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Question 1. Which layer of the skin contains the stratum basale, responsible for keratinocyte proliferation? A) Epidermis B) Dermis C) Hypodermis D) Subcutaneous tissue Answer: A Explanation: The stratum basale is the deepest layer of the epidermis where keratinocytes originate and proliferate. Question 2. The primary function of the acid mantle on the skin surface is to: A) Regulate body temperature B) Prevent bacterial colonization C) Produce melanin D) Store subcutaneous fat Answer: B Explanation: The acid mantle (pH 4.5‑5.5) creates an inhospitable environment for many pathogens, protecting against infection. Question 3. In Jackson’s burn zones, the zone of stasis is characterized by: A) Immediate coagulation necrosis B) Irreversible tissue loss C) Potentially salvageable tissue with compromised perfusion D) Hyperemia with minimal injury Answer: C
Explanation: The zone of stasis surrounds the central zone of coagulation and may recover with proper resuscitation. Question 4. A full‑thickness (third‑degree) burn typically involves which of the following structures? A) Only the epidermis B) Epidermis and papillary dermis C) Entire dermis but not subcutaneous tissue D) Epidermis, dermis, and may extend to hypodermis Answer: D Explanation: Third‑degree burns destroy the epidermis and entire dermis, often reaching the subcutaneous layer. Question 5. The “Rule of Nines” is most accurate for estimating TBSA in which patient population? A) Neonates B. 1‑year‑old children C. Adults D. Elderly with severe edema Answer: C Explanation: The Rule of Nines divides the adult body into 9% sections, providing a quick TBSA estimate. Question 6. When using the Lund‑Browder chart, the most important advantage over the Rule of Nines is: A) Faster calculation B) Greater accuracy in pediatric patients C) Simpler visual layout D) Applicability only to burns >30% TBSA
C) 12,600 mL D) 2,800 mL Answer: A Explanation: 4 mL × 70 kg × 30 % = 8,400 mL; half given in the first 8 hours, remainder over the next 16 hours. Question 10. Which inhalation injury sign most strongly suggests carbon monoxide poisoning? A) Cherry‑red skin coloration B) Hoarseness C) Stridor D) Wheezing Answer: A Explanation: Carbon monoxide binds hemoglobin, producing a characteristic cherry‑red hue to the skin and mucous membranes. Question 11. In a thermal flame burn, the most common cause of early hypovolemic shock is: A) Cardiac tamponade B) Loss of plasma from the damaged capillaries C) Acute myocardial infarction D) Cerebral edema Answer: B Explanation: Burned tissue leads to massive plasma loss through increased capillary permeability, causing hypovolemia. Question 12. Acid burns cause tissue injury primarily through: A) Liquefaction necrosis
B) Coagulation necrosis C) Fat necrosis D) Enzymatic digestion Answer: B Explanation: Acids denature proteins, forming a coagulum that limits deeper penetration but causes coagulation necrosis. Question 13. Alkali burns are more dangerous than acid burns because they: A) Cause immediate pain that masks severity B) Produce coagulation necrosis C) Penetrate deeper via liquefaction necrosis D) Neutralize quickly on contact Answer: C Explanation: Alkalis cause saponification of fats and protein dissolution, leading to deep, progressive tissue damage. Question 14. The “iceberg effect” in electrical burns refers to: A) Visible surface injury being less severe than underlying tissue damage B) Rapid cooling of the skin after contact C) Immediate necrosis limited to the entry point D) Formation of a protective eschar that prevents deeper injury Answer: A Explanation: Electrical current can cause extensive subdermal injury while the surface appears relatively minor. Question 15. Which complication is most associated with high‑voltage electrical injuries?
Question 18. Enzymatic debridement with collagenase is contraindicated in which situation? A) Partial‑thickness burns with viable tissue B) Full‑thickness burns with eschar formation C) Superficial burns less than 5% TBSA D) Chronic ulcer with granulation tissue Answer: B Explanation: Collagenase acts on necrotic collagen; in full‑thickness burns with thick eschar, surgical debridement is preferred. Question 19. Silver sulfadiazine is most effective for: A) Deep dermal burns requiring rapid epithelialization B) Preventing infection in superficial partial‑thickness burns C) Treating burns in patients with sulfa allergy D) Long‑term scar management Answer: B Explanation: Silver sulfadiazine provides broad‑spectrum antimicrobial coverage, especially useful for superficial partial‑thickness burns. Question 20. Which topical antimicrobial is preferred for burn patients with a known sulfonamide allergy? A) Silver sulfadiazine B) Mafenide acetate C) Silver nitrate D) Bacitracin ointment Answer: C
Explanation: Silver nitrate does not contain sulfonamide, making it a safe alternative for allergic patients. Question 21. An escharotomy is indicated when: A) The burn is superficial and heals spontaneously B) There is circumferential full‑thickness burn causing compromised distal perfusion C) The patient has a small, isolated full‑thickness burn on the back D) The wound is infected with Pseudomonas aeruginosa Answer: B Explanation: Escharotomy releases constrictive eschar, restoring circulation to distal tissues in circumferential burns. Question 22. Fasciotomy differs from escharotomy in that it: A) Is performed only on the face B) Involves cutting the underlying fascia to relieve compartment syndrome C) Is always performed before grafting D) Requires no anesthesia Answer: B Explanation: Fasciotomy cuts the deep fascia to decompress compartments, whereas escharotomy cuts only the eschar. Question 23. Split‑thickness skin grafts (STSG) harvest: A) Entire epidermis and dermis B) Epidermis only C) Epidermis and a portion of the papillary dermis D) Full dermis and hypodermis
D) Resistance to infection Answer: B Explanation: CEAs require cell culture, which takes weeks, making them unsuitable for acute massive burns but useful for later reconstruction. Question 27. Hypertrophic scars differ from keloids in that they: A) Extend beyond the original wound margins B) Are more common in darker‑skinned individuals C) Remain confined within the boundaries of the original injury D) Never respond to pressure therapy Answer: C Explanation: Hypertrophic scars stay within the wound edges, whereas keloids proliferate beyond. Question 28. Compression garments aid burn scar management by: A) Increasing local blood flow to the scar B) Providing constant pressure to remodel collagen fibers C) Delivering topical antibiotics D) Enhancing melanin production Answer: B Explanation: Sustained pressure reorganizes collagen, flattening hypertrophic scars and improving pliability. Question 29. Early range‑of‑motion (ROM) exercises after a burn are essential to: A) Accelerate epithelialization of the wound B) Prevent contracture formation by maintaining joint flexibility
C) Reduce the need for analgesics D) Increase systemic inflammatory response Answer: B Explanation: Early mobilization maintains tissue length and joint range, preventing contractures. Question 30. Which psychological issue is most commonly observed in severe burn survivors? A) Schizophrenia B) Post‑traumatic stress disorder (PTSD) C) Bipolar disorder D) Obsessive‑compulsive disorder Answer: B Explanation: PTSD arises from the traumatic event, pain, and body image changes associated with severe burns. Question 31. The primary function of sweat glands in burn patients is: A) To provide antimicrobial peptides B) To assist in thermoregulation, which may be impaired after extensive burns C) To produce sebum for skin lubrication D) To generate electrical signals for wound healing Answer: B Explanation: Sweat glands regulate body temperature; loss of function after burns can lead to hyperthermia. Question 32. In the dermis, the papillary layer is primarily responsible for: A) Storing adipose tissue
Question 35. Which laboratory parameter is most reliable for assessing adequacy of fluid resuscitation in burn patients? A) Serum sodium concentration B) Hemoglobin level C) Urine output (mL/kg/h) D) Serum lactate Answer: C Explanation: Urine output directly reflects renal perfusion and overall intravascular volume status during resuscitation. Question 36. Which burn depth classification is most likely to heal spontaneously within 2‑3 weeks without surgical intervention? A) Superficial (first‑degree) B. Deep partial‑thickness (second‑degree) C. Full‑thickness (third‑degree) D. Fourth‑degree Answer: B Explanation: Deep partial‑thickness burns have viable dermal elements that allow re‑epithelialization within weeks. Question 37. The main advantage of using a moist wound environment for burn care is: A) Increased bacterial colonization B) Faster epithelial migration and reduced scarring C) Decreased patient comfort D) Promotion of eschar formation Answer: B
Explanation: Moisture facilitates cell migration, reduces desiccation, and improves healing outcomes. Question 38. Which topical agent is contraindicated in patients with glucose‑ 6 ‑phosphate dehydrogenase (G6PD) deficiency? A) Silver sulfadiazine B. Mafenide acetate C. Nitrofurazone D. Silver nitrate Answer: C Explanation: Nitrofurazone can precipitate hemolysis in G6PD‑deficient individuals. Question 39. In burn patients, hypermetabolism is primarily driven by: A) Increased catecholamine release B) Decreased thyroid hormone levels C) Elevated insulin secretion D) Reduced cortisol production Answer: A Explanation: Burn injury triggers a catecholamine surge, raising basal metabolic rate and protein catabolism. Question 40. Which of the following statements best describes the “zone of hyperemia” in a burn wound? A) Irreversible coagulation necrosis B) Increased blood flow with minimal cellular damage C) Deep tissue necrosis extending into muscle D) Area of eschar formation
D) 3,150 mL Answer: A Explanation: 4 mL × 70 kg × 15 % = 4,200 mL total; half (2,100 mL) is given in the first 8 hours. Question 44. Which burn etiology is most likely to produce a “charred” appearance of the skin? A) Scald injury B) Flame burn C) Chemical acid burn D) Electrical low‑voltage burn Answer: B Explanation: Direct flame contact causes carbonization and a characteristic charred look. Question 45. The primary purpose of using a non‑adhesive dressing over a fresh burn is to: A) Provide antimicrobial activity B) Prevent adherence to the wound and reduce pain on removal C) Increase wound temperature D) Deliver systemic antibiotics Answer: B Explanation: Non‑adhesive dressings protect the wound while minimizing trauma during dressing changes. Question 46. Which of the following is a typical early systemic manifestation of severe burns? A) Hyperglycemia due to stress response B) Hypothermia due to loss of skin insulation C) Bradycardia from vagal stimulation
D) Hypertension from fluid overload Answer: A Explanation: The catecholamine and cortisol surge induces hyperglycemia as part of the stress response. Question 47. In the management of electrical burns, continuous cardiac monitoring is essential because: A) Electrical current can cause myocardial necrosis and arrhythmias B) It prevents infection of the wound C) It reduces the need for analgesics D) It accelerates skin graft acceptance Answer: A Explanation: Electrical currents can disrupt cardiac conduction, necessitating monitoring for arrhythmias. Question 48. Which of the following statements about the “golden period” for burn excision and grafting is correct? A) It occurs within the first 24 hours after injury B) It is optimal between days 3‑5 when the wound is clean and granulation tissue forms C) It refers to grafting after 6 weeks to ensure scar maturation D) It is only relevant for superficial burns Answer: B Explanation: Early excision (days 3‑5) removes necrotic tissue, reduces infection risk, and improves graft take. Question 49. The most common organism causing burn wound infection in the first week is: A) Pseudomonas aeruginosa
Question 52. Which of the following is a hallmark of the zone of coagulation? A) Viable capillary loops B) Irreversible protein denaturation and cell death C) Hyperemia with increased perfusion D) Minimal inflammation Answer: B Explanation: The zone of coagulation experiences immediate, irreversible necrosis due to protein coagulation. Question 53. A patient presents with a 2% TBSA scald burn on the forearm. The most appropriate initial management is: A) Immediate grafting B) Application of silver sulfadiazine and dressing C) Oral antibiotics D) Escharotomy Answer: B Explanation: Small superficial burns are managed conservatively with topical antimicrobial and dressing. Question 54. Which factor most significantly increases the risk of developing contractures after a burn? A) Early mobilization B) Prolonged immobilization and deep partial‑thickness burns over joints C) Use of compression garments D) Adequate nutrition Answer: B Explanation: Immobilization and deep burns crossing joints lead to fibrosis and contracture formation.
Question 55. The primary purpose of a split‑thickness skin graft is to: A) Provide permanent coverage with minimal donor site morbidity B) Serve as a temporary biologic dressing C) Replace full dermal thickness for cosmetic purposes D) Deliver systemic antibiotics Answer: A Explanation: STSG offers durable coverage while allowing donor site healing due to retained dermal elements. Question 56. In burn patients, hyperkalemia in the first 24 hours is most likely due to: A) Renal failure from rhabdomyolysis B) Massive tissue necrosis releasing intracellular potassium C) Excessive potassium‑containing IV fluids D) Use of beta‑blockers Answer: B Explanation: Burn‑induced cell lysis releases potassium into the extracellular space, causing early hyperkalemia. Question 57. Which of the following is a contraindication to using a silicone gel sheet for scar management? A) Mature, stable scar B) Open, exudative wound C) Hypertrophic scar with pruritus D) Scar located on the forearm Answer: B
