the mid-1980s. A tetanus booster should be administered in the emergency room. (See Schwartz 9th ed., p 198.)

Question 7

4. A 4-year-old patient presents with a diffuse scald wound after being held in a hot tub of water. There are circumferential blisters present over the right leg (from hip to toes) and circumferential blistering over the lower left leg (from knee to toes). The right thigh, abdomen and back below the umbilicus, as well as the buttocks and perineum are red but without blisters. What is the total BSA burn?
   A. 25%
   B. 36%
   C. 46%
   D. 54%

Answer 7

A. 25%

Right leg (circumferential): 14%
Lower left leg (circumferential, knee to toes): 7%

The ‘rule of nines’ is a crude but quick and effective method of estimating burn size (Fig. 8-1). In adults, the anterior and posterior trunk each account for 18%, each lower extremity is 18%, each upper extremity is 9%, and the head is 9%. In children younger than 3 years old, the head accounts for a larger relative surface area and should be taken into account when estimating burn size. Diagrams such as the Lund and Browder chart give a more accurate accounting of the true burn size in children. The importance of an accurate burn size assessment cannot be overemphasized. Superficial or first-degree burns should not be included when calculating the percent of TBSA, and thorough cleaning of soot and debris is mandatory to avoid confusing areas of soiling with burns. Examination of referral data suggests that physicians inexperienced with burns tend to overestimate the size of small burns and underestimate the size of large burns, with potentially detrimental effects on pretransfer resuscitation.
If patient in question is over the age of 3; the adult estimates can be used. Only the areas of partial thickness (in this case, blistering) are used to calculate the burn area. The left leg is 18%, and the lower right leg should be slightly less than half of 18% (i.e., approximately 7-8%). (See Schwartz 9th ed., p 198.)

Question 8

5. 100% inhaled oxygen decreases the half-life of carbon monoxide from 250
   minutes to approximately
   A. 200 minutes
   B. 150 minutes
   C. 100 minutes
   D. 50 minutes

Answer 8

D. 50 minutes

Administration of 100% oxygen is the gold standard for treatment of CO poisoning, and reduces the half-life of CO from 250 minutes in room air to 40 to 60 minutes. (See Schwartz 9th ed., p 198.)

Question 9

6. Which of the following is used to treat severe hydrogen cyanide poisoning?
   A. Hydroxocobalamin
   B. Methylene blue
   C. Dialysis
   D. None of the above-there is no effective treatment

Answer 9

A. Hydroxocobalamin

Hydrogen cyanide toxicity may also be a component of smoke inhalation injury. Afflicted patients may have a persistent lactic acidosis or S-T elevation on electrocardiogram (ECG). Cyanide inhibits cytochrome oxidase, which in turn inhibits cellular oxygenation. Treatment consists of sodium thiosulfate, hydroxocobalamin, and 100% oxygen. Sodium thiosulfate works by transforming cyanide into a nontoxic thiocyanate derivative; however, it works slowly and is not effective for acute therapy. Hydroxocobalamin quickly complexes with cyanide and is excreted by the kidney, and is recommended for immediate therapy. In the majority of patients, the lactic acidosis will resolve with ventilation and sodium thiosulfate treatment becomes unnecessary. (See Schwartz 9th ed., p 198.)

Question 10

7. Most chemical burns require large volumes of water to remove the chemical.
   Which of the following chemical burns should be treated by careful wiping or sweeping of the skin, rather than water?
   A. Powdered form of lye
   B. Formic acid
   C. Hydrofluoric acid
   D. Acetic acid

Answer 10

A. Powdered form of lye

Chemical burns are less common, but potentially are severe burns. The most important components of initial therapy are careful removal of the toxic substance from the patient and irrigation of the affected area with water for a minimum of 30 minutes. An exception to this is in cases of concrete powder or powdered forms of lye, which should be swept from the patient to avoid activating the aluminum hydroxide with water. (See Schwartz 9th ed., p 199.)

Question 11

8. Formic acid burns are associated with
   A. Hemoglobinuria
   B. Rhabdomyolosis
   C. Hypocalemia
   D. Hypokalemia

Answer 11

A. Hemoglobinuria

The offending agents in chemical burns can be systemically absorbed and may cause specific metabolic derangements. Formic acid has been known to cause hemolysis and hemoglobinuria. (See Schwartz 9thed., p 199.)

Question 12

9. The agent most effective in treating hydrofluoric acid burns is
   A. Calcium
   B. Magnesium
   C. Vitamin K
   D. Vitamin A

Answer 12

A. Calcium

Hydrofluoric acid is a particularly common offender due to its widespread industrial uses. Calcium-based therapies are the mainstay of treating hydrofluoric acid burns, with topical calcium gluconate applied to wounds, and subcutaneous or IV infiltration of calcium gluconate for systemic symptoms. Intra-arterial infusion of calcium gluconate may be effective in the most severe cases. Patients undergoing intra-arterial therapy need continuous cardiac monitoring. Persistent electrocardiac abnormalities or refractory hypocalcemia may signal the need for emergent excision of the burned areas. (See Schwartz 9th ed., p 199.)

Question 13

10. The major improvement in burn survival in the 20th century can be attributed to the introduction of which of the following therapies:
    A. Antibiotics
    B. Central venous fluid resuscitation
    C. Nutritional support
    D. Early excision of the burn wound

Answer 13

D. Early excision of the burn wound

The strategy of early excision and grafting in burned patients revolutionized survival outcomes in burn care. Not only did it improve mortality, but early excision decreased reconstruction surgery, improved hospital length of stay, and reduced costs of care. After the initial resuscitation is complete and the patient is hemodynamically stable, attention should be turned to excising the burn wound. Burn excision and wound coverage should ideally start within the first several days, and in larger burns, serial excisions can be performed as the patient’s condition allows. (See Schwartz 9th ed., p 204.)

Question 14

1. A 22-year-old man is brought to the emergency room after a house fire. He has burns around his mouth and his voice is hoarse, but breathing is unlabored. What most appropriate next step in management?
   A. Immediate endotracheal intubation.
   B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available.
   C. Place on supplemental oxygen.
   D. Placement of two large-bore intravenous (IV) catheters with fluid resuscitation.

Answer 14

B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available.

Question 15

2. What percentage burn does a patient have who has suffered burns to one leg (circumferential), one arm (circum-ferential), and the anterior trunk?
   A. 18%
   B. 27%
   C. 36%
   D. 45%

Answer 15

D. 45%

To calculate the percentage of burns using the Rule of Nines for an adult, let’s consider the areas mentioned:

One leg (circumferential): Since each leg is 18% of the body’s surface area (9% anterior and 9% posterior), a circumferential burn to one leg accounts for 18%.

One arm (circumferential): Each arm is 9% of the body’s surface area (4.5% anterior and 4.5% posterior), so a circumferential burn to one arm accounts for 9%.

Anterior trunk: The trunk can be divided into the anterior and posterior trunk, each accounting for 18% of the body’s surface area. Therefore, burns to the anterior trunk account for 18%.

Adding these percentages together:

Leg: 18%
Arm: 9%
Anterior trunk: 18%
Total = 18% + 9% + 18% = 45%

Therefore, the correct answer is D. 45%.

Question 16

3. A 40-year-old woman is admitted to the burn unit after an industrial fire at a plastics manufacturing plant with burns to the face and arms. Her electrocardiogram (ECG) shows
   S-T elevation, and initial chemistry panel and arterial blood gas reveal an anion gap metabolic acidosis with normal arterial carboxyhemoglobin. What is the most appropriate next step?
   A. Correction of acidosis by adding sodium bicarbonate to IV fluids.
   B. Administration of 100% oxygen and hydroxocobalamin.
   C. Transthoracic echocardiogram.
   D. Blood culture with IV antibiotics.

Answer 16

B. Administration of 100% oxygen and hydroxocobalamin.

Question 17

4. Which of the following is a common sequelae of electrical injury?
   A. Cardiac arrhythmias
   B. Paralysis
   C. Brain damage
   D. Cataracts

Answer 17

D. Cataracts

Question 18

5. An 8-year-old boy is brought to the emergency room after accidentally touching a hot iron with his forearm. On examination, the burned area has weeping blisters and is very tender to the touch. What is the burn depth?
   A. First degree
   B. Second degree
   C. Third degree
   D. Fourth degree

Answer 18

B. Second degree

Question 19

6. Three hours after a burn injury that consisted of circum-ferential, third-degree burns at the wrist and elbow of the right arm, a patient loses sensation to light touch in his fin-gers. Motor function of his digits, however, remains intact.
   The most appropriate treatment for this patient now would consist of:

A. Elevation of the extremity, Doppler ultrasonography every 4 hours, and if distal pulses are absent 8 hours later, immediate escharotomy.
B. Palpation for distal pulses and immediate escharotomy if pulses are absent.
C. Doppler ultrasonography for assessment of peripheral flow and immediate escharotomy if flow is decreased.
D. Immediate escharotomy under general anesthesia from above the elbow to below the wrist on both medial and lateral aspects of the arm.

Answer 19

C. Doppler ultrasonography for assessment of peripheral flow and immediate escharotomy if flow is decreased.

Question 20

7. What is the fluid requirement of a 50-kg man with first-degree burns to his left arm and leg, circumferential second-degree burn to his right arm, and third-degree burns to his torso and right leg. What is the rate of initial fluid resuscitation?
   A. 4.5 L over 8 hours, followed by 4.5 Lover 16 hours
   B. 4.5 L over 8 hours, followed by 6 L over 16 hours
   C. 6 L over 8 hours, followed by 6 Lover 16 hours
   D. 6 L over 8 hours, followed by 9 Lover 16 hours

Answer 20

A. 4.5 L over 8 hours, followed by 4.5 Lover 16 hours

Question 21

A patient with a 90% burn encompassing the entire torso develops an increasing co, and peak inspiratory pressure.
Which of the following is most likely to resolve this problem?
A. Increase the delivered tidal volume.
B. Increase the respiratory rate.
C. Increase the Fio,*
D. Perform a thoracic escharotomy.

Answer 21

D. Perform a thoracic escharotomy.

The adequacy of respiration must be monitored continuously throughout the resuscitation period. Early respiratory distress may be due to the compromise of ventilation caused by chest wall inelasticity related to a deep circumferential burn wound of the thorax. Pressures required for ventilation increase and arterial Pco, rises. Inhalation injury, pneumothorax, or other causes can also result in respiratory distress and should be appropriately treated.
Thoracic escharotomy is seldom required, even with a circumferential chest wall burn. When required, escharotomies are performed bilaterally in the anterior axillary lines. If there is significant extension of the burn onto the adjacent abdominal wall, the escharotomy incisions should be extended to this area by a transverse incision along the costal margins. (See
Schwartz 10th ed., p. 230.)

Question 22

9. Which of the following is FALSE regarding silver sulfadiazine?
   A. Used as prophylaxis against burn wound infections with a wide range of antimicrobial activity.
   B. Safe to use on full and partial thickness burn wounds, as well as skin grafts.
   C. Has limited systemic absorption.
   D. May inhibit epithelial migration in partial thickness wound healing

Answer 22

B. Safe to use on full and partial thickness burn wounds, as well as skin grafts.

Question 23

10. Successful antibiotic penetration of a burn eschar can be
    achieved with
    A. Mafenide acetate
    B. Neomycin
    C. Silver nitrate
    D. Silver sulfadiazine

Answer 23

A. Mafenide acetate

Question 24

11. Which of the following is true regarding nutritional needs of burn patients?
    A. The hypermetabolic response to burn wounds typically raises the basic metabolic rate by 120%.
    B. Oxandrolone, an anabolic steroid, can improve lean body mass but can be associated with hyperglycemia and clinically significant rise in hepatic transaminitis.
    C. Early enteral feeding is safe when burns are less than 20% TBSA, otherwise enteral feeding should await return of bowel function to avoid feeding a patient with gastric ileus.
    D. For patients with greater than 40% TBSA, caloric needs are estimated to be 25 kcal/kg/day plus 40 kcal/%TBSA/day.

Answer 24

D. For patients with greater than 40% TBSA, caloric needs are estimated to be 25 kcal/kg/day plus 40 kcal/%TBSA/day.

Question 25

12. A 14-year-old girl sustains a steam burn measuring 6 by 7 inches over the ulnar aspect of her right forearm. Blisters develop over the entire area of the burn wound, and by the time the patient is seen 6 hours after the injury, some of the blisters have ruptured spontaneously. All of the following therapeutic regimens might be considered appropriate for this patient EXCEPT A. Application of silver sulfadiazine cream (Silvadene) and daily washes, but no dressing. B. Application of mafenide acetate cream (Sulfamylon), but no daily washes or dressing. C. Homograft application without sutures to secure it in place, but no daily washes or dressing. D. Heterograft (pigskin) application with sutures to secure it in place and daily washes, but no dressing.

Answer 25

D. Heterograft (pigskin) application with sutures to secure it in place and daily washes, but no dressing.

Question 26

13. Which is FALSE concerning surgical treatment of burn wounds? A. Tangential excision consists of tangential slices of burn tissue until bleeding tissue is encountered. Thus, excision can be associated with potentially significant blood loss. B. Human cadaveric allograft is a permanent alternative to split-thickness skin grafts when there are insuficient donor sites. C. Bleeding from tangential excision can be helped with injection of epinephrine tumescence solution, pneumatic tourniquets, epinephrine soaked compresses, and fibrinogen and thrombin spray sealant. D. Meshed split thickness skin grafts allow serosangui-nous drainage to prevent graft loss and provide a greater area of wound coverage.

Answer 26

B. Human cadaveric allograft is a permanent alternative to split-thickness skin grafts when there are insuficient donor sites.

Question 27

14. A 45-year-old woman is admitted to a hospital because of a third-degree burn injury to 40% of her TBSA, and her wounds are treated with topical silver sulfadiazine cream (Silvadene). Three days after admission, a burn wound biopsy semiquantitative culture shows 104 Pseudomonas organisms per gram of tissue. T e patient's condition is stable at this time. The most appropriate management for this patient would be to A. Repeat the biopsy and culture in 24 hours. B. Start subeschar clysis with antibiotics. C. Administer systemic antibiotics. D. Surgically excise the burn wounds.

Answer 27

B. Start subeschar clysis with antibiotics.

Question 28

15. Fourteen days after admission to the hospital for a 30% partial thickness burn and hemodynamic instability requiring central venous access, a patient develops a spiking temperature curve. On physical examination, the central venous catheter insertion site was red, tender, and warm. The best treatment for this complication is to A. Exchange of central venous catheter over guidewire, culture tip of previous catheter. B. Treat patient with IV antibiotics until blood cultures drawn from catheter are negative. C. Removal of central venous catheter, culture tip, and placement of new catheter on contralateral site. D. Removal of catheter and treat patient with oral antibiotics and pain medication as needed.

Answer 28

C. Removal of central venous catheter, culture tip, and placement of new catheter on contralateral site.

Question 29

2. What percentage burn does a patient have who has suffered partial- thickness burns to their anterior right leg and anterior chest and abdomen as well as superficial burns to their right arm? A. 18% B. 27% C. 36% D. 45%

Answer 29

C. 36% The distribution for an adult is approximately as follows: Head and neck: 9% Each arm: 9% Each leg: 18% (anterior 9% + posterior 9%) Anterior trunk (chest and abdomen): 18% Posterior trunk (back and buttocks): 18% Perineum: 1% Given the patient has suffered: Partial-thickness burns to their anterior right leg (9%) Anterior chest and abdomen (18%) Superficial burns to their right arm

Question 30

4. In order to assess the special concerns associated with electrical burns: A. All extremity compartments should be evaluated and a baseline ECG should be obtained. B. A full neurologic assessment including ophthalmologic is required to evaluate acute intraocular pathology. C. A Foley catheter should be placed to allow for titration of fluid administration. D. Workup should include an echocardiogram to evaluate ventricular wall motion.

Answer 30

A. All extremity compartments should be evaluated and a baseline ECG should be obtained. Electrical burns make up 3% of US hospital admissions but have special concerns, including cardiac arrhythmia and compartment syndrome with concurrent rhabdomyolysis. A baseline ECG is recommended in all patients with an electrical injury, and a normal ECG in a low-voltage injury (<1000 V) may preclude hospital admission. Because compartment syndrome and rhabdomyolysis are common in high-voltage electrical injuries, vigilance must be maintained for neurologic or vascular compromise, and fasciotomies should be performed even in cases of moderate clinical suspicion. For patients with rhabdomyolysis, a Foley catheter and monitoring of electrolytes may be aid in renal function monitoring, but fluid administration and urine output is not prioritized as highly in electrical when compared to external burns. Long-term neurologic symptoms and cataract development are not uncommon with high-voltage electrical injuries, and neurologic and ophthalmologic consultation should be obtained to define baseline patient function. However, acute intraocular pathology is unlikely to be uncovered. (See Schwartz 11th ed., p. 252.)

Question 31

5. What is the zone of coagulation and what is the appropriate treatment? A. The most severely burned portion is typically in the center of the wound, which will require excision and grafting. B. The most severely burned portion is typically in the center of the wound, which will likely heal without surgical intervention if adequate perfusion is maintained and infection is prevented. C. It has variable degrees of vasoconstriction and resultant ischemia, which will require excision and grafting. D. It is hyperemic and extremely painful to touch, but will not require surgical excision or grafting.

Answer 31

A. The most severely burned portion is typically in the center of the wound, which will require excision and grafting.

Question 32

6. Which of the following describes a partial-thickness, second-degree burn? A. Leathery, painless, and nonblanching B. Painful but do not blister C. Dermal involvement and are extremely painful with weeping and blisters D. Will need excision and grafting

Answer 32

C. Dermal involvement and are extremely painful with weeping and blisters

Question 33

7. What is the fluid requirement of a 50-kg man with first-degree burns to his left arm and leg, circumferential second-degree burn to his right arm, and third-degree burns to his torso and right leg. What is the rate of initial fluid resuscitation? A. 4.5 L over 8 hours, followed by 4.5 L over 16 hours B. 4.5 L over 8 hours, followed by 6 L over 16 hours C. 6 L over 8 hours, followed by 6 L over 16 hours D. 6 L over 8 hours, followed by 9 L over 16 hours

Answer 33

A. 4.5 L over 8 hours, followed by 4.5 L over 16 hours The most commonly used formula, the Parkland or Baxter formula, consists of 3 to 4 mL/kg per % burn of Lactated Ringer's, of which half is given during the first 8 hours after burn and the remaining half is given over the subsequent 16 hours. The most recent American Burn Association consensus formula recommends 2 mL/kg per % burn of Lactated Ringers given the tendency toward excessive fluid administration with the traditional formulas. The concept behind continuous fluid requirements is simple. The burn (and/or inhalation injury) drives an inflammatory response that leads to capillary leak; as plasma leaks into the extravascular space, crystalloid administration maintains the intravascular volume. Therefore, if a patient receives a large fluid bolus in a prehospital setting or emergency department, the fluid has likely leaked into the interstitium, and the patient still requires ongoing burn resuscitation according to the estimates. Continuation of fluid volumes should depend on the time since injury, urine output, and mean arterial pressure (MAP). As the capillary leak closes, the patient will require less volume to maintain these two resuscitation endpoints. Children under 20 kg have the additional requirement that they do not have sufficient glycogen stores to maintain an adequate glucose level in response to the inflammatory response. Specific pediatric formulas have been described, but the simplest approach is to deliver a weight-based maintenance IV fluid with glucose supplementation in addition to the calculated resuscitation with lactated Ringer's. (See Schwartz 11th ed., p. 254.)

Question 34

8. A patient with partial- and full-thickness burns to their torso was intubated emergently and has become increasingly difficult to ventilate demonstrating rising PCOz and peak inspiratory pressure. The most important treatment includes: A. Low tidal volume (6 cc/kg) for lung-protection ventilation. B. High-frequency percussive ventilation (HFPV). C. Increase the F102 and decrease in positive end-expiratory pressure (PEEP). D. Eschar release along the anterior axillary lines with bilateral subcostal and subclavicular extensions.

Answer 34

D. Eschar release along the anterior axillary lines with bilateral subcostal and subclavicular extensions. Hypoventilation, increased airway pressures, and hypotension may also characterize thoracic compartment syndrome. Escharotomies are rarely needed within the first 8 hours following injury and should not be performed unless indicated because of the terrible aesthetic sequelae. When indicated, they are usually performed at the bedside, preferably with electrocutery to minimize blood loss. Extremity incisions are made on the lateral and medial aspects of the limbs in an anatomic position and may extend onto thenar and hypothenar eminences of the hand. Digital escharotomies do not usually result in any meaningful salvage of functional tissue and are not recommended. Inadequate perfusion despite proper escharotomies may indicate the need for fasciotomy, but this procedure should not be routinely performed as part of the eschar release. Thoracic escharotomies should be placed along the anterior axillary lines with bilateral subcostal and subclavicular extensions. Extension of the anterior axillary incisions down the lateral abdomen typically will allow adequate release of abdominal eschar. (See Schwartz 11th ed., p. 259.)

Question 35

9. What is the indication for the topical therapy which can cause neutropenia when applied to burns? A. Primarily as prophylaxis against burn wound infections with a wide range of antimicrobial activity B. Primarily as antimicrobial prophylaxis against eschar and newly grafted areas C. MRSA culture-positive burn wound infections D. To improve patient comfort while reducing the need for daily dressing changes

Answer 35

A. Primarily as prophylaxis against burn wound infections with a wide range of antimicrobial activity

Question 36

10. Successful antibiotic penetration of a burn eschar can be achieved with: A. Mafenide acetate. B. Neomycin. C. Silver nitrate. D. Silver sulfadiazine.

Answer 36

A. Mafenide acetate.

Question 37

12. A 42-year-old man with burns of >40% TBSA was required a high volume of intravenous fluids over the first 3 days of his ICU admission to maintain his urine output, which had finally stabilized. However, he has become increasingly difficult to ventilate, with high peak pressures, and his urine output is now declining without response to additional crystalloid. What treatment is now required for this patient? A. Discontinuation of crystalloid administration, favoring vasopressor initiation for hemodynamic support, if required B. Transitioning from crystalloid to colloid C. Torso escharotomies D. Decompressive laparotomy

Answer 37

D. Decompressive laparotomy

Question 38

13. Which of the following statements is FALSE concerning surgical treatment of burn wounds? A. Tangential excision consists of tangential slices of burn tissue until bleeding tissue is encountered. Thus, excision can be associated with potentially significant blood loss. B. Xenographs are a permanent alternative to split thickness skin grafts when there is insufficient donor sites. C. Bleeding from tangential excision can be helped with injection of epinephrine tumescence solution, pneumatic tourniquets, epinephrine-soaked compresses, and fibrinogen and thrombin spray sealant. D. Meshed split-thickness skin grafts allow serosanguinous drainage to prevent graft loss and provide a greater area of wound coverage.

Answer 38

B. Xenographs are a permanent alternative to split thickness skin grafts when there is insufficient donor sites.

Question 39

14. Which of the following late complications of an acute burn has the appropriately described treatment? A. Hypertrophic burn scars should be excised and revised to minimize the increasing inflammatory response. B. The most common type of contracture is that of the hand which rarely requires surgical excision. C. Heterotopic ossification (HO) associated pain can be often successfully treated with oral pain control, physiotherapy, and radiation therapy. D. HO requires surgical excision to prevent malignant transformation of pathologic lamellar bone.

Answer 39

C. Heterotopic ossification (HO) associated pain can be often successfully treated with oral pain control, physiotherapy, and radiation therapy.

Question 40

15. Which of the following descriptions of a burn disaster is TRUE? A. Do not include exposure to radioactive materials. B. Should be coordinated by local hospital systems, regionalization and national plans inappropriately allocate resources. C. Thirty percent of patients in mass casualty incidents suffer from burn injury. D. Globally, they occur most commonly in the United States.

Answer 40

C. Thirty percent of patients in mass casualty incidents suffer from burn injury.

Question 41

1. Why does carbon monoxide (CO) poisoning lead to anoxia and potentially death in burn patients? A) CO increases the levels of oxygenated hemoglobin. B) CO has a lower affinity for hemoglobin than oxygen. C) CO has a significantly higher affinity for hemoglobin than oxygen, decreasing oxygenated hemoglobin levels. D) CO directly damages the respiratory center in the brain.

Answer 41

C) CO has a significantly higher affinity for hemoglobin than oxygen, decreasing oxygenated hemoglobin levels. Rationale: Carbon monoxide has a 200–250 times greater affinity for hemoglobin than oxygen does. This high affinity leads to a decrease in the levels of oxygenated hemoglobin, resulting in anoxia (lack of oxygen) and can lead to death if not treated promptly.

Question 42

2. Why are pulse oximetry readings misleading in the diagnosis of CO poisoning in burn patients? A) Pulse oximetry can accurately measure carboxyhemoglobin levels. B) CO poisoning does not affect pulse oximetry readings. C) Pulse oximetry readings can be misleadingly high due to CO's higher affinity for hemoglobin than oxygen. D) Pulse oximetry readings are unaffected by hemoglobin levels.

Answer 42

C) Pulse oximetry readings can be misleadingly high due to CO's higher affinity for hemoglobin than oxygen. Rationale: Pulse oximetry measures oxygen saturation levels in the blood. However, because CO binds more readily to hemoglobin than oxygen does, the device may show falsely high oxygen saturation levels in the presence of CO poisoning. This is why measuring arterial carboxyhemoglobin levels is crucial for accurate diagnosis.

Question 43

3. What is the primary use of mafenide acetate in burn treatment? A) To increase oxygenation in burn areas. B) As an effective topical antimicrobial agent for burns. C) To reduce the affinity of CO for hemoglobin. D) As a pain reliever for burn patients.

Answer 43

B) As an effective topical antimicrobial agent for burns. Rationale: Mafenide acetate is used in burn treatment due to its effectiveness as an antimicrobial agent. It can be applied in both cream and solution forms and remains effective even in the presence of eschar, helping to treat and prevent wound infections.

Question 44

4. What significant side effect can occur with the systemic absorption of mafenide acetate? A) Increased oxygenation of hemoglobin. B) Decreased risk of CO poisoning. C) Metabolic acidosis due to inhibition of carbonic anhydrase. D) Improved wound healing without complications.

Answer 44

C) Metabolic acidosis due to inhibition of carbonic anhydrase. Rationale: While mafenide acetate is beneficial for treating burns and fresh skin grafts, its systemic absorption can lead to metabolic acidosis. This is because mafenide acetate inhibits carbonic anhydrase, an enzyme important for maintaining acid-base balance in the body.

Question 45

1. What criterion necessitates the transfer of a burn patient to a specialized burn center? A) Partial-thickness burns covering less than 5% of Total Body Surface Area (TBSA). B) Burns involving an entire joint. C) First-degree burns regardless of TBSA. D) All burns, irrespective of severity and TBSA.

Answer 45

B) Burns involving an entire joint. Rationale: Burns involving an entire joint require specialized care due to the complexity of treatment needed for such injuries. This highlights the importance of transferring patients with such burns to a specialized burn center where they can receive the appropriate care.

Question 46

2. Under which condition should children with burns be transferred to a specialized burn center? A) If the burn covers more than 5% TBSA. B) If the initial facility lacks the expertise to care for pediatric burn patients. C) Only if the child has burns on the face, regardless of TBSA. D) All children with any size burn should be transferred.

Answer 46

B) If the initial facility lacks the expertise to care for pediatric burn patients. Rationale: The decision to transfer a child with burns to a specialized burn center depends on the initial facility's capability to provide the necessary care for pediatric patients. A child with a 7% TBSA burn might not require transfer if the facility is equipped to handle such cases.

Question 47

3. What is the protocol for burn patients with additional major traumas? A) Immediate transfer to a burn center regardless of trauma severity. B) Stabilization at a trauma center before considering transfer to a burn center. C) Transfer to a pediatric center if the patient is a child, regardless of the burn severity. D) All trauma patients are treated on-site without consideration for transfer.

Answer 47

B) Stabilization at a trauma center before considering transfer to a burn center. Rationale: Patients with burns and other major traumas should first be stabilized in a trauma center. The decision to transfer to a burn center depends on the severity and specifics of their injuries, ensuring that the patient is stable enough for transfer.

Question 48

4. Which symptom is especially concerning and warrants prompt elective endotracheal intubation in burn patients? A) Mild cough without other symptoms. B) Perioral burns without respiratory symptoms. C) Subjective dyspnea. D) Singed nasal hairs alone.

Answer 48

C) Subjective dyspnea. Rationale: Subjective dyspnea, or the patient's feeling of difficulty breathing, is especially concerning in burn patients. It indicates potential respiratory compromise and warrants prompt evaluation for elective endotracheal intubation to secure the airway and support breathing.

Question 49

1. Why should prophylactic antibiotics not be administered to patients with acute burn injuries? A) They enhance wound healing by promoting rapid tissue regeneration. B) They are effective in preventing all types of infections in burn patients. C) They risk promoting fungal infections and resistant bacterial strains. D) They are only effective against viral infections.

Answer 49

C) They risk promoting fungal infections and resistant bacterial strains. Rationale: The administration of prophylactic antibiotics in acute burn injuries was discontinued in the mid-1980s due to the risk of promoting fungal infections and the development of resistant bacterial strains, which can complicate treatment and recovery.

Question 50

2. When is a tetanus booster recommended for burn injury patients? A) Only if the patient has never received a tetanus vaccine. B) In all cases, regardless of vaccination history. C) In the emergency room setting for patients with burn injuries. D) Only for burns that cover more than 50% TBSA.

Answer 50

C) In the emergency room setting for patients with burn injuries. Rationale: A tetanus booster is recommended to be administered in the emergency room setting for patients with burn injuries to prevent tetanus infection, which can be a risk due to the nature of burn wounds.

Question 51

3. Which method is considered less accurate for estimating burn size in children under 3 years of age? A) Lund and Browder Chart. B) Rule of Nines. C) Both methods are equally accurate for all age groups. D) Estimating based on the child's weight.

Answer 51

B) Rule of Nines. Rationale: The Rule of Nines is less accurate for children under 3 years of age because it does not account for the larger proportion of the body surface area represented by the head in young children. The Lund and Browder Chart is preferred for a more accurate assessment in this age group.

Question 52

4. What is crucial for accurate burn size assessment and why? A) Including superficial or first-degree burns in TBSA calculations to ensure comprehensive treatment. B) Cleaning of soot and debris for accurate assessment, as it affects pretransfer resuscitation and overall management. C) Using the patient's weight as the primary factor for estimating burn size. D) Applying the Rule of Nines for all patients, regardless of age, for consistency.

Answer 52

B) Cleaning of soot and debris for accurate assessment, as it affects pretransfer resuscitation and overall management. Rationale: Cleaning of soot and debris is crucial for accurate burn size assessment. Superficial or first-degree burns should not be included in TBSA calculations. Inaccurate estimation can affect pretransfer resuscitation and overall management, making it essential to accurately assess the burn size for effective treatment planning.

Question 53

1. What is the gold standard treatment for carbon monoxide (CO) poisoning? A) Administration of antibiotics. B) 100% oxygen administration. C) Oral hydration therapy. D) Use of antipyretics.

Answer 53

B) 100% oxygen administration. Rationale: The gold standard for treating CO poisoning is the administration of 100% oxygen. This treatment significantly reduces the half-life of CO in the blood, enhancing the elimination of CO from the body and rapidly improving the patient's condition.

Question 54

2. Which symptom is indicative of potential hydrogen cyanide exposure in patients? A) Persistent lactic acidosis or S-T elevation on an electrocardiogram (ECG). B) Rapid resolution of symptoms following hydration. C) Decrease in blood pressure upon standing. D) Increase in body temperature.

Answer 54

A) Persistent lactic acidosis or S-T elevation on an electrocardiogram (ECG). Rationale: Persistent lactic acidosis or S-T elevation on an ECG are symptoms that may indicate hydrogen cyanide exposure. These symptoms suggest the need for further evaluation and consideration of cyanide toxicity in the differential diagnosis.

Question 55

3. What is the mechanism of toxicity for hydrogen cyanide? A) Cyanide promotes oxygenation of cells, leading to hyperoxia. B) Cyanide increases the production of lactic acid in the muscles. C) Cyanide inhibits cytochrome oxidase, crucial for cellular oxygenation, leading to cellular asphyxiation. D) Cyanide causes dehydration, leading to increased blood viscosity.

Answer 55

C) Cyanide inhibits cytochrome oxidase, crucial for cellular oxygenation, leading to cellular asphyxiation. Rationale: Cyanide's mechanism of toxicity involves the inhibition of cytochrome oxidase, an enzyme crucial for cellular oxygenation. This inhibition leads to cellular asphyxiation, as cells are unable to utilize oxygen effectively.

Question 56

4. Which treatment option is recommended for immediate therapy in hydrogen cyanide toxicity? A) Sodium Thiosulfate. B) Hydroxocobalamin. C) Oral rehydration salts. D) Intravenous glucose.

Answer 56

B) Hydroxocobalamin. Rationale: Hydroxocobalamin is recommended for immediate therapy in cases of hydrogen cyanide toxicity. It binds rapidly with cyanide to form a non-toxic complex that is excreted by the kidneys, making it an effective treatment option for acute exposure.

Question 57

1. What is the general approach to treating chemical burns? A) Immediate application of a neutralizing agent. B) Careful removal of the chemical agent and irrigation with water for at least 30 minutes. C) Immediate application of ice to the affected area. D) Covering the burn with dry dressings without irrigation.

Answer 57

B) Careful removal of the chemical agent and irrigation with water for at least 30 minutes. Rationale: The initial therapy for chemical burns involves the immediate and careful removal of the chemical agent from the patient's skin and irrigation of the affected area with water for at least 30 minutes to dilute and remove the chemical, minimizing damage.

Question 58

2. How should concrete powder or powdered lye be handled when treating chemical burns? A) Irrigate immediately with water. B) Brush off rather than irrigate with water. C) Apply a neutralizing agent directly. D) Leave in place and cover with dry dressings.

Answer 58

B) Brush off rather than irrigate with water. Rationale: For substances like concrete powder or powdered lye, it is recommended to brush them off rather than irrigate with water. This prevents activating harmful chemical reactions with the aluminum hydroxide in the concrete, which could exacerbate the burn.

Question 59

3. What systemic effects can formic acid have in chemical burns? A) It causes dehydration and electrolyte imbalance. B) It is known to cause hemolysis and hemoglobinuria. C) It leads to rapid wound healing without complications. D) It has no systemic effects, only local skin damage.

Answer 59

B) It is known to cause hemolysis and hemoglobinuria. Rationale: Formic acid can have systemic effects beyond the site of the burn, including causing hemolysis (the breakdown of red blood cells) and hemoglobinuria (the presence of hemoglobin in the urine), indicating its potential for systemic toxicity.

Question 60

4. What is the cornerstone of treatment for hydrofluoric acid burns? A) Corticosteroid therapy. B) Calcium-based therapies. C) Immediate surgical excision of the burn area. D) Application of petroleum jelly.

Answer 60

B) Calcium-based therapies. Rationale: Calcium-based therapies are the cornerstone of treatment for hydrofluoric acid burns. This includes the topical application of calcium gluconate gel, subcutaneous or intravenous infiltration of calcium gluconate for systemic symptoms, and intra-arterial infusion in severe cases. These treatments help to counteract the toxic effects of hydrofluoric acid.

Question 61

1. What has been the impact of early excision and grafting on the treatment outcomes of burn patients? A) Increased need for reconstructive surgery. B) Significantly improved mortality rates and reduced hospital stays. C) Extended hospital stays and increased care costs. D) No significant impact on survival outcomes.

Answer 61

B) Significantly improved mortality rates and reduced hospital stays. Rationale: Early excision and grafting have revolutionized burn care by significantly improving mortality rates, reducing the need for reconstructive surgery, shortening hospital stays, and lowering care costs, thereby enhancing overall treatment outcomes.

Question 62

2. When should the procedure of excising the burn wound ideally begin? A) Within the first week of injury, after initial resuscitation and stabilization. B) Only after all wounds have fully healed. C) Immediately upon hospital admission, before resuscitation. D) Six months post-injury to allow for natural healing.

Answer 62

A) Within the first week of injury, after initial resuscitation and stabilization. Rationale: The ideal timing for beginning the excision of the burn wound is within the first several days post-injury, following initial resuscitation and stabilization. This timing helps in reducing the risk of infection and other complications.

Question 63

3. What is the recommended management approach for extensive burns? A) Immediate excision of all damaged tissue in one procedure. B) Serial excisions as the patient's condition permits. C) No surgical intervention, only topical treatments. D) Delayed excision and grafting until all burns have scarred.

Answer 63

B) Serial excisions as the patient's condition permits. Rationale: For extensive burns, serial excisions are recommended, allowing for the gradual removal of damaged tissue and wound coverage. This approach is tailored to the patient's condition and helps in managing large areas of injury effectively.

Question 64

1. Why should prophylactic antibiotics not be administered to patients with acute burn injuries? A) They enhance wound healing by promoting rapid tissue regeneration. B) They are effective in preventing all types of infections in burn patients. C) They risk promoting fungal infections and resistant bacterial strains. D) They are only effective against viral infections.

Answer 64

C) They risk promoting fungal infections and resistant bacterial strains. Rationale: The administration of prophylactic antibiotics in acute burn injuries was discontinued in the mid-1980s due to the risk of promoting fungal infections and the development of resistant bacterial strains, which can complicate treatment and recovery.

Question 65

2. When is a tetanus booster recommended for burn injury patients? A) Only if the patient has never received a tetanus vaccine. B) In all cases, regardless of vaccination history. C) In the emergency room setting for patients with burn injuries. D) Only for burns that cover more than 50% TBSA.

Answer 65

C) In the emergency room setting for patients with burn injuries. Rationale: A tetanus booster is recommended to be administered in the emergency room setting for patients with burn injuries to prevent tetanus infection, which can be a risk due to the nature of burn wounds.

Question 66

3. Which method is considered less accurate for estimating burn size in children under 3 years of age? A) Lund and Browder Chart. B) Rule of Nines. C) Both methods are equally accurate for all age groups. D) Estimating based on the child's weight.

Answer 66

B) Rule of Nines. Rationale: The Rule of Nines is less accurate for children under 3 years of age because it does not account for the larger proportion of the body surface area represented by the head in young children. The Lund and Browder Chart is preferred for a more accurate assessment in this age group.

Question 67

4. What is crucial for accurate burn size assessment and why? A) Including superficial or first-degree burns in TBSA calculations to ensure comprehensive treatment. B) Cleaning of soot and debris for accurate assessment, as it affects pretransfer resuscitation and overall management. C) Using the patient's weight as the primary factor for estimating burn size. D) Applying the Rule of Nines for all patients, regardless of age, for consistency.

Answer 67

B) Cleaning of soot and debris for accurate assessment, as it affects pretransfer resuscitation and overall management. Rationale: Cleaning of soot and debris is crucial for accurate burn size assessment. Superficial or first-degree burns should not be included in TBSA calculations. Inaccurate estimation can affect pretransfer resuscitation and overall management, making it essential to accurately assess the burn size for effective treatment planning.

Question 68

1. What is the gold standard treatment for carbon monoxide (CO) poisoning? A) Administration of antibiotics. B) 100% oxygen administration. C) Oral hydration therapy. D) Use of antipyretics.

Answer 68

B) 100% oxygen administration. Rationale: The gold standard for treating CO poisoning is the administration of 100% oxygen. This treatment significantly reduces the half-life of CO in the blood, enhancing the elimination of CO from the body and rapidly improving the patient's condition.

Question 69

2. Which symptom is indicative of potential hydrogen cyanide exposure in patients? A) Persistent lactic acidosis or S-T elevation on an electrocardiogram (ECG). B) Rapid resolution of symptoms following hydration. C) Decrease in blood pressure upon standing. D) Increase in body temperature.

Answer 69

A) Persistent lactic acidosis or S-T elevation on an electrocardiogram (ECG). Rationale: Persistent lactic acidosis or S-T elevation on an ECG are symptoms that may indicate hydrogen cyanide exposure. These symptoms suggest the need for further evaluation and consideration of cyanide toxicity in the differential diagnosis.

Question 70

3. What is the mechanism of toxicity for hydrogen cyanide? A) Cyanide promotes oxygenation of cells, leading to hyperoxia. B) Cyanide increases the production of lactic acid in the muscles. C) Cyanide inhibits cytochrome oxidase, crucial for cellular oxygenation, leading to cellular asphyxiation. D) Cyanide causes dehydration, leading to increased blood viscosity.

Answer 70

C) Cyanide inhibits cytochrome oxidase, crucial for cellular oxygenation, leading to cellular asphyxiation. Rationale: Cyanide's mechanism of toxicity involves the inhibition of cytochrome oxidase, an enzyme crucial for cellular oxygenation. This inhibition leads to cellular asphyxiation, as cells are unable to utilize oxygen effectively.

Question 71

4. Which treatment option is recommended for immediate therapy in hydrogen cyanide toxicity? A) Sodium Thiosulfate. B) Hydroxocobalamin. C) Oral rehydration salts. D) Intravenous glucose.

Answer 71

B) Hydroxocobalamin. Rationale: Hydroxocobalamin is recommended for immediate therapy in cases of hydrogen cyanide toxicity. It binds rapidly with cyanide to form a non-toxic complex that is excreted by the kidneys, making it an effective treatment option for acute exposure.

Question 72

1. What is the general approach to treating chemical burns? A) Immediate application of a neutralizing agent. B) Careful removal of the chemical agent and irrigation with water for at least 30 minutes. C) Immediate application of ice to the affected area. D) Covering the burn with dry dressings without irrigation.

Answer 72

B) Careful removal of the chemical agent and irrigation with water for at least 30 minutes. Rationale: The initial therapy for chemical burns involves the immediate and careful removal of the chemical agent from the patient's skin and irrigation of the affected area with water for at least 30 minutes to dilute and remove the chemical, minimizing damage.

Question 73

2. How should concrete powder or powdered lye be handled when treating chemical burns? A) Irrigate immediately with water. B) Brush off rather than irrigate with water. C) Apply a neutralizing agent directly. D) Leave in place and cover with dry dressings.

Answer 73

B) Brush off rather than irrigate with water. Rationale: For substances like concrete powder or powdered lye, it is recommended to brush them off rather than irrigate with water. This prevents activating harmful chemical reactions with the aluminum hydroxide in the concrete, which could exacerbate the burn.

Question 74

3. What systemic effects can formic acid have in chemical burns? A) It causes dehydration and electrolyte imbalance. B) It is known to cause hemolysis and hemoglobinuria. C) It leads to rapid wound healing without complications. D) It has no systemic effects, only local skin damage.

Answer 74

B) It is known to cause hemolysis and hemoglobinuria. Rationale: Formic acid can have systemic effects beyond the site of the burn, including causing hemolysis (the breakdown of red blood cells) and hemoglobinuria (the presence of hemoglobin in the urine), indicating its potential for systemic toxicity.

Question 75

1. What is a consequence of electrical burns leading to the release of myoglobin into the circulation? A) Increased risk of hypertension. B) Irreversible renal failure if untreated. C) Immediate cardiac arrest. D) Enhanced muscle regeneration.

Answer 75

B) Irreversible renal failure if untreated. Rationale: Electrical burns can disrupt muscle cells, causing myoglobin to be released into the circulation. If untreated, this can lead to myoglobinuria, which may result in irreversible renal failure due to the toxic effects of myoglobin on the kidneys.

Question 76

2. How are electrical burns that cause myocardial contusion or infarction typically managed? A) Immediate coronary artery bypass graft surgery. B) Administration of high-dose steroids. C) Continuous ECG monitoring and cardiac enzyme analysis in an ICU setting for 24 hours post-injury. D) Continuous ECG monitoring is deemed unnecessary for patients with stable cardiac rhythms upon admission.

Answer 76

D) Continuous ECG monitoring is deemed unnecessary for patients with stable cardiac rhythms upon admission. Rationale: For patients with electrical burns who have stable cardiac rhythms upon admission, continuous ECG monitoring and cardiac enzyme analysis in an ICU setting for 24 hours post-injury are generally considered unnecessary. This is based on the observation that a normal cardiac rhythm upon admission usually indicates that subsequent dysrhythmias are unlikely.

Question 77

3. Which nervous system injury is most severe when current passes through the head? A) Peripheral nerve damage. B) Spinal cord damage. C) Brain damage. D) Autonomic nervous system dysfunction.

Answer 77

C) Brain damage. Rationale: Brain damage is the most severe form of nervous system injury when the electrical current passes through the head, due to the brain's high sensitivity to electricity and the critical functions it controls.

Question 78

4. What is a recognized sequel of high-voltage electrical burns, often occurring bilaterally? A) Glaucoma. B) Macular degeneration. C) Cataracts. D) Retinal detachment.

Answer 78

C) Cataracts. Rationale: Cataracts are a recognized sequel of high-voltage electrical burns, occurring in 5 to 7% of patients. They often develop bilaterally and typically manifest within 1 to 2 years of the injury, regardless of the contact points on the head.

Question 79

1. Why must the adequacy of respiration be continuously monitored in burn patients? A) To ensure proper medication dosage. B) To detect early signs of respiratory distress. C) To monitor for potential cardiac arrest. D) To assess the need for nutritional support.

Answer 79

B) To detect early signs of respiratory distress. Rationale: Continuous monitoring of respiration in burn patients is crucial to detect early signs of respiratory distress, allowing for timely intervention and management of any complications that may arise during the resuscitation period.

Question 80

2. What can cause increased pressures required for ventilation in burn patients? A) High altitude. B) Chest wall inelasticity due to deep circumferential burns to the thorax. C) Overhydration during resuscitation. D) Administration of sedatives.

Answer 80

B) Chest wall inelasticity due to deep circumferential burns to the thorax. Rationale: Deep circumferential burns to the thorax can lead to chest wall inelasticity, making ventilation more difficult. This results in increased pressures required for ventilation and a potential rise in arterial Pco2, complicating respiratory management.

Question 81

3. What is a potential complication of inhalation injury in burn patients? A) Decreased risk of infection. B) Improved pulmonary function. C) Significant respiratory distress. D) Enhanced oxygen delivery to tissues.

Answer 81

C) Significant respiratory distress. Rationale: Inhalation injury, caused by inhaling hot gases, smoke, or toxic substances, can cause significant respiratory distress in burn patients. This type of injury damages the airways and can severely impair respiratory function.

Question 82

4. When is a thoracic escharotomy indicated for circumferential chest wall burns? A) Routinely in all burn patients. B) When chest wall inelasticity significantly impedes ventilation. C) Only in cases of minor burns. D) As a preventive measure in all inhalation injuries.

Answer 82

B) When chest wall inelasticity significantly impedes ventilation. Rationale: Thoracic escharotomy is seldom required for circumferential chest wall burns but becomes necessary when chest wall inelasticity significantly impedes ventilation. The procedure, performed bilaterally along the anterior axillary lines, relieves pressure and improves chest wall compliance, facilitating better respiratory function.

Question 83

Which among the following statement/s is/are true? * A. Clothing does not retain the heat on the skin for a longer period in scald burn B. thick soups and sauces causes deep burns because it remain in contact longer with the skin C. exposed areas tend to be burned less deeply than areas covered with thin clothing D. A and B E. C and B

Question 84

What is the single most important factor in predicting burn related morbidity and mortality A. Type of burn B. Associated medical condition C. Etiology of burn D. Size of burn

Question 85

A 49 year old female came in because of multiple car collision. On P.e. the px bp=100/60 pr=120/min: rr = 30/min. The px sustained multiple Facial bone fractures, fx of the left femur; decrease breath sound on the left. Which of the following will be the first step in the treatment A. Foley catheter insertion B. Internal jugular vein catheterization C. Close tube thoracostomy D. Cricothyrodotomy

Question 86

Deep dermal burns does not cause wound scarring. A. True B. False

Question 87

Grade 1 liver injury is best managed by A. Hepatorrhaphy B. Segmental resection C. Packing D. None of the above

Question 88

Fiberoptic bronchoscopy is needed to diagnose smoke inhalation injury A. True B. False

Question 89

The first priority in the management of trauma is A. Ensure respiration B. Restore effectiev circulating blood volume C. Splint all fractures D. Obtain an adequate airway

Question 90

30 year old male sustained a circumferential deep dermal burn over the chest. After 6 hours from injury, patient complained of difficulty of breathing. 100% O2 mask was placed. What would be the best treatment option? A. Escharotomy B. IV antibiotic C. O2 face mask D. Endotracheal tube intubation E. Fasciotomy

Question 91

A 43 YEAR OLD FEMALE CAME IN BECAUSE OF MULTIPLE CAR COLLISION. ON P.E. THE PX BP=100/60 PR=120/MIN; RR = 30/MIN. THE PX SUSTAINED MULTIPLE FACIAL BONE FRACTURES. FX OF THE LEFT FEMUR: DECREASE BREATH SOUND ON THE LEFT. ON CHEST XRAY A HOMOGENOUS DENSITY WAS NOTED ON THE LEFT LUNG FIELD WITH SEGMENTAL FRACTURE OF THE 3RD,4TH, 5TH AND 6TH RIBS ON THE LEFT. THE BEST STEP WOULD BE A. CHEST UTZ B. CLOSE TUBE THORACOSTOMY C. ENDOTRACHEAL INTUBATION WITH POSITIVE PRESSURE BREATHING D. NONE OF THE ABOVE

Question 92

A 60 YEAR OLD MALE WHILE DRIVING WAS REAR ENDED BY TRUCK AT 80 KM/HR SPEED. PX IS UNCONSCIOUS WITH STABLE VITAL SIGNS WHICH OF THE FOLLOWING RADIOLOGIC PROCEDURES MUST BE REQUESTED * A. CERVICAL SPINE X-RAY B. SKULL X-RAY C. CHEST X-RAY D. BONE SURVEY

Question 93

Which of the following are signs of inhalational injury? * A. Hoarseness B. Coughing C. Expiratory wheezes D. Sneezing

Question 94

47 year old male sustained a circumferential deep dermal burn over the chest. After 6 hours from injury, patient complained of difficulty of breathing. 100% 02 mask was placed. What was the most likely cause of difficulty of breathing? A. pneumothorax B. inhalation injury C. deep circumferential chest burn D. pneumonia E. none of the above

Question 95

Which of the following are sure signs of inhalation injury? A. Expiratory wheezing B. Carbonaceous sputum C. Acrid smell of smoke on a victim's throat D. Burn in an enclosed area E. All of the above

Question 96

Which of the following can create the deepest form of scald burn A. Boiling water B. Brewed coffee C. Hot oil D. Asphalt E. None of the above

Question 97

The most common cause of airway obstruction is A. Foreign body B. Soft tissue swelling C. Dentures D. Blood

Question 98

A 45 year old male came in because of a stab wound on the 5th ics mcl rt. A chest tube was inserted and the initial output was 1,500 Cc.of non clotting blood the next best step would be * A. Open thoracotomy B. Blood transfusion of fresh whole blood C. Watchful waiting D. Administration of hematinics

Question 99

A 37 y/o male accidentally spilled a water with a temperature of 100 degrees centigrade. What is the most probable depth of burn? A. Full thickness burns B. Superficial dermal burns C. Fourth degree burns D. Deep dermal burns E. First degree burns

Question 100

THE MOST COMMON INTRAABDOMINAL ORGAN INJURED IN BLUNT TRAUMA IS A. INTESTINES B. SPLEEN C. LIVER D. PANCREAS

Question 101

Which of the following should be done to a 4 year old patient with complete immunization suffering from a 30% TBSA superficial burn? A. Admission to a burn unit B. Cutdown of lower extremity for IV line C. Tetanus prophylaxis D. A&C E. B&C

Question 102

Even when using precise diagrams in determining burn size, interobserver variation may vary by as much as +10%. A. True
 B. False

Question 103

Small burns may be treated initially with? A. tomatoes B. ice water C. mentholated creams D. toothpaste E. cool water

Question 104

An observer's experience with burned patients, rather than educational level, appears to be the best predictor of the accuracy of burn size estimation. A. True B. False

Question 105

A 50 YEAR OLD PX CAME DUE TO A VEHICULAR ACCIDENT. ON THE RADIAL PULSE CAN BE APPRECIATED. THE SYSTOLIC PRESSURE IS PROBABLY A. 70 MMHG B. 80MM HG C. 90 MM HG D. 60MMHG

Question 106

A 19 Year Old Male Came In With A Laceration To The Zone 2 Of The Neck. On Wound Exploration At The Er, It Was Noted That Wound Penetrated The Platysma. The Best Step Would Be * A. Neck Exploration B. Suture The Wound C. Pack The Wound D. Hemostasis

Question 107

A 56 Year Old Female Came In Because Of Multiple Car Collision, On P.E. The Px Bp=100/60 Pr=120/Min: Rr = 30/Min. The Px Sustained Multiple Facial Bone Fractures, Fx Of The Left Femur: Decrease Breath Sound On The Left. The Preferred Iv Fluid Is..* A. D5W B. Lactated Ringers C. Plasmalyte D. Dextran

Question 108

A Px With A Glasgow Coma Scale Of 3 Which Of The Following Is True A. Incomphensble Sounds B. Decorticate Rigidity C. Eye Openning On Painful Stimulus D. None Of The Above E. All Of The Above

Question 109

Which of the following conditions will require admission to a burn unit except? * A. 2nd and 3rd degree burns greater than 10% TBSA I patients under 15 years old or over 50 years old B. Electrical burns, including lightning injury. C. Second- and third-degree turns involving the face, hands, feet, genitalia, perineum, and major joints. D. Burn injury in children admitted to a hospital without qualified personnel or equipment for pediatric care,

Question 110

A 40 y/o female was brought to the emergency room after sustaining a 40% TBSA deep dermal burn from a scald burn. What should be the first priority at the ER? * A. Burn wound management B. Breathing C. Referral to a burn unit D. Circulation E. Secure airway

Question 111

Which of the following should be the preferred mode of transportation if the distance is 150 km to the nearest hospital with burn unit? A. ground ambulance B. helicopter transport C. aircraft D. none of the above

Question 112

A 60 Year Old Male Came In Because Of Multiple Car Collision. On P.E.The Px Bp=100/60 Pr=120/Min; Rr = 30/Min. The Px Sustained Multiple Facial Bone Fractures, Fx Of The Left Femur: Decrease Breath Sound On The Left. What Is The Best Diagnostic Procedure In The Above Px* A. Whole Abdomen Ct Scan B. Bone Survey C. Chest X-Ray D. FAST

Question 113

Which Of The Following Is The Primary Determinant Of The Patient's Long Term Appearance And Function? A. Type Of Burn B. Associated Medical Condition C. Size Of Burn D. Etiology Of Burn

Question 114

A Patient With Third Degree Circumferential Burn Of Upper Extremity Came In At The ER. Which Of The Following Are Signs Indicating Poor Perfusion Requiring Escharotomy? * A. Cyanosis B. Paresthesia C. Pulselessness D. A&C E. All Of The Above