# Burns(Thermal injury): Extend of burns.

### Burns(Thermal injury): Extend of burns.

Q. 1

A patient suffered from 3rd degree burn of right upper limb, 21d degree burns of right lower limb and 1st degree burn of whole of the back. Total percentage of burn will be?

 A 27 % B 36 % C 45 % D 54 %
Q. 1

A patient suffered from 3rd degree burn of right upper limb, 21d degree burns of right lower limb and 1st degree burn of whole of the back. Total percentage of burn will be?

 A 27 % B 36 % C 45 % D 54 %
Ans. C

Explanation:

45 % REF: Sabiston 18th e chapter 22

Burn size is generally assessed by the so-called rule of nines. In adults, each upper extremity and the head and neck are 9% of TBSA (total body surface area), the lower extremities and the anterior and posterior aspects of the trunk are 18% each, and the perineum and genitalia are assumed to be 1% of TBSA.

Degree of burn has nothing to do with calculation of percentage of burns. However different degrees of burns can be allotted their respective shares; for example a total of 45 % burns as in this case can be said as 9% of 3rd degree + 18% of 2′ degree + 18% of 1st degree burn.

Q. 2

A 28 year old woman is brought to you with burns over the head, neck and front of trunk. Calculate the % surface area of burns in this scenario?

 A 9% B 18% C 27% D 36%
Q. 2

A 28 year old woman is brought to you with burns over the head, neck and front of trunk. Calculate the % surface area of burns in this scenario?

 A 9% B 18% C 27% D 36%
Ans. C

Explanation:

The estimation of body surface area burns in an adult is given below:

Area of body:
Head and neck              9%
Front of trunk               18%
Back of trunk                18%
Upper limb                   18%
Lower limb                   36%
Genitalia                      1%

So in this case area of head and neck + front of trunk = 9+18 = 27%.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page – 272

Q. 3

A 5 year old has burns on the surface of his body corresponding to the size of his palm. The percentage of burns is?

 A 1% B 5% C 10% D 9%
Q. 3

A 5 year old has burns on the surface of his body corresponding to the size of his palm. The percentage of burns is?

 A 1% B 5% C 10% D 9%
Ans. A

Explanation:

A i.e. 1%

Palmar surface of patient’s hand is about 1% of body surface areaQ (in children and adult both).

Q. 4

A 5 year old child spills boiling water accidentally over her face and trunk. Which of the following methods is the most accurate to estimate the body surface area involved in burns?

 A Rule of Palm B Rule of Nine C Lund and Browder chart D Berkow tables
Q. 4

A 5 year old child spills boiling water accidentally over her face and trunk. Which of the following methods is the most accurate to estimate the body surface area involved in burns?

 A Rule of Palm B Rule of Nine C Lund and Browder chart D Berkow tables
Ans. C

Explanation:

Ans is ‘c’ i.e. Lund and Browder chart

“The total body surface area involved in the burn is most accurately determined by using the age related charts designed by Lund and Browder.” – CSDT

A thorough and accurate estimation of burn size is essential as critical management decisions are based on it i.e. to guide therapy and to determine when to transfer a patient to a burn center.

The extent of burns is expressed as the total percentage of body surface area (TBSA). Superficial or first degree burns are not included in the TBSA burn assessment. The location of partial-thickness and full-thickness burned areas are recorded on a burn diagram. Burns with an appearance compatible with either deep partial-thickness or full-thickness are presumed to be full-thickness until accurate differentiation is possible.

The two commonly used methods of assessing TBSA in adults are the Lund-Browder chart and “Rule of Nines,” whereas in children, the Lund-Browder chart is the recommended method because it takes into account the relative percentage of body surface area affected by growth.

• When the burn is irregular and/or patchy, the palm method may be useful.

Lund-Browder chart:

• The Lund-Browder chart is the most accurate method for estimating TBSA for both adults and children.

It takes into account the relative percentage of body surface area affected by growth. Children have proportionally larger heads and smaller lower extremities, so the percentage BSA is more accurately estimated using the Lund-Browder chart.

Rule of Nines

The “rule of nines” is a crude but quick and effective method of estimating burn size

• In an adult

each upper extremity accounts for —> 9% of TBSA

Each lower extremity accounts for —> 18% of TBSA

–       anterior or posterior trunk, each account for —> 18% of TBSA

–       head and neck account for –> 9%

–       perineum accounts for —> 1%

Palm method

Small or patchy burns can be approximated by using the surface area of the patient’s palm. The palm of the patient’s hand, excluding the fingers, is approximately 0.5 percent of total body surface area and the entire palmar surface including fingers is 1 percent in children and adults.

Q. 5

Head & neck involvement in burns in infant is ‑

 A 9% B 18% C 27% D 32%
Q. 5

Head & neck involvement in burns in infant is ‑

 A 9% B 18% C 27% D 32%
Ans. B

Explanation:

Answer is ‘b’ i.e. 18%

Children have a relatively larger portion of the body surface area in the head and neck which is compensated for by a relatively smaller surface area in the lower extremities. Infants have 21% of TBSA in the head and neck and 13% in each leg.

The burn size, mentioned as a proportion of the patients TBSA (total body surface area) is the single most important factor in predicting burn related mortality.

Q. 6

Calculate the percentage of burns on the head, neck and face in a child of one year –

 A 10% B 16% C 13% D None
Q. 6

Calculate the percentage of burns on the head, neck and face in a child of one year –

 A 10% B 16% C 13% D None
Ans. D

Explanation:

Ans. is None

Q. 7

Whole hand burns represent what percentage of total body surface area:

 A 1% B 9% C 18% D 27%
Q. 7

Whole hand burns represent what percentage of total body surface area:

 A 1% B 9% C 18% D 27%
Ans. A

Explanation:

Ans: A i.e. 1%

Percentage of burns

• The patients whole hand is 1% TBSA, and is a useful guide in small burns
• Each upper limb and head & neck is 9% as per rule of nine
• Each lower limb & torso, each side is 18%

Q. 8

Rule of 9 in burns is used to denote:

NEET 14

 A Depth of burns B Total body surface area involved C Severity of burns D Type of burns
Q. 8

Rule of 9 in burns is used to denote:

NEET 14

 A Depth of burns B Total body surface area involved C Severity of burns D Type of burns
Ans. B

Explanation:

Ans. Total body surface area involved

Q. 9

According to ‘rule of 9% perineum burns constitute:

FMGE 09

 A 1% burns B 9% bums C 18% burns D 27% burns
Q. 9

According to ‘rule of 9% perineum burns constitute:

FMGE 09

 A 1% burns B 9% bums C 18% burns D 27% burns
Ans. A

Explanation:

Ans. 1% burns

Q. 10

Burns in children assessed by:

AIIMS 13

 A Rule of nine B Lund and Browder C Palmer surface method D Hasse’s rule
Q. 10

Burns in children assessed by:

AIIMS 13

 A Rule of nine B Lund and Browder C Palmer surface method D Hasse’s rule
Ans. B

Explanation:

Ans. Lund and Browder

Q. 11

A 2-year-old child had burns on buttocks, both legs, face, neck and singeing of hair. Total surface area burnt:

JIPMER 14

 A 27% B 37% C 45% D 55%
Q. 11

A 2-year-old child had burns on buttocks, both legs, face, neck and singeing of hair. Total surface area burnt:

JIPMER 14

 A 27% B 37% C 45% D 55%
Ans. B

Explanation:

Ans. 37%

Q. 12

In a 6-year-old child with burns involving whole of head and trunk, the estimated body surface area involved:

JIPMER 09

 A 44% B 48% C 55% D 58%
Q. 12

In a 6-year-old child with burns involving whole of head and trunk, the estimated body surface area involved:

JIPMER 09

 A 44% B 48% C 55% D 58%
Ans. B

Explanation:

Ans. 48%

Q. 13

In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area:
NIMHANS 08; TN 11

 A 5% B 10% C 15% D 20%
Q. 13

In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area:
NIMHANS 08; TN 11

 A 5% B 10% C 15% D 20%
Ans. C

Explanation:

Ans. 15%

Q. 14

Rule of 9 in burns is used to denote ‑

 A Depth of bums B % of total body surfacearea C Severity of bums D Type of bums
Q. 14

Rule of 9 in burns is used to denote ‑

 A Depth of bums B % of total body surfacearea C Severity of bums D Type of bums
Ans. B

Explanation:

Ans. is ‘b’ i.e., % of total body surface area

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