Surgery — Burns and Soft Tissue Injury, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
1. A burn is dry, leathery and painless. What is the depth, and why is the absence of pain significant?
Answer: Full thickness. It is painless because the nerve endings within the skin have been destroyed. Absence of pain therefore indicates greater depth — it is the worst sign, not a reassuring one.
2. What is the correct immediate first aid for a burn, and what should not be applied?
Answer: Cool with running water and continue cooling, because retained heat keeps damaging tissue after the source is removed. Keep the patient warm while doing so. Do not use ice, which causes further injury, and do not apply butter, oil, toothpaste or ash — they introduce infection and obscure the wound.
3. A patient rescued from a house fire is hoarse with soot around the nostrils but is breathing comfortably. Why is this urgent?
Answer: The history and signs suggest inhalation injury, and the airway swelling is progressive. An airway adequate now may obstruct over the next hours, and will be far harder to secure once distorted by swelling. It should be secured early on suspicion, with senior help, rather than observed.
4. Why does a large burn cause shock when no blood has been lost?
Answer: Injured capillaries leak throughout the body, so fluid moves out of the circulation into the tissues. It remains within the patient but no longer contributes to circulating volume, which is why the patient swells as the blood pressure falls.
5. A patient with a circumferential forearm burn had a warm hand on admission; two hours later it is cool with sluggish capillary refill. What has happened?
Answer: Full-thickness skin is rigid and does not stretch, so the tissue swelling beneath it has raised pressure enough to compromise the circulation. This needs urgent surgical release. It also illustrates why circumferential burns must be rechecked repeatedly rather than assessed once.
6. A patient is hypotensive fifteen minutes after sustaining a burn. What does this suggest?
Answer: Not the burn. Burn shock develops over hours as capillary leak accumulates, so shock this early points to bleeding or another injury sustained at the same time — for example a fall while escaping. The correct response is to search for that cause, not simply to increase fluids.
7. Why should a fluid-resuscitation formula not be followed as a fixed prescription?
Answer: Because it provides a starting estimate based on burn size and weight, which is then titrated against the response — urine output in particular. Following it rigidly risks under-resuscitation and renal failure in one patient and over-resuscitation with oedema in another, since the actual requirement varies widely.
8. A toddler presents with a sharply demarcated burn to both feet, and the history offered has changed between tellings. What must be considered?
Answer: Non-accidental injury. A sharply demarcated symmetrical pattern suggesting forced immersion, together with an inconsistent history or delayed presentation, is a recognised warning pattern. The discrepancy must be raised and documented and safeguarding procedures followed, alongside treating the burn.
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