Integumentary Flashcards
a. Necrotizing fasciitis b. Burns i. Depth ii. TBSA iii. Parkland formula c. SJS/TEN d. Pressure injuries i. Prevention ii. Staging
1
Q
- Question: A patient with a history of major burns (>15% TBSA) requires fluid resuscitation. What formula is most appropriate to calculate their fluid needs for the first 24 hours?
* A) 3 mL/kg/TBSA
* B) 4 mL/kg/TBSA
* C) 5 mL/kg/TBSA
* D) 6 mL/kg/TBSA
A
Answer: B) 4 mL/kg/TBSA
2
Q
- Question: In Stevens-Johnson Syndrome (SJS), which sign is diagnostic?
* A) Nikolsky sign
* B) Tinel’s sign
* C) Babinski sign
* D) Chvostek’s sign
A
Answer: A) Nikolsky sign
3
Q
Which intervention is most appropriate for a patient with SJS involving >30% of the body surface area?
* A) Discontinue the offending drug
* B) Apply topical corticosteroids
* C) Administer antibiotics
* D) Perform a skin biopsy
A
Answer: A) Discontinue the offending drug
4
Q
- Question: What is the Parkland formula for a 70 kg patient with 40% TBSA burns?
* A) 4,000 mL over 24 hours
* B) 8,400 mL over 24 hours
* C) 11,200 mL over 24 hours
* D) 16,800 mL over 24 hours
A
Answer: C) 11,200 mL over 24 hours
5
Q
- Question: Which burn depth is characterized by a cherry-red appearance that does not blanch?
* A) Superficial partial thickness
* B) Deep partial thickness
* C) Full thickness
* D) Fourth-degree
A
Answer: B) Deep partial thickness
6
Q
What is the target urine output for burn resuscitation in thermal injuries?
* A) 0.25 mL/kg/hr
* B) 0.5 mL/kg/hr
* C) 1 mL/kg/hr
* D) 2 mL/kg/hr
A
Answer: B) 0.5 mL/kg/hr
7
Q
- Question: What is the Parkland formula calculation for a 60 kg patient with 50% TBSA burns?
* A) 6,000 mL
* B) 8,000 mL
* C) 12,000 mL
* D) 15,000 mL
A
Answer: C) 12,000 mL
8
Q
Which depth of burn requires silver sulfadiazine for wound care?
* A) Superficial burns
* B) Superficial partial-thickness burns
* C) Deep partial-thickness burns
* D) First-degree burns
A
Answer: C) Deep partial-thickness burns
9
Q
What is the Parkland formula calculation for a 60 kg patient with 50% TBSA burns?
* A) 6,000 mL
* B) 8,000 mL
* C) 12,000 mL
* D) 15,000 mL
A
Answer: C) 12,000 mL
10
Q
Necrotizing Fasciitis
A 57-year-old male with a history of diabetes presents with severe pain in his left leg. On exam, the leg appears swollen with erythema and bullae. Crepitus is palpable, and his vital signs show BP 85/50 mmHg, HR 135 bpm, Temp 102.3°F.
1. What is the immediate priority for managing this patient?
A) Administer IV antibiotics
B) Perform immediate surgical debridement
C) Order blood cultures and imaging studies
D) Begin IV fluids and vasopressors
A
D) Begin IV fluids and vasopressors
11
Q
- Which diagnostic test is most specific for necrotizing fasciitis?
A) Plain X-ray
B) MRI of the affected limb
C) White blood cell count
D) Serum creatine phosphokinase (CPK)
A
Answer: B) MRI of the affected limb
12
Q
A 40-year-old woman sustains 40% TBSA burns in a house fire. She weighs 70 kg and has soot in her mouth with singed nasal hairs.
1. What is the initial step in managing her airway?
A) Perform rapid sequence intubation
B) Administer 100% oxygen via face mask
C) Assess vocal cord function
D) Obtain ABGs
A
Answer: A) Perform rapid sequence intubation
13
Q
- Using the Parkland formula, how much fluid should she receive in the first 8 hours?
A) 4,200 mL
B) 5,600 mL
C) 8,400 mL
D) 11,200 mL
A
Answer: B) 5,600 mL (4 mL × 70 kg × 40% ÷ 2 for first 8 hours)
14
Q
SJS/TEN
A 35-year-old male develops a painful, peeling rash with mucosal ulcers 10 days after starting allopurinol. He is febrile, tachycardic, and hypotensive.
1. What is the most critical first step in management?
A) Administer corticosteroids
B) Discontinue allopurinol
C) Admit to a burn unit
D) Start IV fluids
A
Answer: B) Discontinue allopurinol
15
Q
SJS/TEN
2. What supportive care is essential to prevent mortality in this patient?
A) Empiric antibiotic therapy
B) Aggressive fluid and electrolyte management
C) Wound debridement in the operating room
D) Plasma exchange therapy
A
Answer: B) Aggressive fluid and electrolyte management
16
Q
A 72-year-old male in a long-term care facility has developed a sacral pressure injury with exposed adipose tissue and tunneling. His BMI is 18.5, and labs show albumin of 2.8 g/dL.
1. What is the most appropriate wound care for this stage 3 pressure injury?
A) Wet-to-dry dressings
B) Foam dressing with enzymatic debridement
C) Sharp debridement in the OR
D) Negative pressure wound therapy
A
Answer: B) Foam dressing with enzymatic debridement
17
Q
- What nutritional support should be provided to promote wound healing?
A) High-fat diet with vitamin D supplementation
B) High-protein diet with multivitamins
C) Low-protein diet to avoid renal stress
D) Carbohydrate-focused diet for energy
A
Answer: B) High-protein diet with multivitamins
18
Q
- What is the primary pathophysiologic mechanism of necrotizing fasciitis?
A) Immune-mediated vasculitis
B) Rapidly spreading infection of subcutaneous tissues and fascia
C) Gradual inflammatory process involving dermis
D) Ischemia caused by vascular occlusion
A
Answer: B) Rapidly spreading infection of subcutaneous tissues and fascia
19
Q
- Which diagnostic clue strongly suggests necrotizing fasciitis?
A) Localized erythema and swelling
B) Crepitus and severe pain out of proportion to clinical findings
C) Mild fever with draining abscess
D) Pruritic rash
A
Answer: B) Crepitus and severe pain out of proportion to clinical findings
20
Q
he primary management for necrotizing fasciitis includes:
A) Oral antibiotics and observation
B) Surgical debridement and IV antibiotics
C) Antihistamines and topical steroids
D) Hyperbaric oxygen therapy alone
A
Answer: B) Surgical debridement and IV antibiotics
21
Q
- What complication is most likely if necrotizing fasciitis is left untreated?
A) Sepsis and multi-organ failure
B) Chronic pain syndrome
C) Skin hyperpigmentation
D) Joint contractures
A
Answer: A) Sepsis and multi-organ failure
22
Q
- A full-thickness burn involves damage to:
A) Epidermis only
B) Epidermis and partial dermis
C) Epidermis, dermis, and subcutaneous tissues
D) Epidermis and superficial fascia only
A
Answer: C) Epidermis, dermis, and subcutaneous tissues
23
Q
- When assessing burn severity, what is the most critical factor affecting initial resuscitation efforts?
A) Depth of the burn
B) Location of the burn
C) Total Body Surface Area (TBSA) affected
D) Patient’s age
A
Answer: C) Total Body Surface Area (TBSA) affected
24
Q
- The Parkland formula for fluid resuscitation is:
A) 4 mL/kg/% TBSA in the first 24 hours, half in the first 8 hours
B) 2 mL/kg/% TBSA in the first 12 hours, evenly distributed
C) 5 mL/kg/% TBSA in the first 48 hours, evenly distributed
D) 3 mL/kg/% TBSA in the first 24 hours, half in the first 12 hours
A
Answer: A) 4 mL/kg/% TBSA in the first 24 hours, half in the first 8 hours
25
8. Which intervention is crucial for a burn patient with inhalation injury?
A) Early intubation and supplemental oxygen
B) Topical silver sulfadiazine application
C) Continuous electrolyte monitoring
D) Administering beta-blockers
Answer: A) Early intubation and supplemental oxygen
26
9. The leading cause of death in patients with extensive burns is:
A) Hypothermia
B) Sepsis
C) Neuropathy
D) Chronic scar formation
Answer: B) Sepsis
27
10. SJS/TEN is primarily caused by:
A) Bacterial infections
B) Drug hypersensitivity reactions
C) UV radiation exposure
D) Prolonged contact dermatitis
Answer: B) Drug hypersensitivity reactions
28
11. Which clinical feature is most indicative of SJS/TEN?
A) Urticaria with blanching rash
B) Painful mucosal involvement with epidermal detachment
C) Non-blanchable petechiae
D) Pruritic vesicles
Answer: B) Painful mucosal involvement with epidermal detachment
29
12. First-line treatment for SJS/TEN includes:
A) Immediate corticosteroids and antibiotics
B) Supportive care in a burn unit or ICU
C) Cyclosporine and antiviral therapy
D) Antihistamines and topical emollients
Answer: B) Supportive care in a burn unit or ICU
30
13. The most critical complication of SJS/TEN is:
A) Secondary infection and sepsis
B) Permanent vision loss
C) Hyperpigmentation of skin
D) Chronic itching
Answer: A) Secondary infection and sepsis
31
14. What is the primary cause of pressure injuries?
A) Trauma from shearing forces
B) Prolonged unrelieved pressure leading to ischemia
C) Bacterial skin infections
D) Vitamin deficiency
Answer: B) Prolonged unrelieved pressure leading to ischemia
32
15. A wound with exposed bone or tendon and slough that cannot be removed is classified as:
A) Stage 2 pressure injury
B) Unstageable pressure injury
C) Stage 4 pressure injury
D) Deep tissue injury
Answer: B) Unstageable pressure injury
33
16. The most effective prevention strategy for pressure injuries is:
A) Antibiotics and nutritional supplementation
B) Frequent repositioning and offloading pressure
C) Moisture-retentive dressings
D) Early surgical intervention
Answer: B) Frequent repositioning and offloading pressure
34
17. What is the most serious complication of a stage 4 pressure injury?
A) Chronic pain
B) Delayed wound healing
C) Osteomyelitis and sepsis
D) Hypertrophic scarring
Answer: C) Osteomyelitis and sepsis
35
A patient presents with signs and symptoms resembling cellulitis but rates his pain higher than expected. What diagnosis would you include in your differential?
Group of answer choices:
* Stevens-Johnson syndrome
* Necrotizing fasciitis
* Sepsis
* Erythema multiforme
* Necrotizing fasciitis (Correct Answer)
Rationale: Necrotizing fasciitis typically presents with severe pain that is out of proportion to clinical findings and is a critical condition requiring immediate intervention.
36
A patient presents with a 72% total body surface area burn. The patient weighs 95 kg. What is his 24-hour fluid requirement?
Group of answer choices:
* 6,840 ml
* 27,360 ml
* 13,680 ml
* 20,520 ml
* 27,360 ml (Correct Answer)
Rationale: Using the Parkland formula:
4 ml × body weight (kg) × TBSA (%) = fluid requirement in 24 hours.
4 × 95 × 72 = 27,360 ml.
36
In an adult with burns on the anterior torso, both arms (front only), and the perineum, what is the estimated TBSA affected?
A) 28%
B) 31%
C) 36%
D) 40%
Answer: A) 28%
37
A child has burns on the front of their torso and the entire head. According to the Rule of Nines for children, what percentage of TBSA is affected?
A) 27%
B) 36%
C) 45%
D) 54%
Answer: B) 36%
38
A burn patient has injuries covering the posterior torso and one arm (front and back). What is the total TBSA affected in an adult?
A) 9%
B) 18%
C) 27%
D) 36%
Answer: C) 27%
39
In an adult, if both legs (front and back) are burned, what is the total percentage of TBSA affected?
A) 18%
B) 27%
C) 36%
D) 45%
Answer: C) 36%
40
According to the Rule of Nines, what percentage of TBSA is assigned to the anterior torso in an adult?
A) 9%
B) 18%
C) 27%
D) 36%
Answer: B) 18%
41
What differentiates Stevens-Johnson syndrome from toxic epidermal necrolysis?
Group of answer choices:
* Mucous membrane involvement
* Epidermal detachment
* Skin erosion
* Total body surface area involved
Total body surface area involved (Correct Answer)
Rationale: Stevens-Johnson syndrome involves <10% TBSA, while toxic epidermal necrolysis involves >30% TBSA. Between 10-30% TBSA is considered an overlap syndrome.
42
What is an important diagnostic assessment when working up a patient with suspected Stevens-Johnson syndrome?
Group of answer choices:
* Asboe-Hansen sign
* Nikolsky sign
* Homan’s sign
* Auspitz sign
Nikolsky sign (Correct Answer)
Rationale: Nikolsky sign, which involves the detachment of the epidermis when slight pressure is applied, is an important diagnostic marker for Stevens-Johnson syndrome.
43
8. Which intervention is crucial for a burn patient with inhalation injury?
A) Early intubation and supplemental oxygen
B) Topical silver sulfadiazine application
C) Continuous electrolyte monitoring
D) Administering beta-blockers
Answer: A) Early intubation and supplemental oxygen
44
9. The leading cause of death in patients with extensive burns is:
A) Hypothermia
B) Sepsis
C) Neuropathy
D) Chronic scar formation
Answer: B) Sepsis
45
10. SJS/TEN is primarily caused by:
A) Bacterial infections
B) Drug hypersensitivity reactions
C) UV radiation exposure
D) Prolonged contact dermatitis
Answer: B) Drug hypersensitivity reactions
46
11. Which clinical feature is most indicative of SJS/TEN?
A) Urticaria with blanching rash
B) Painful mucosal involvement with epidermal detachment
C) Non-blanchable petechiae
D) Pruritic vesicles
Answer: B) Painful mucosal involvement with epidermal detachment
47
12. First-line treatment for SJS/TEN includes:
A) Immediate corticosteroids and antibiotics
B) Supportive care in a burn unit or ICU
C) Cyclosporine and antiviral therapy
D) Antihistamines and topical emollients
Answer: B) Supportive care in a burn unit or ICU
48
13. The most critical complication of SJS/TEN is:
A) Secondary infection and sepsis
B) Permanent vision loss
C) Hyperpigmentation of skin
D) Chronic itching
Answer: A) Secondary infection and sepsis
49
14. What is the primary cause of pressure injuries?
A) Trauma from shearing forces
B) Prolonged unrelieved pressure leading to ischemia
C) Bacterial skin infections
D) Vitamin deficiency
Answer: B) Prolonged unrelieved pressure leading to ischemia
50
15. A wound with exposed bone or tendon and slough that cannot be removed is classified as:
A) Stage 2 pressure injury
B) Unstageable pressure injury
C) Stage 4 pressure injury
D) Deep tissue injury
Answer: B) Unstageable pressure injury
51
17. What is the most serious complication of a stage 4 pressure injury?
A) Chronic pain
B) Delayed wound healing
C) Osteomyelitis and sepsis
D) Hypertrophic scarring
Answer: C) Osteomyelitis and sepsis
52
1. What is the initial phase of normal wound healing?
A) Inflammation
B) Hemostasis
C) Remodeling
D) Angiogenesis
Answer: B) Hemostasis
53
2. Which of the following factors is NOT a common contributor to chronic wound formation?
A) Diabetes
B) Ischemia
C) Excessive exercise
D) Corticosteroid use
Answer: C) Excessive exercise
54
3. A patient presents with intact skin and non-blanchable erythema over a bony prominence. What stage of pressure injury does this represent?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Answer: A) Stage 1
55
4. What distinguishes a stage 4 pressure injury from a stage 3?
A) Presence of slough
B) Exposure of muscle or bone
C) Granulation tissue in the wound bed
D) Undermining or tunneling
Answer: B) Exposure of muscle or bone
56
5. What is the most appropriate first step in managing a stage 1 pressure injury?
A) Apply enzymatic debridement
B) Offload pressure and monitor
C) Perform sharp debridement
D) Start antibiotic therapy
Answer: B) Offload pressure and monitor
57
6. Which of the following treatments is contraindicated for stable eschar on an ischemic heel?
A) Moist dressing
B) Surgical debridement
C) Offloading pressure
D) Monitoring for infection
Answer: B) Surgical debridement
58
7. What is the primary complication of an unstageable pressure injury if left untreated?
A) Pain
B) Infection and sepsis
C) Loss of sensation
D) Hypergranulation
Answer: B) Infection and sepsis
59
8. Which of the following is a common complication of deep tissue injuries?
A) Rapid healing
B) Evolution into stage 3 or 4 pressure injuries
C) Dry wound bed
D) Decreased blood supply
Answer: B) Evolution into stage 3 or 4 pressure injuries
60
1. Which of the following is the most common causative agent for cellulitis?
A) Pseudomonas
B) Clostridium
C) Staphylococcus or Streptococcus
D) Escherichia coli
Answer: C) Staphylococcus or Streptococcus
61
2. A purulent wound in cellulitis is most likely caused by which organism?
A) Group A Streptococcus
B) MRSA
C) Clostridium perfringens
D) Escherichia coli
Answer: B) MRSA
62
1. Which of the following conditions should prompt consideration of an aminoglycoside, fluoroquinolone, or third-generation cephalosporin for cellulitis treatment?
A) Animal bite
B) Freshwater contamination
C) Human bite
D) None of the above
Answer: B) Freshwater contamination
63
4. What is the primary diagnostic approach for cellulitis?
A) Wound culture
B) Patient history and clinical presentation
C) Skin biopsy
D) MRI
Answer: B) Patient history and clinical presentation
64
6. Which diagnostic test is most commonly used for suspected necrotizing fasciitis?
A) MRI
B) CT scan
C) X-ray
D) Ultrasound
Answer: B) CT scan
65
7. Fournier’s gangrene refers to necrotizing fasciitis affecting which area?
A) Extremities
B) Abdominal wall
C) Perineal area
D) Post-operative sites
Answer: C) Perineal area
66
8. What is the initial surgical treatment for necrotizing fasciitis?
A) Skin grafting
B) Amputation
C) Surgical debridement
D) Antibiotic therapy alone
Answer: C) Surgical debridement
67
9. What is the primary cause of Steven-Johnson Syndrome (SJS) and TEN?
A) Bacterial infections
B) Adverse drug reactions
C) Viral infections
D) Environmental factors
Answer: B) Adverse drug reactions
68
10. Which diagnostic test can confirm SJS/TEN?
A) Biopsy
B) CT scan
C) Nikolsky sign
D) Both A and C
Answer: D) Both A and C
69
11. In patients with SJS/TEN, involvement of which mucous membrane significantly increases mortality risk?
A) Conjunctiva
B) Oropharynx
C) Urethra
D) Respiratory tract
Answer: D) Respiratory tract
70
>20% total body surface area involvement?
A) 0.1-0.5 mL/kg/hr
B) 0.5-1 mL/kg/hr
C) 2-4 mL/kg/hr
D) 5-6 mL/kg/hr
Answer: C) 2-4 mL/kg/hr
71
13. Which of the following burn types involves the epidermis only?
A) Superficial partial-thickness burn
B) Full-thickness burn
C) First-degree burn
D) Deep partial-thickness burn
Answer: C) First-degree burn
72
14. What is the most common cause of burn injuries in the United States?
A) Electrical burns
B) Chemical burns
C) Thermal burns
D) Frostbite
Answer: C) Thermal burns
73
15. The rule of nines estimates total body surface area for burns. What percentage is assigned to the anterior torso?
A) 9%
B) 18%
C) 27%
D) 36%
Answer: B) 18%
74
16. Which characteristic is associated with full-thickness burns?
A) Blisters with pink, moist tissue
B) Leathery appearance, non-blanchable
C) Bright red and moist wound bed
D) Superficial dry skin
Answer: B) Leathery appearance, non-blanchable
75
17. What is the first-line treatment for inhalation injuries resulting from structural fires?
A) Carbon monoxide antidote
B) High-flow oxygen
C) Antibiotics
D) Bronchoscopy
Answer: B) High-flow oxygen
76
18. Which burn severity is classified as major?
A) Full-thickness burns <2% TBSA
B) Superficial partial-thickness burns >15% TBSA
C) Second-degree burns <15% TBSA
D) First-degree burns covering the back and chest
Answer: B) Superficial partial-thickness burns >15% TBSA
77
A 65-year-old diabetic patient presents with rapidly spreading erythema and swelling in the left thigh following a minor cut. He describes severe pain disproportionate to the appearance of the wound. Examination reveals bullae with a dusky appearance and crepitus on palpation.
Question: What is the next best step in management?
A) Prescribe oral antibiotics and discharge
B) Perform wound culture and start antibiotics
C) Immediate surgical debridement
D) Order an MRI for detailed imaging
Necrotizing Fasciitis
Answer: C) Immediate surgical debridement
78
SJS Presentation
A 40-year-old woman reports a 7-day history of fever, malaise, and purpuric macules on her face and torso after starting allopurinol. Examination reveals dusky areas of skin with epidermal sloughing. Mucous membrane involvement is noted in the oropharynx.
Question: What is the initial management priority?
A) Start topical corticosteroids
B) Discontinue allopurinol immediately
C) Perform a skin biopsy
D) Start oral antibiotics
Answer: B) Discontinue allopurinol immediately
79
A 28-year-old man presents after spilling boiling water on his arm. The affected area is moist, pink, and blanches with pressure. Capillary refill is delayed. The total affected area is 6% of the body surface area.
Question: What is the classification of this burn?
A) First-degree
B) Superficial partial-thickness
C) Deep partial-thickness
D) Full-thickness
Answer: C) Deep partial-thickness
80
Inhalation Injury
A 50-year-old woman was rescued from a house fire and presents with soot around her nose and mouth. She has a hoarse voice and mild difficulty breathing.
Question: What is the immediate next step?
A) Order a chest X-ray
B) Administer high-flow oxygen
C) Perform a bronchoscopy
D) Start IV antibiotics
Answer: B) Administer high-flow oxygen
81
Animal Bite Cellulitis
A 29-year-old man is bitten by a dog on his hand. Two days later, he develops erythema, warmth, and swelling around the wound.
Question: What is the most appropriate antibiotic choice?
A) Ciprofloxacin
B) Amoxicillin-clavulanate
C) Clindamycin
D) Trimethoprim-sulfamethoxazole
Answer: B) Amoxicillin-clavulanate
82
A 55-year-old man with a history of alcohol use disorder presents with pain, redness, and swelling in his left calf following a minor laceration. The pain is severe and disproportionate to the physical findings.
Question: Which risk factor in his history increases his likelihood of necrotizing fasciitis?
A) Age
B) Alcohol use disorder
C) Minor laceration
D) Recent travel
Answer: B) Alcohol use disorder
83
A 60-year-old man with a new diagnosis of gout presents with fever, malaise, and widespread purpuric macules that have progressed to epidermal detachment involving 15% of his body surface area.
Question: What is the diagnosis?
A) Steven-Johnson Syndrome
B) Toxic Epidermal Necrolysis
C) SJS/TEN overlap
D) Erythema multiforme
Answer: C) SJS/TEN overlap
84
Burn Transfer Criteria
A 72-year-old woman suffers burns covering 25% of her body in a structural fire. She has hoarseness and carbonaceous sputum.
Question: What is the most appropriate course of action?
A) Treat in the local hospital burn unit
B) Transfer to a burn center
C) Start IV fluids and monitor locally
D) Discharge with outpatient follow-up
Answer: B) Transfer to a burn center
85
2. When calculating total body surface area for burns, which types of burns are included?
A) First, second, and third-degree burns
B) Second and third-degree burns only
C) Only third-degree burns
D) Superficial burns and partial-thickness burns
Answer: B) Second and third-degree burns only
86
3. Using the Parkland formula, how much fluid should a 70 kg patient with 30% TBSA burns receive in the first 8 hours?
A) 4,200 mL
B) 8,400 mL
C) 2,100 mL
D) 9,000 mL
Answer: A) 4,200 mL
(Parkland formula: 4 mL x TBSA x kg; total = 8,400 mL in 24 hours, half given in 8 hours.)
87
4. What is the target urine output for a burn patient with electrical injuries?
A) 0.5 mL/kg/hr
B) 1.0 mL/kg/hr
C) 2.0 mL/kg/hr
D) 1.5 mL/kg/hr
Answer: B) 1.0 mL/kg/hr
88
5. What is the immediate treatment for carbon monoxide poisoning in burn patients?
A) Intravenous fluids
B) Hyperbaric oxygen therapy
C) 100% oxygen via non-rebreather mask
D) Mechanical ventilation
Answer: C) 100% oxygen via non-rebreather mask
89
6. Which physical sign suggests airway injury in a burn patient?
A) Hoarseness and singed nasal hairs
B) Rapid capillary refill
C) Non-blanchable erythema
D) Clear chest X-ray
Answer: A) Hoarseness and singed nasal hairs
90
7. Circumferential burns of the chest are most concerning due to their impact on:
A) Circulation
B) Thermoregulation
C) Breathing
D) Wound healing
Answer: C) Breathing
91
8. What is the primary purpose of an escharotomy in burn patients?
A) Prevent sepsis
B) Reduce compartment syndrome risk
C) Promote wound healing
D) Increase nutritional absorption
Answer: B) Reduce compartment syndrome risk
92
9. Which complication of electrical burns is most associated with acute kidney injury?
A) Fluid overload
B) Rhabdomyolysis
C) Hyperkalemia
D) Tetanus
Answer: B) Rhabdomyolysis
93
10. In patients with large burns, systemic antibiotics should be administered when:
A) Blisters are present
B) The patient has a fever above 38.5°C
C) Signs of systemic infection are evident
D) Tetanus prophylaxis is overdue
Answer: C) Signs of systemic infection are evident
94
11. What type of diet is most appropriate for burn patients to support wound healing?
A) Low protein, high fat
B) High protein, low fat
C) Low carbohydrate, low protein
D) High fat, high carbohydrate
Answer: B) High protein, low fat
95
12. Which interprofessional team member is crucial in managing nutrition for burn patients?
A) Physical therapist
B) Occupational therapist
C) Dietitian
D) Social worker
Answer: C) Dietitian
96
13. What is the AMPLE history used for in burn care?
A) Assessing airway compromise
B) Calculating TBSA for fluid resuscitation
C) Collecting allergies, medications, past medical history, last meal, and events
D) Estimating total nutritional requirements
Answer: C) Collecting allergies, medications, past medical history, last meal, and events
97
14. Which wounds are generally left uncovered in burn patients?
A) Circumferential chest burns
B) Facial and head burns
C) Blisters on extremities
D) Deep partial-thickness burns
Answer: B) Facial and head burns
98
A) Frequent systemic antibiotics
B) Applying topical antimicrobial agents
C) Keeping wounds dry and uncovered
D) Performing daily escharotomies
Answer: B) Applying topical antimicrobial agents
99
1. Which of the following is a primary sign of under-resuscitation in a burn patient?
A) Pulmonary edema
B) Lactic acidosis
C) Hyperglycemia
D) Decreased urine specific gravity
Answer: B) Lactic acidosis
100
2. Which physical finding would most likely indicate the need for early intubation in a burn patient?
A) Soot in the oropharynx
B) Hoarseness with clear lungs
C) Chest wall burns
D) Blisters on the arms
Answer: A) Soot in the oropharynx
101
3. In the Parkland formula, why are first-degree burns excluded from the total body surface area calculation?
A) They do not contribute to fluid loss
B) They heal without medical intervention
C) They have less impact on metabolic demand
D) They are superficial and not life-threatening
Answer: A) They do not contribute to fluid loss
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4. What is the most likely outcome if a circumferential burn on the extremity is left untreated?
A) Hyperglycemia
B) Thrombocytopenia
C) Compartment syndrome
D) Rhabdomyolysis
Answer: C) Compartment syndrome
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5. Which burn-related complication requires immediate involvement of the pharmacist to adjust medication doses?
A) Hyperglycemia
B) Sepsis with altered fluid dynamics
C) Acute kidney injury
D) Circumferential chest burns
C) Acute kidney injury
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1. Which of the following is the primary goal of fluid resuscitation in burn patients?
A) Prevent pulmonary edema
B) Maintain adequate tissue perfusion
C) Reduce the risk of infection
D) Increase metabolic rate for wound healing
Answer: B) Maintain adequate tissue perfusion
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2. What is the most common complication associated with over-resuscitation in burn patients?
A) Lactic acidosis
B) Hyperglycemia
C) Pulmonary edema
D) Rhabdomyolysis
Answer: C) Pulmonary edema
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3. Why are enteral tube feedings typically initiated within 24 hours of burn resuscitation?
A) To reduce the risk of infection
B) To prevent hyperglycemia
C) To meet the increased metabolic demands for wound healing
D) To stabilize fluid balance
Answer: C) To meet the increased metabolic demands for wound healing
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4. What is the purpose of using non-adherent dressings for burn wounds?
A) To prevent the wound from drying out
B) To reduce the risk of tetanus
C) To avoid disturbing the wound bed during dressing changes
D) To promote antimicrobial absorption
Answer: C) To avoid disturbing the wound bed during dressing changes
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5. Which patients are at the highest risk for rhabdomyolysis following a burn injury?
A) Patients with circumferential chest burns
B) Patients with electrical burns involving deep muscle tissue
C) Patients with inhalation injuries
D) Patients with partial-thickness burns greater than 15% TBSA
Answer: B) Patients with electrical burns involving deep muscle tissue
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Fluid Resuscitation with Parkland Formula
A 35-year-old male weighing 80 kg presents with 40% total body surface area (TBSA) burns.
Question: How much fluid should this patient receive in the first 8 hours?
A) 3,200 mL
B) 6,400 mL
C) 9,600 mL
D) 12,800 mL
B) 6,400 mL
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A 50-year-old woman rescued from a structural fire presents with soot in her oropharynx, hoarseness, and singed nasal hairs.
Question: What is the most appropriate next step?
A) Observe for 24 hours
B) Administer oxygen and monitor
C) Intubate immediately
D) Perform a bronchoscopy
Answer: C) Intubate immediately
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Circumferential Chest Burn
A 28-year-old male with deep partial-thickness burns around the chest is experiencing difficulty breathing and reduced chest wall movement.
Question: What is the next step to manage this patient?
A) Perform an escharotomy
B) Start IV antibiotics
C) Increase fluid resuscitation
D) Administer bronchodilators
Answer: A) Perform an escharotomy
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Rhabdomyolysis Risk
A 40-year-old man presents after an electrical burn injury with dark-colored urine and reduced urine output. His creatine kinase levels are elevated.
Question: What is the immediate intervention to prevent kidney damage?
A) Start diuretics
B) Increase IV fluid rate
C) Administer antibiotics
D) Perform dialysis
Answer: B) Increase IV fluid rate
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A 65-year-old burn patient with 25% TBSA burns has a fever of 39°C, leukocytosis, and purulent wound drainage.
Question: What is the most appropriate management?
A) Start systemic antibiotics based on culture results
B) Increase fluid resuscitation
C) Perform debridement
D) Apply topical antibiotics only
Answer: A) Start systemic antibiotics based on culture results
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Hyperglycemia in Burn Patients
A 55-year-old patient with 35% TBSA burns develops hyperglycemia despite not having a history of diabetes. Enteral tube feeds were initiated 24 hours ago.
Question: What is the most likely cause of the hyperglycemia?
A) Poor insulin sensitivity in burn tissues
B) Excessive carbohydrate intake
C) Reduced fluid resuscitation
D) Infection
Answer: A) Poor insulin sensitivity in burn tissues
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A 30-year-old man presents with deep partial-thickness burns to his arms. His blisters are intact and not impeding joint mobility.
Question: What is the best initial wound care for this patient?
A) Debride all blisters
B) Keep blisters intact and apply topical antimicrobials
C) Leave the wound open to air
D) Apply systemic antibiotics
Answer: B) Keep blisters intact and apply topical antimicrobials
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A 40-year-old man rescued from a house fire presents with altered mental status. His SpO₂ is 98%, but he is lethargic.
Question: What is the next best step?
A) Obtain an arterial blood gas to check carboxyhemoglobin levels
B) Administer IV fluids
C) Perform a bronchoscopy
D) Monitor oxygen saturation continuously
Answer: A) Obtain an arterial blood gas to check carboxyhemoglobin levels
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A 60-year-old woman with partial-thickness burns covering 20% TBSA has an unknown tetanus vaccination history.
Question: What is the most appropriate tetanus prophylaxis?
A) Administer tetanus vaccine and tetanus immune globulin
B) Administer tetanus vaccine only
C) No intervention needed
D) Administer tetanus immune globulin only
Answer: A) Administer tetanus vaccine and tetanus immune globulin
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A 45-year-old male with 50% TBSA burns is started on enteral feeds 24 hours post-burn.
Question: Why is early nutrition important in burn patients?
A) To prevent infection
B) To meet increased metabolic demands for wound healing
C) To prevent electrolyte imbalances
D) To manage fluid shifts
Answer: B) To meet increased metabolic demands for wound healing
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A 35-year-old patient with 25% TBSA burns is receiving fluids per the Parkland formula. After 4 hours, their urine output is 15 mL/hour, and their heart rate remains elevated.
Question: What is the next step in management?
A) Increase fluid infusion rate
B) Administer diuretics
C) Monitor for another 2 hours
D) Reduce fluid infusion rate
Answer: A) Increase fluid infusion rate
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A 40-year-old woman with superficial and partial-thickness burns on her face reports eye discomfort. Examination shows redness and irritation of the conjunctiva.
Question: What is the next best step?
A) Apply topical antimicrobial ointment to the eyes
B) Administer systemic antibiotics
C) Consult ophthalmology
D) Use a non-adherent dressing over the eyes
Answer: C) Consult ophthalmology
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A 28-year-old male with circumferential burns on his right forearm reports severe pain, numbness, and tingling. On examination, the skin is tight, and capillary refill is delayed.
Question: What is the immediate intervention?
A) Perform an escharotomy
B) Apply compression bandages
C) Increase fluid resuscitation
D) Administer opioids for pain management
Answer: A) Perform an escharotomy
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A 50-year-old patient with 30% TBSA burns develops a fever, leukocytosis, and greenish drainage from a burn wound.
Question: What is the most appropriate next step?
A) Start systemic broad-spectrum antibiotics
B) Increase fluid resuscitation
C) Debride the wound and reassess
D) Change to a different topical antimicrobial
Answer: A) Start systemic broad-spectrum antibiotics
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A 45-year-old male with 40% TBSA burns was started on enteral nutrition 24 hours post-injury. Blood glucose levels remain persistently elevated above 180 mg/dL despite sliding-scale insulin.
Question: What is the best action to address this issue?
A) Increase insulin infusion rate
B) Stop enteral nutrition temporarily
C) Switch to parenteral nutrition
D) Reduce fluid resuscitation rate
Answer: A) Increase insulin infusion rate
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which PI stage
Stage 1 Intact skin with localized non-blanchable erythema
Stage 1
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Which PI stage
Stage 2
Partial thickness skin loss with exposed dermis, with/without blister.
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Stage 3 PI
Full thickness loss of skin, adipose tissue visible
Granulation, rolled wound edges (epibole) often present
If slough or eschar: unstageable
Undermining and tunneling
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Stage 4 PI
Full thickness skin and tissue loss with exposed/palpable fascia, muscle, tendon, ligament, cartilage, bone
If slough/eschar: unstageable
Epibole, undermining, tunneling
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Unstageable PI
Full thickness skin and tissue loss; extent of damage is obscured by slough or eschar
May be stage 3 or 4 after slough/eschar removed
Stable eschar on the heel or ischemic limb should not be removed or softened!
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Deep tissue PI
Intact or non-intact skin with localized non-blanchable, deep red, maroon, or purple discoloration or epidermal separation with a dark wound bed/fluid filled blister
Discoloration appears differently in darkly pigmented skin
May evolve with or without tissue loss
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Prevention
Basic treatment of
Cleanse, prevent infection
Debridement of necrotic tissue: sharp vs. enzymatic
Dressing choice
Prevention
Basic treatment of Pressure injuries
