CBRN Burn Pathophysiology & Wound Care Management 3 — Questions and Answers
Question 1: A burn patient develops Curling's ulcer. Which burn-related mechanism is the primary cause?
- Hyperacidity from stress response and mucosal ischemia (Correct answer)
- Direct chemical injury to gastric mucosa
- Elevated prostaglandin E2 levels
- Corticosteroid administration
Correct answer: Hyperacidity from stress response and mucosal ischemia
Curling's ulcer results from splanchnic vasoconstriction and mucosal ischemia combined with increased gastric acid secretion during the stress response.
Question 2: Which clinical sign best differentiates a superficial partial-thickness burn from a deep partial-thickness burn?
- Presence of blisters
- Wound color (pink vs. pale/mottled) (Correct answer)
- Capillary refill time
- Wound size in cm²
Correct answer: Wound color (pink vs. pale/mottled)
Superficial partial-thickness burns appear pink and moist, while deep partial-thickness burns are pale, mottled, or white due to greater dermal destruction.
Question 3: A 70 kg patient has 40% TBSA burns. Using the Parkland formula, how many mL of Lactated Ringer's should be administered in the first 8 hours post-burn?
- 5,600 mL (Correct answer)
- 11,200 mL
- 2,800 mL
- 8,000 mL
Correct answer: 5,600 mL
Parkland: 4 mL × 70 kg × 40% = 11,200 mL total; half (5,600 mL) is given in the first 8 hours.
Question 4: Mafenide acetate (Sulfamylon) is preferred over silver sulfadiazine in which clinical scenario?
- Burns to the face with minimal eschar
- Deep burns with thick eschar requiring penetration (Correct answer)
- Superficial partial-thickness burns in children
- Electrical burns to the extremities
Correct answer: Deep burns with thick eschar requiring penetration
Mafenide acetate penetrates eschar effectively, making it superior for burns with thick eschar where penetration is critical.
Question 5: During burn wound excision, which surgical technique involves removing layers of burn tissue until viable bleeding tissue is encountered?
- Fascial excision
- Sequential (tangential) excision (Correct answer)
- Laser ablation
- Enzymatic debridement
Correct answer: Sequential (tangential) excision
Tangential (sequential) excision removes thin layers of burned tissue until a healthy, bleeding wound bed is exposed, preserving viable tissue.
Question 6: Which electrolyte abnormality is most commonly seen during the first 48 hours of major burn resuscitation?
- Hypernatremia
- Hyperkalemia (Correct answer)
- Hypercalcemia
- Hypomagnesemia
Correct answer: Hyperkalemia
Massive cell destruction releases intracellular potassium, causing hyperkalemia in the immediate post-burn period.
Question 7: A burn patient's wound culture grows Pseudomonas aeruginosa. Which topical antimicrobial provides the best coverage for this organism?
- Mupirocin (Bactroban)
- Silver nitrate 0.5% solution (Correct answer)
- Bacitracin ointment
- Clotrimazole cream
Correct answer: Silver nitrate 0.5% solution
Silver nitrate 0.5% solution provides broad-spectrum coverage including Pseudomonas and is used for large burn wounds with gram-negative colonization.
CBRN Burn Pathophysiology & Wound Care Management 3
A burn patient develops Curling's ulcer.
Which burn-related mechanism is the primary cause?