Burns Management — MCQs
All of the following are causes of death in burn patients except
A man presents with deep burns covering 60% of his body. What is the immediate concern?
Fluid given in first 8 hours to a 28 years old woman with 50 kg weight having burns on both lower limbs?
A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
Parkland's formula is used to calculate the fluid replacement to be given in the first 24 hours in a case of deep burns. What is the Parkland formula?
The best guide to adequate tissue perfusion in the fluid management of a patient with burns is to ensure a minimum hourly urine output of:
A 56-year-old male is burned while sleeping in his home. His right upper and lower extremity and the anterior chest have extensive second-degree burns. What is the total percentage of body surface area affected? Reference: Rule of Nines for Adults - Each arm: 9% - Head: 9% - Anterior trunk: 18% - Posterior trunk: 18% - Each leg: 18% - Total: 99%
Which of the following is the most important initial step in managing a patient with extensive burns?
Which of the following statements about Nitrous Oxide (N2O) is true?
Which of the following is the induction anesthesia of choice in the pediatric age group?
Burns Management Indian Medical PG Practice Questions and MCQs
Question 1: All of the following are causes of death in burn patients except
- A. ARDS
- B. Sepsis
- C. Hyponatremia (Correct Answer)
- D. Shock
Explanation: ***Hyponatremia*** - While **hyponatremia** can occur in burn patients due to fluid shifts or inappropriate ADH secretion, it is rarely a direct cause of death on its own. - Severe hyponatremia would typically need to be profound and uncorrected to be lethal, and other major burn complications are more immediate and common causes of mortality. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a severe and common complication in burn patients, often due to smoke inhalation injury or systemic inflammation. - It leads to profound **hypoxemia** and is a significant cause of mortality in both early and late stages of burn care. *Sepsis* - **Sepsis** is a leading cause of death in burn patients, especially with extensive burns, due to the loss of skin barrier function and increased susceptibility to infection. - The systemic inflammatory response and subsequent **multiple organ dysfunction syndrome (MODS)** are often fatal. *Shock* - **Hypovolemic shock** is a prominent cause of early death in severely burned patients due to massive fluid loss from the burn wound. - Other forms of shock, such as **distributive (septic) shock**, can also occur later and contribute significantly to overall mortality.
Question 2: A man presents with deep burns covering 60% of his body. What is the immediate concern?
- A. Infection
- B. Sepsis
- C. Organ failure
- D. Shock (Correct Answer)
Explanation: ***Shock*** - With deep burns covering 60% of the body, the immediate and most critical concern is **hypovolemic shock** due to massive fluid shifting from the intravascular space into burnt tissues and interstitial spaces. - This rapid fluid loss leads to decreased circulatory volume, reduced cardiac output, and inadequate tissue perfusion, demanding urgent fluid resuscitation to prevent irreversible organ damage. *Infection* - While infection is a significant concern in burn patients, especially with extensive full-thickness burns, it is a **subsequent complication** that develops over hours to days rather than an immediate concern in the first few minutes or hours. - The initial threat to life is circulatory collapse from fluid loss, not septicemia from infection. *Sepsis* - Sepsis is a systemic response to infection and typically manifests **later in the course** of burn injury, after infection has set in and multiplied. - It involves a complex inflammatory cascade and organ dysfunction, but the most immediate life-threatening problem upon presentation is the acute fluid shift leading to shock. *Organ failure* - Organ failure can be a devastating consequence of severe burn injury, often as a result of prolonged **hypoperfusion** and **shock** if not promptly managed. - However, in the immediate presentation, organ failure is a potential outcome of untreated shock rather than the primary immediate concern itself.
Question 3: Fluid given in first 8 hours to a 28 years old woman with 50 kg weight having burns on both lower limbs?
- A. 950 ml
- B. 3600 ml (Correct Answer)
- C. 1900 ml
- D. 7400 ml
Explanation: ***3600 ml*** - Both lower limbs account for **36% TBSA deep burns** (18% for each leg). Using the Parkland formula (4mL x Body weight (kg) x %TBSA burned) gives 4mL x 50kg x 36% = **7200 mL total fluid** for the first 24 hours. - Half of the total fluid (7200 mL / 2 = 3600 mL) should be administered in the **first 8 hours** following the burn injury. *950 ml* - This amount is significantly less than the calculated fluid requirement for a patient with deep burns over 36% TBSA, which would lead to **under-resuscitation** and potential burn shock. - Inadequate fluid resuscitation can result in **organ hypoperfusion** and increased mortality in burn patients. *1900 ml* - While a substantial amount, 1900 mL is still less than half of the calculated 24-hour fluid requirement, meaning this would still lead to **under-resuscitation** in the critical initial 8-hour window. - This represents roughly a quarter of the total 24-hour fluid, which is insufficient for the **initial rapid fluid shift** seen in severe burns. *7400 ml* - This amount represents more than the entire 24-hour fluid requirement according to the Parkland formula (7200 mL). Administering this much fluid in the first 8 hours would lead to **over-resuscitation**. - **Over-resuscitation (fluid creep)** can cause complications such as pulmonary edema, abdominal compartment syndrome, and acute respiratory distress syndrome (ARDS).
Question 4: A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
- A. 3rd degree burn (Correct Answer)
- B. 2nd degree superficial
- C. 2nd degree deep
- D. 1st degree
Explanation: ***3rd degree burn*** - **Third-degree burns** involve the entire thickness of the skin (dermis and epidermis) and often extend into the **subcutaneous tissue**, muscle, or bone. - These burns typically appear dry, leathery, and often lack pain sensation due to nerve destruction. *2nd degree superficial* - **Superficial second-degree burns** involve the epidermis and the superficial part of the dermis, often presenting with **blisters** and painful, red, moist skin. - They do not extend to the subcutaneous tissue, which is a key feature of the burn described. *2nd degree deep* - **Deep second-degree burns** involve the epidermis and deeper layers of the dermis, but not the entire dermis or subcutaneous tissue. - While they can be less painful and appear dry, the involvement of **subcutaneous tissue** pushes the classification to third-degree. *1st degree* - **First-degree burns** only affect the epidermis, causing redness and pain but **no blistering** or damage to deeper layers. - These are typically sunburns or minor scalds and do not involve the dermis or subcutaneous tissue.
Question 5: Parkland's formula is used to calculate the fluid replacement to be given in the first 24 hours in a case of deep burns. What is the Parkland formula?
- A. TBSA x weight in kg x 4 (Correct Answer)
- B. TBSA x weight in kg x 2
- C. TBSA x weight in kg x 3
- D. TBSA x weight in kg
Explanation: ***TBSA x weight in kg x 4*** - Parkland's formula calculates the **total fluid replacement during the first 24 hours** post-burn as 4 mL of Ringer's Lactate per kilogram of body weight per percentage of **total body surface area (TBSA)** burned. - Half of the calculated volume is administered within the first 8 hours, and the remaining half over the next 16 hours. *TBSA x weight in kg x 2* - This value represents half of the recommended fluid volume using the Parkland formula, and would be insufficient for total 24-hour resuscitation. - Inadequate fluid resuscitation can lead to **burn shock**, characterized by hypoperfusion and organ dysfunction. *TBSA x weight in kg x 3* - This multiplier falls short of the recommended 4 mL/kg/TBSA for comprehensive fluid resuscitation in adults. - Using this formula could result in undertreatment, potentially compromising tissue perfusion and increasing the risk of complications. *TBSA x weight in kg* - This formula represents one-fourth of the recommended fluid volume according to the Parkland formula. - This significantly inadequate fluid replacement would lead to severe **hypovolemia**, organ failure, and a very poor prognosis.
Question 6: The best guide to adequate tissue perfusion in the fluid management of a patient with burns is to ensure a minimum hourly urine output of:
- A. 70-100 ml
- B. 10 - 15 ml
- C. 15 - 30 ml
- D. 30 - 50 ml (Correct Answer)
Explanation: ***30 - 50 ml*** - Maintaining a **urine output of 30-50 ml/hour** is generally accepted as an indicator of adequate renal perfusion and systemic tissue perfusion in adult burn patients. - This range ensures that the kidneys are being adequately perfused, and it helps prevent **acute kidney injury** while avoiding over-resuscitation. *70-100 ml* - A urine output in this range might indicate **over-resuscitation**, leading to potential complications such as **pulmonary edema** or compartment syndrome. - While high urine output suggests good renal perfusion, excessive fluid administration can be detrimental in burn patients. *10 - 15 ml* - This low urine output indicates **inadequate fluid resuscitation** and potential **hypoperfusion** of the kidneys and other vital organs. - Insufficient urine production can lead to **acute kidney injury** and worsening of the patient's condition. *15 - 30 ml* - A urine output in this range is often considered **borderline adequate** but may still suggest mild **under-resuscitation**, especially if sustained. - It might not fully reflect optimal renal perfusion and could put the patient at risk for renal compromise.
Question 7: A 56-year-old male is burned while sleeping in his home. His right upper and lower extremity and the anterior chest have extensive second-degree burns. What is the total percentage of body surface area affected? Reference: Rule of Nines for Adults - Each arm: 9% - Head: 9% - Anterior trunk: 18% - Posterior trunk: 18% - Each leg: 18% - Total: 99%
- A. 10%
- B. 20%
- C. 40% (Correct Answer)
- D. 30%
Explanation: ***40%*** - The **Rule of Nines** is used to estimate the percentage of total body surface area (TBSA) affected by burns in adults. - **Right upper extremity** (entire arm): 9% - **Right lower extremity** (entire leg): 18% - **Anterior chest**: The burn involves a significant portion of the anterior trunk, accounting for approximately 13% (more than half of the 18% anterior trunk) - **Total**: 9% + 18% + 13% = **40%** - This patient has a major burn requiring fluid resuscitation and likely transfer to a burn center. *10%* - This percentage is far too low for the described burn distribution, which includes an entire arm and an entire leg alone (27% combined). - A 10% burn would typically involve only one arm or the head. *20%* - This percentage significantly underestimates the extent of injury. - This would represent approximately one arm (9%) plus one leg (18%), but fails to account for the anterior chest burns. *30%* - While closer, 30% still underestimates the total body surface area affected. - This would account for the arm (9%) and leg (18%) but significantly underestimates the extent of anterior chest involvement described in the scenario.
Question 8: Which of the following is the most important initial step in managing a patient with extensive burns?
- A. Begin immediate fluid resuscitation with crystalloids
- B. Administer prophylactic antibiotics
- C. Perform immediate escharotomy for circumferential burns
- D. Secure the airway and assess for inhalation injury (Correct Answer)
Explanation: ***Secure the airway and assess for inhalation injury*** - **Airway management** is the most critical initial step in all trauma patients, including burns, following the **ABCDE protocol**. - In extensive burns, especially those involving **face/neck**, rapid airway swelling can occur due to **thermal injury** and inflammation, requiring early assessment for **inhalation injury signs** (singed nasal hairs, carbonaceous sputum, hoarse voice). *Begin immediate fluid resuscitation with crystalloids* - Critical for preventing **burn shock** in extensive burns and should begin promptly after airway assessment. - Uses formulas like **Parkland formula** for calculation and is part of **circulation management** in ABCDE protocol. *Perform immediate escharotomy for circumferential burns* - Important intervention for **circumferential full-thickness burns** causing **compartment syndrome**. - Should be performed when indicated, but only after **airway and breathing** are secured, as not all extensive burn patients have circumferential burns requiring immediate escharotomy. *Administer prophylactic antibiotics* - **NOT recommended** in initial burn management as it can promote **antibiotic resistance** and mask early infection signs. - Antibiotics should be reserved for treating **documented infections**.
Question 9: Which of the following statements about Nitrous Oxide (N2O) is true?
- A. Least potent inhalational anesthetic (Correct Answer)
- B. Lighter than air
- C. Effective muscle relaxant
- D. Does not cause diffusion hypoxia
Explanation: **Least potent inhalational anesthetic** - Nitrous oxide has a **high Minimum Alveolar Concentration (MAC)** of approximately 104%, making it the least potent of the commonly used inhalational anesthetics. - Its high MAC means a very high concentration is required to achieve surgical anesthesia, which is why it is typically used as an adjunct to more potent agents. *Lighter than air* - The molecular weight of nitrous oxide (N2O) is 44, which is **heavier than air** (average molecular weight approximately 29 g/mol). - Its density is greater than air, meaning it would tend to sink rather than rise. *Effective muscle relaxant* - Nitrous oxide provides **minimal to no skeletal muscle relaxation** benefits. - If muscle relaxation is required, a neuromuscular blocking agent must be administered separately. *Does not cause diffusion hypoxia* - Nitrous oxide rapidly diffuses out of the blood into the alveoli during emergence, diluting the oxygen and carbon dioxide there. - This rapid diffusion can lead to **diffusion hypoxia** (also known as the "second gas effect"), necessitating the administration of 100% oxygen during recovery to prevent this complication.
Question 10: Which of the following is the induction anesthesia of choice in the pediatric age group?
- A. A. Sevoflurane (Correct Answer)
- B. B. Desflurane
- C. C. Halothane
- D. D. Isoflurane
Explanation: ***A. Sevoflurane*** - **Sevoflurane** is an inhalation anesthetic widely preferred for **pediatric induction** due to its rapid onset and non-pungent odor, which makes it well-tolerated by children. - Its low blood-gas partition coefficient allows for swift changes in anesthetic depth and rapid emergence. *B. Desflurane* - **Desflurane** has a **pungent odor** and is known to cause airway irritation, making it unsuitable for inhalational induction in children. - Its rapid onset and offset are beneficial, but its irritant properties limit its use for induction, especially in younger patients. *C. Halothane* - **Halothane** was previously used for pediatric induction but has largely been replaced due to its association with **hepatotoxicity** and cardiac arrhythmias. - It also has a slower onset and offset compared to newer agents like sevoflurane. *D. Isoflurane* - **Isoflurane** has a **pungent odor** and can cause airway irritation, making it less suitable for inhalational induction in children compared to sevoflurane. - While effective for maintenance, its irritant properties make for a less smooth and potentially distressing induction experience for pediatric patients.
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