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Question 1. Which anatomical feature makes children more prone to deeper burns from a brief contact with a hot surface? A) Thicker epidermis B) Higher subcutaneous fat proportion C) Thinner dermis and epidermis D) Larger body surface area to weight ratio Answer: C Explanation: Children have a thinner dermis and epidermis, so a given temperature penetrates more quickly, producing deeper burns. Question 2. The surface area to body mass ratio in infants compared with adults is: A) Lower, leading to slower heat loss B) Higher, increasing risk of hypothermia C) Similar, having no clinical impact D) Variable, depending on gestational age only Answer: B Explanation: Infants have a larger surface area relative to their mass, which accelerates heat loss and predisposes them to rapid hypothermia after a burn. Question 3. Which of the following is the most common mechanism of pediatric scald burns? A) Direct flame contact B) Immersion in hot liquids C) Electrical shock from outlets D) Contact with hot metal surfaces Answer: B Explanation: Immersion in hot liquids (e.g., bath water, cooking pots) accounts for the majority of scald injuries in children.
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Question 4. A child presents with a circular, sharply demarcated burn on the dorsal hand after a brief touch to a curling iron. This pattern most likely represents: A) Flame burn B) Scald burn C) Contact burn D) Chemical burn Answer: C Explanation: Contact burns produce well-defined, uniform lesions corresponding to the shape of the hot object. Question 5. Low-voltage electrical injuries in children are most commonly caused by: A) Overhead power lines B) Household outlets C) Lightning strikes D) Industrial machinery Answer: B Explanation: Household outlets (120 V in the U.S.) are the usual source of low-voltage electrical injury in the pediatric population. Question 6. Which of the following is NOT a typical sign of inhalation injury in a burned child? A) Singed nasal hairs B) Carbonaceous sputum C) Rapid capillary refill D) Stridor on inspiration Answer: C Explanation: Rapid capillary refill indicates good peripheral perfusion, not an inhalation injury sign. The other options are classic indicators.
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Question 10. The Rule of Nines is less accurate in pediatric patients because: A) Children have proportionally larger heads and smaller legs B) Their skin is more elastic C) Their TBSA is always less than 50% D) It overestimates the trunk area only Answer: A Explanation: The Rule of Nines does not account for the different body proportion ratios in children, especially the larger head and smaller lower extremities. Question 11. A burn that appears pink, moist, and painful, with intact capillary refill, is classified as: A) Superficial (first-degree) B) Superficial partial-thickness (second-degree) C) Deep partial-thickness D) Full-thickness (third-degree) Answer: B Explanation: Superficial partial-thickness burns retain a pink, moist appearance, are painful, and have good capillary refill. Question 12. Which depth of burn is most likely to heal without surgical grafting if managed appropriately? A) Superficial (first-degree) B) Deep partial-thickness C) Full-thickness D) Fourth-degree Answer: B Explanation: Deep partial-thickness burns can re-epithelialize within 2-3 weeks with proper wound care, often avoiding grafting. Question 13. The hallmark of a fourth-degree burn is:
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A) Involvement of epidermis only B) Damage limited to the dermis C) Involvement of muscle, bone, or tendon D) Presence of blisters containing clear fluid Answer: C Explanation: Fourth-degree burns extend through skin into underlying structures such as muscle, bone, or tendon. Question 14. Which of the following best describes the pathophysiologic basis for rapid hypothermia in burned children? A) Increased metabolic rate producing excess heat B) Loss of insulating subcutaneous fat C) Large surface area exposure leading to heat loss D) Hyperglycemia causing vasodilation Answer: C Explanation: The large surface area relative to body mass in children accelerates heat loss, leading to hypothermia. Question 15. Immature hepatic function in infants affects burn management primarily by: A) Reducing the risk of hyperkalemia B) Decreasing the metabolism of opioids and causing prolonged sedation C) Enhancing renal clearance of fluids D) Increasing the conversion of pro-drugs to active forms Answer: B Explanation: The immature liver metabolizes many drugs more slowly, leading to prolonged effects of opioids and other medications. Question 16. The most appropriate immediate first-aid measure for a scald burn in a child is:
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Question 19. For children weighing less than 30 kg, the initial resuscitation fluid should include: A) 0.9 % saline only B) Dextrose-containing solution (e.g., D5-½ NS) C) Lactated Ringer’s without dextrose D) Hypertonic saline (3 %) Answer: B Explanation: Young children have limited glycogen stores; adding dextrose prevents hypoglycemia during resuscitation. Question 20. The target urine output for a pediatric burn patient during the first 24 hours of fluid resuscitation is: A) 0.5 mL/kg/hr B) 1 mL/kg/hr C) 2 mL/kg/hr D) 3 mL/kg/hr Answer: B Explanation: A urine output of 1 mL/kg/hr indicates adequate perfusion in children. Question 21. Which hormone surge contributes most to the hypermetabolic response after a severe burn? A) Insulin B) Thyroxine C) Catecholamines D) Parathyroid hormone Answer: C Explanation: Catecholamines (epinephrine, norepinephrine) rise dramatically after burns, driving hypermetabolism and catabolism.
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Question 22. Early enteral nutrition in burned children is primarily instituted to prevent: A) Hypernatremia B) Curling’s ulcer formation C) Hypocalcemia D) Acute respiratory distress syndrome (ARDS) Answer: B Explanation: Early enteral feeding reduces gastric acid hypersecretion and stress ulcer formation (Curling’s ulcer). Question 23. A burned child develops a serum sodium of 125 mmol/L. The most likely cause is: A) Excessive isotonic fluid administration B) Inadequate fluid resuscitation C) Dilutional hyponatremia from hypotonic maintenance fluids D) Renal failure with sodium retention Answer: C Explanation: Use of hypotonic maintenance fluids without proper monitoring can cause dilutional hyponatremia. Question 24. Which electrolyte abnormality is most commonly associated with massive tissue necrosis in severe burns? A) Hypercalcemia B) Hyperkalemia C) Hypophosphatemia D) Hypermagnesemia Answer: B Explanation: Cellular destruction releases intracellular potassium, leading to hyperkalemia. Question 25. Escharotomy is indicated in which of the following scenarios?
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B) Allows painless removal and earlier re-epithelialization C) Requires daily dressing changes D) Is less expensive than topical creams Answer: B Explanation: Biosynthetic dressings (e.g., Biobrane) adhere to the wound, reduce pain, and promote faster re-epithelialization compared with daily sulfadiazine changes. Question 29. In pediatric burn pain management, breakthrough pain is best treated with: A) Scheduled NSAIDs only B) Patient-controlled analgesia (PCA) bolus doses C) Continuous low-dose opioids without rescue medication D) Non-pharmacologic distraction alone Answer: B Explanation: Breakthrough pain requires rapid-acting rescue medication, often delivered via PCA bolus doses. Question 30. Which adjuvant analgesic is most appropriate for neuropathic pain after a deep burn injury in a child? A) Acetaminophen B) Gabapentin C) Ibuprofen D) Morphine Answer: B Explanation: Gabapentin is effective for neuropathic pain, which can develop after deep burns involving nerve injury. Question 31. Virtual reality as a non-pharmacologic adjunct in pediatric burn care primarily works by: A) Reducing the metabolic rate
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B) Distracting the patient’s attention away from nociceptive input C) Enhancing opioid metabolism D) Providing analgesic medication through the headset Answer: B Explanation: VR provides immersive distraction, decreasing perceived pain intensity. Question 32. Which of the following patterns is most suspicious for non-accidental trauma (NAT) in a pediatric burn? A) Uniform splash pattern on the forearm from a pot of boiling water B) Symmetrical circular burns on both palms C) “Stocking” distribution on the foot with clear lines of demarcation D) Linear contact burn on the back from a hot iron Answer: C Explanation: “Stocking” or “glove” patterns with clear demarcation and sparing of flexor surfaces raise suspicion for forced immersion, a hallmark of NAT. Question 33. A child with a facial burn is at increased risk for which of the following complications? A) Renal failure B) Airway edema leading to obstruction C) Deep vein thrombosis D) Hepatic encephalopathy Answer: B Explanation: Facial and neck burns can cause airway edema, compromising the airway rapidly. Question 34. The most reliable early clinical indicator of compartment syndrome in a circumferential limb burn? A) Pain on passive stretch of the muscles distal to the burn
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C) Reduce collagen synthesis by applying sustained pressure D) Deliver topical antibiotics Answer: C Explanation: Sustained pressure interferes with fibroblast activity, reducing collagen deposition and scar elevation. Question 38. A child with a deep partial-thickness burn on the hand is placed in a static splint. The most important reason for this intervention is to: A) Immobilize the joint to prevent infection B) Prevent contracture formation during healing C) Increase blood flow to the area D) Facilitate early range-of-motion exercises Answer: B Explanation: Static splinting maintains the joint in a functional position, preventing contractures as the wound heals. Question 39. According to the American Burn Association, a pediatric patient should be transferred to a verified Pediatric Burn Center if: A) Burn size is >5 % TBSA regardless of location B) Any burn involves the face, hands, feet, genitalia, or major joints C) The patient is older than 12 years D) The burn is superficial only Answer: B Explanation: Burns involving critical areas (face, hands, feet, genitalia, major joints) warrant specialized care regardless of TBSA. Question 40. Which of the following statements about fluid resuscitation in children with electrical burns is correct? A) They require less fluid than thermal burns of equivalent TBSA B) They often need additional fluid due to deep tissue damage not reflected in surface area
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C) Fluid calculation should be based solely on the Rule of Nines D) No dextrose is needed because of hyperglycemia risk Answer: B Explanation: Electrical burns cause extensive deep tissue injury that may not be apparent on the surface, often necessitating additional fluid beyond standard calculations. Question 41. In pediatric patients, the most common cause of death related to inhalation injury is: A) Pulmonary edema B) Airway obstruction from edema and carbonaceous sputum C) Myocardial infarction D) Renal failure Answer: B Explanation: Airway edema and carbonaceous secretions can rapidly compromise the airway, leading to fatal obstruction. Question 42. Which laboratory finding is most indicative of early cyanide toxicity in a child exposed to a house fire? A) Elevated lactate levels B) Low arterial pO₂ C) High bicarbonate D) Decreased serum calcium Answer: A Explanation: Cyanide inhibits oxidative phosphorylation, causing lactic acidosis and elevated lactate. Question 43. The most appropriate method to assess the depth of a burn in a conscious child is: A) Palpation for blanching and capillary refill B) MRI of the burned area
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C) Increased respiratory effort with reduced chest wall excursion D) Elevated blood pressure Answer: C Explanation: Restrictive eschar limits chest expansion, causing increased work of breathing. Question 47. Which statement about the use of ketamine for procedural analgesia in burned children is true? A) It depresses the respiratory drive and must be avoided B) It provides analgesia without affecting hemodynamics C) It can increase sympathetic tone, raising heart rate and blood pressure D) It is contraindicated in patients with head injuries Answer: C Explanation: Ketamine stimulates sympathetic output, often increasing HR and BP, which can be beneficial in burn patients with hypovolemia. Question 48. The most appropriate timing for the first dressing change in a superficial partial-thickness burn managed with silver sulfadiazine is: A) Every 2 hours B) Every 24 hours C) Every 48 hours D) Only when the dressing becomes saturated Answer: B Explanation: Silver sulfadiazine dressings are typically changed daily to assess healing and prevent maceration. Question 49. A 7-year-old with a 30 % TBSA flame burn is receiving enteral nutrition. Which nutrient is most critical to prevent muscle catabolism in the hypermetabolic state? A) High-protein formula delivering 2 g/kg/day B) High-fat formula with omega-3 fatty acids only
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C) Simple carbohydrate solution D) Low-protein, high-carbohydrate formula Answer: A Explanation: Adequate protein (≈2 g/kg/day) is essential to counteract the catabolic response and preserve lean body mass. Question 50. Which of the following is the most reliable method to prevent wound infection in a pediatric burn patient? A) Routine prophylactic systemic antibiotics for all burns >5 % TBSA B) Early excision and grafting of full-thickness burns C) Application of topical antimicrobial dressings D) Daily changing of all dressings regardless of condition Answer: C Explanation: Topical antimicrobial dressings directly reduce bacterial colonization and are standard for burn wound infection prophylaxis. Question 51. In the assessment of a pediatric burn, the “Rule of Palms” estimates TBSA by: A) Counting the patient’s palm (including fingers) as 1 % of total body surface area B) Using the adult palm as a reference for children C) Measuring the burn length in centimeters D) Applying the Lund-Browder chart exclusively Answer: A Explanation: The patient’s own palm (including fingers) approximates 1 % of TBSA, useful for quick bedside estimation. Question 52. Which of the following best explains why children with burns are at higher risk for developing Curling’s ulcers? A) Decreased gastric acid secretion B) Increased splanchnic blood flow after injury
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B) Eschar constriction of the chest wall C) Pneumothorax D) Cardiac tamponade Answer: B Explanation: The “double-cuff” indicates a tight circumferential eschar limiting chest expansion, often prompting escharotomy. Question 56. In a pediatric patient with a burn involving the perineum, the most critical initial management step is: A) Immediate grafting B) Aggressive debridement of all necrotic tissue C) Ensuring urinary catheterization to prevent retention D) Application of a pressure garment Answer: C Explanation: Maintaining urinary drainage prevents urinary retention and reduces infection risk in perineal burns. Question 57. Which of the following is the best indicator that a pediatric burn wound is ready for grafting? A) Presence of granulation tissue covering >90 % of the wound bed B) Complete epithelialization C) Absence of pain on the wound surface D) Development of blistering Answer: A Explanation: Granulation tissue provides a vascularized bed suitable for graft acceptance. Question 58. A child with a 5 % TBSA burn receives 600 mL of crystalloid solution in the first 8 hours. The urine output is 0.8 mL/kg/hr. The next step is to: A) Add a diuretic to increase urine output
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B) Reduce the fluid rate to prevent overload C) Continue the same rate and monitor D) Switch to hypertonic saline Answer: C Explanation: Urine output of 0.8 mL/kg/hr is close to the target (1 mL/kg/hr); continuing the current rate with monitoring is appropriate. Question 59. Which of the following best describes the role of the “burn team” in pediatric care? A) A single surgeon performing all procedures B) A multidisciplinary group including surgeons, nurses, therapists, and psychologists C) Only physicians and pharmacists D) Emergency medical technicians only Answer: B Explanation: Effective pediatric burn care requires a multidisciplinary team to address medical, surgical, rehabilitative, and psychosocial needs. Question 60. Which of the following is a contraindication to the use of a tourniquet for a circumferential limb burn? A) Presence of a deep partial-thickness burn B) Signs of distal ischemia (pale, cold extremity) before tourniquet placement C) Burn size less than 10 % TBSA D) Patient age under 5 years Answer: B Explanation: If distal ischemia already exists, a tourniquet would exacerbate tissue compromise and is contraindicated. Question 61. In managing a pediatric patient with a suspected inhalation injury, the most urgent airway intervention is: A) Administration of high-flow oxygen only
