Burns Management — MCQs

10 questions

Fluid given in first 8 hours to a 28 years old woman with 50 kg weight having burns on both lower limbs?

Which of the following is not true about resuscitation in burns patients?

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?

Escharotomies are required in which degree/type of burns:

Curling ulcer is seen in:

In an accident involving potential cervical spine damage, the first line of management is:

A 17-year-old boy is admitted to the hospital after a road traffic accident. Per abdomen examination is normal. After adequate resuscitation, his pulse rate is 80/min and BP is 110/70 mm Hg. Abdominal CT reveals a laceration in the left lobe of the liver extending from the dome more than half way through the parenchyma. Appropriate management at this time would be:

In which of the following conditions is neurosurgery not indicated?

Q10

All of the following are causes of death in burn patients except

Burns Management Indian Medical PG Practice Questions and MCQs

Question 1: 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 2: Which of the following is not true about resuscitation in burns patients?

A. Target mean arterial pressure in resuscitation is 60 mmHg.
B. Ringer's lactate is the preferred crystalloid solution.
C. Quantity of crystalloid needed is calculated using the Parkland formula - 6 mL/kg body weight per % of the total body surface area burnt. (Correct Answer)
D. Fluid shift from intravascular to extravascular compartment in the burns patient is maximum in the first 24 hours.

Explanation: ***Quantity of crystalloid needed is calculated using the Parkland formula - 6 mL/kg body weight per % of the total body surface area burnt.*** - The **Parkland formula** is **4 mL/kg/%TBSA burned**, not 6 mL/kg/%TBSA. This formula is used to calculate the total fluid needed in the first 24 hours (half in the first 8 hours, remaining half in the next 16 hours). - This incorrect statement makes this the correct answer to the "not true" question. - The correct formula helps estimate intravenous fluid requirements to maintain adequate organ perfusion and prevent burn shock. *Target mean arterial pressure in resuscitation is 60 mmHg.* - This statement is TRUE. The target mean arterial pressure (MAP) in burn resuscitation is usually **60-70 mmHg** in adults to ensure adequate organ perfusion. - A MAP of ≥60 mmHg is the standard threshold for maintaining perfusion to vital organs during resuscitation. *Ringer's lactate is the preferred crystalloid solution.* - This statement is TRUE. **Ringer's lactate (Hartmann's solution)** is the preferred crystalloid for burn resuscitation due to its balanced electrolyte composition. - It closely mimics extracellular fluid and helps prevent hyperchloremic acidosis that can occur with large volumes of normal saline. *Fluid shift from intravascular to extravascular compartment in the burns patient is maximum in the first 24 hours.* - This statement is TRUE. The peak period for **capillary leak** and fluid shift into the extravascular space occurs within the first 8-24 hours post-burn. - This massive fluid shift leads to edema formation and is the reason aggressive fluid resuscitation is needed during this critical period.

Question 3: 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 4: 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 5: Escharotomies are required in which degree/type of burns:

A. 1st degree
B. 3rd degree (full thickness) (Correct Answer)
C. Electrical
D. 2nd degree superficial

Explanation: ***3rd degree (full thickness)*** - **Full-thickness burns** destroy all layers of the skin, including nerve endings, making the burn site **insensate** and forming a tough, non-elastic eschar. - This **rigid eschar** can impair circulation, especially in circumferential burns, and restrict ventilation in thoracic burns, necessitating **escharotomies** to relieve pressure and restore blood flow or breathing. *1st degree* - **First-degree burns** only affect the epidermis, causing redness and mild pain without blistering; they do not form a constricting eschar. - These burns heal spontaneously within a few days and do not require surgical intervention like **escharotomies**. *Electrical* - **Electrical burns** can cause deep tissue damage and internal organ injury, but the primary concern is often cardiac arrhythmias and deep tissue necrosis rather than a constricting eschar that requires escharotomy. - While they can lead to full-thickness skin damage, **escharotomy** is performed if a full thickness burn with constricting eschar. The primary reason for escharotomy is the nature of the burn not its cause. *2nd degree superficial* - **Superficial partial-thickness burns** involve the epidermis and superficial dermis, causing blisters, pain, and redness, but the skin remains pliable and does not form a constricting eschar. - These burns typically heal without scarring and do not require **escharotomies**.

Question 6: Curling ulcer is seen in:

A. Corticosteroids
B. Burn (Correct Answer)
C. TPN
D. Head injury

Explanation: ***Burn*** - **Curling's ulcer** is a type of acute peptic ulcer that can develop in the **duodenum** in patients suffering from severe burns. - It is believed to be caused by **ischemia** due to reduced plasma volume and systemic vasoconstriction following the burn injury, leading to decreased blood flow to the gastrointestinal tract. *Corticosteroids* - Corticosteroid use can increase the risk of **peptic ulcer disease** by impairing mucosal defense and inhibiting prostaglandin synthesis. - However, the ulcers associated with corticosteroids are not specifically termed Curling's ulcers; this term is reserved for ulcers caused by severe burns. *TPN* - Total Parenteral Nutrition (TPN) itself does not directly cause specific ulcers like Curling's ulcers. - Complications of TPN can include issues like **cholestasis** or **catheter-related infections**, but not acute stress ulcers. *Head injury* - Acute gastric ulcers that can develop after a severe head injury or other central nervous system trauma are known as **Cushing's ulcers**. - These ulcers are thought to be caused by **increased vagal stimulation** and excessive gastric acid secretion.

Question 7: In an accident involving potential cervical spine damage, the first line of management is:

A. x-ray
B. turn head to side
C. maintain airway (Correct Answer)
D. stabilize the cervical spine

Explanation: ***Correct: Maintain airway*** - In trauma management, the **ATLS protocol** follows the **A-B-C-D-E** approach where **Airway is the first priority** - In suspected cervical spine injury, airway management is performed **with concurrent cervical spine protection** (using jaw thrust maneuver instead of head tilt-chin lift) - A compromised airway leads to death within minutes, making it the **immediate first-line intervention** - **Cervical spine stabilization is performed simultaneously** during airway assessment and management, not as a separate preceding step - The correct approach: **"Airway with cervical spine protection"** - both are done together, but airway assessment/management takes priority *Incorrect: Stabilize the cervical spine* - While **cervical spine stabilization** is critical and must be maintained throughout trauma management, it is **not performed before airway assessment** - Manual inline stabilization and cervical collar application are done **during** airway management, not before it - ATLS teaches that C-spine protection is **integrated into** airway management, not a separate first step *Incorrect: X-ray* - **X-ray** is a diagnostic tool performed after initial stabilization and resuscitation - Imaging is part of the **secondary survey**, not primary trauma management - Never delay life-saving interventions for diagnostic studies *Incorrect: Turn head to side* - **Turning the head** is absolutely contraindicated in suspected cervical spine injury - Any movement can convert an unstable fracture into a **complete spinal cord injury** - If airway management is needed, use **jaw thrust** or **chin lift without head tilt**

Question 8: A 17-year-old boy is admitted to the hospital after a road traffic accident. Per abdomen examination is normal. After adequate resuscitation, his pulse rate is 80/min and BP is 110/70 mm Hg. Abdominal CT reveals a laceration in the left lobe of the liver extending from the dome more than half way through the parenchyma. Appropriate management at this time would be:

A. Conservative treatment (Correct Answer)
B. Abdominal exploration and packing of hepatic wounds
C. Abdominal exploration and ligation of left hepatic artery
D. Left hepatectomy

Explanation: ***Conservative treatment*** - The patient is **hemodynamically stable** after resuscitation, with normal vital signs (pulse 80/min, BP 110/70 mm Hg), and his abdominal exam is normal despite a liver laceration. - A laceration extending more than halfway through the left hepatic lobe represents a **Grade III liver injury**. In hemodynamically stable patients, non-operative management is the preferred approach for most blunt liver injuries, including Grade III injuries, with success rates exceeding 90%. - Conservative management includes **serial clinical monitoring**, hemoglobin checks, and repeat imaging if needed, with intervention only if the patient deteriorates. *Abdominal exploration and packing of hepatic wounds* - This aggressive approach is typically reserved for patients with **hemodynamic instability** due to ongoing hemorrhage from liver trauma or those who fail non-operative management. - Perihepatic packing is a damage control technique for severe, uncontrolled bleeding, but it is not indicated for a stable patient as it comes with risks including **infection**, abdominal compartment syndrome, and the need for re-operation. *Abdominal exploration and ligation of left hepatic artery* - Hepatic artery ligation is a measure used to control **severe arterial bleeding** from hepatic injuries, usually via angioembolization (preferred) or surgical ligation in highly unstable patients after other methods have failed. - While the liver has a dual blood supply (hepatic artery and portal vein), this intervention carries risks of hepatic **necrosis** and abscess formation, which are unwarranted in a stable patient suitable for conservative management. *Left hepatectomy* - **Resective surgery** like hepatectomy is indicated for severe and complex liver injuries involving massive tissue destruction, complete devascularization, or injuries to major intrahepatic vessels causing persistent hemorrhage despite other interventions. - This patient's stable hemodynamics make major surgical resection unnecessary and inappropriate, as hepatectomy carries significant **morbidity and mortality** (10-20% mortality rate for major hepatic resections in trauma).

Question 9: In which of the following conditions is neurosurgery not indicated?

A. Subdural hematoma (SDH)
B. Epidural hematoma (EDH)
C. Diffuse axonal injury (DAI) (Correct Answer)
D. Intracerebral hemorrhage

Explanation: ***Diffuse axonal injury (DAI)*** - Neurosurgery is generally **not indicated** for diffuse axonal injury because the primary damage involves widespread shearing of axons throughout the white matter, rather than a focal, surgically accessible lesion. - Management of DAI is primarily **supportive**, focusing on managing intracranial pressure and optimizing cerebral perfusion, as there is no specific surgical intervention to reverse the axonal damage. *Subdural hematoma (SDH)* - Surgical intervention, such as a **craniotomy** or **burr hole drainage**, is often indicated for acute or subacute subdural hematomas, especially when they are large, causing mass effect, or leading to neurological deterioration. - The goal of surgery is to **evacuate the blood clot** and relieve pressure on the brain. *Epidural hematoma (EDH)* - **Epidural hematomas** are typically surgical emergencies that require urgent craniotomy for evacuation of the hematoma to relieve pressure on the brain. - This is due to their rapid development and tendency to cause significant **mass effect** and brain herniation. *Intracerebral hemorrhage* - Neurosurgery may be indicated for certain types of **intracerebral hemorrhage (ICH)**, particularly those that are superficial, large, causing significant mass effect, or located in a surgically accessible area. - The decision for surgery often depends on the **size and location of the bleed**, the patient's neurological status, and the risk of further deterioration.

Question 10: 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.

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