A 23-year-old woman comes to the surgical OPD with a firm, shiny, itchy swelling on the right earlobe that began a few months after ear piercing. It has spread well beyond the piercing site, and an earlier simple excision at a local clinic was followed by a larger recurrence. What is the most appropriate first-line treatment now?

Intralesional triamcinolone injections

Observation, as it regresses with time

Topical antibiotic and steroid cream

Repeat excision with primary closure

A 30-year-old man was rescued from a burning godown after 20 minutes in a closed, smoke-filled room. He has facial burns, singed nasal hairs, soot in the mouth, carbonaceous sputum and a hoarse voice that is getting worse. SpO2 is 97% on oxygen. What is the most appropriate next step?

High-flow oxygen by face mask only

Burns, wounds, shock and fluid management

27 NEET-PG practice questions on Burns, wounds, shock and fluid management, part of General Surgery. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 23-year-old woman comes to the surgical OPD with a firm, shiny, itchy swelling on the right earlobe that began a few months after ear piercing. It has spread well beyond the piercing site, and an earlier simple excision at a local clinic was followed by a larger recurrence. What is the most appropriate first-line treatment now?
1. AObservation, as it regresses with time
2. BTopical antibiotic and steroid cream
3. CIntralesional triamcinolone injections
4. DRepeat excision with primary closure
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Answer: C · Intralesional triamcinolone injections
Growth beyond the original wound margins, onset months after injury and recurrence after excision mark this as a keloid, not a hypertrophic scar. Keloids come from excess, disorganised type I and III collagen laid down by overactive fibroblasts, commonest on the earlobe, sternum and shoulders and in darker skin. Serial intralesional triamcinolone injections soften and flatten the scar and are first-line, often with silicone sheeting or pressure. If excision is needed, it is combined with steroid injections or radiotherapy, because excision alone recurs in most cases.
- A: Keloids do not regress; it is hypertrophic scars that settle over months.
- B: Topical creams do not reach the dermal collagen and do not treat a keloid.
- D: Excision alone is followed by recurrence, often larger, in most keloids.
Question 2 · Medium
A 30-year-old man was rescued from a burning godown after 20 minutes in a closed, smoke-filled room. He has facial burns, singed nasal hairs, soot in the mouth, carbonaceous sputum and a hoarse voice that is getting worse. SpO2 is 97% on oxygen. What is the most appropriate next step?
1. AChest X-ray before deciding
2. BHigh-flow oxygen by face mask only
3. CNebulised salbutamol and watch
4. DEarly endotracheal intubation
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Answer: D · Early endotracheal intubation
Closed-space fire, facial burns, singed nasal hairs, soot in the mouth, carbonaceous sputum and progressive hoarseness indicate inhalation injury with impending upper airway oedema. Swelling worsens over the first hours, especially during fluid resuscitation, and delayed intubation can become impossible. The airway should therefore be secured early by an experienced operator, using an uncut tube. The normal SpO2 is falsely reassuring, since carbon monoxide can also be present.
- A: The early chest X-ray is usually normal and only delays airway control.
- B: Oxygen alone does not protect an airway that is closing.
- C: Bronchodilators do not prevent upper airway oedema.
Question 3 · Easy
A 30-year-old woman had a clean laparotomy wound closed 4 days ago. Fibroblasts in the healing wound are laying down new collagen. Which collagen type predominates in this early granulation tissue, before it is remodelled?
1. AType II
2. BType III
3. CType I
4. DType IV
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Answer: B · Type III
Early granulation tissue contains mostly type III collagen, laid down by fibroblasts in the proliferative phase. During remodelling, which lasts months, type III is gradually replaced by the stronger type I collagen and cross-linking increases. Even so, a scar reaches only about 70-80% of the strength of unwounded skin. Vitamin C, oxygen and adequate nutrition are needed for normal collagen synthesis.
- A: Type II is the collagen of cartilage.
- C: Type I dominates the mature, remodelled scar, not the early wound.
- D: Type IV forms basement membranes.
Question 4 · Medium
During a surgery skills session, interns are asked to classify sutures. They list four statements: 1. Polydioxanone is a synthetic absorbable monofilament. 2. Polypropylene is a synthetic absorbable monofilament. 3. Silk is a natural, non-absorbable suture. 4. Polyglactin 910 is a synthetic, braided, absorbable suture. Which statements are correct?
1. A1, 2 and 3 only
2. B2, 3 and 4 only
3. C3 and 4 only
4. D1, 3 and 4 only
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Answer: D · 1, 3 and 4 only
Statements 1, 3 and 4 are correct. Polyglactin 910 (Vicryl) is braided, synthetic and absorbable; silk is natural, braided and non-absorbable (it slowly loses strength but is classed as non-absorbable); polydioxanone (PDS) is a synthetic monofilament absorbed slowly, which suits abdominal mass closure. Statement 2 is wrong: polypropylene (Prolene) is a non-absorbable monofilament used for vascular anastomoses and hernia repair.
- A: Includes the false claim that polypropylene is absorbable and drops polyglactin.
- B: Includes the false statement 2 and leaves out PDS.
- C: Leaves out statement 1; PDS is an absorbable monofilament.
Question 5 · Easy
In the plastic surgery OT, a split-thickness skin graft is being harvested from a burn patient's thigh to cover a granulating wound. Which instrument is classically used to cut the graft freehand?
1. AHumby knife
2. BBard-Parker handle
3. CGigli saw
4. DMayo scissors
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Answer: A · Humby knife
The Humby knife (and its modification, the Watson knife) is a hand-held skin-grafting knife with an adjustable roller that sets the thickness of a split-thickness graft. Powered dermatomes are an alternative for large areas. The thigh is a common donor site, and it heals by re-epithelialisation from the skin appendages left in the dermis. A split graft first survives by plasmatic imbibition and then by inosculation and new vessel growth.
- B: A Bard-Parker handle holds a scalpel blade, not suited to even-thickness grafts.
- C: A Gigli saw is a wire saw for bone.
- D: Mayo scissors cut tissue and sutures, not skin grafts.
Question 6 · Medium
After an emergency midline laparotomy in a 50-year-old man, the surgeon closes the linea alba with a continuous mass closure. To reduce the risk of burst abdomen and incisional hernia, what ratio of suture length to wound length should be used?
1. AAbout 1:1
2. BAbout 3:1
3. CAbout 2:1
4. DAt least 4:1
Answer and explanation in LearnFree account
Question 7 · Hard
A 64-year-old woman with faecal peritonitis from a perforated sigmoid diverticulum has been fluid-resuscitated in the surgical ICU. A pulmonary artery catheter has been placed. Which haemodynamic profile is expected in this phase of her shock?
1. ALow cardiac output, low SVR, high PCWP
2. BLow cardiac output, high SVR, high PCWP
3. CLow cardiac output, high SVR, low PCWP
4. DHigh cardiac output, low SVR, low-normal PCWP
Answer and explanation in LearnFree account
Question 8 · Medium
A 65-year-old man, living alone on a diet of rice and dal with no fruit or vegetables, has a laparotomy wound that keeps breaking down. He also has bleeding gums, perifollicular haemorrhages and corkscrew hairs. Which step of wound healing is defective?
1. AHydroxylation of proline and lysine in collagen
2. BMigration of neutrophils into the wound
3. CContraction of the wound by myofibroblasts
4. DRe-epithelialisation from the wound edges
Answer and explanation in LearnFree account
Question 9 · Medium
A family of four is found drowsy in a closed room where a charcoal brazier had been kept burning overnight in winter. The father has headache, confusion and vomiting; his pulse oximeter reads 99% on room air. Which test confirms the diagnosis?
1. APulse oximetry on oxygen
2. BMethaemoglobin level on a blood gas
3. CSerum lactate
4. DCarboxyhaemoglobin by co-oximetry
Answer and explanation in LearnFree account
Question 10 · Medium
A 58-year-old man with duodenal ulcer perforation and generalised peritonitis is in the surgical ICU before surgery. After 30 mL/kg of Ringer lactate and antibiotics, his BP is 82/44 mmHg (MAP 57 mmHg), his peripheries are warm, and lactate is 4.6 mmol/L. Which vasopressor should be started first?
1. AVasopressin
2. BDobutamine
3. CNoradrenaline
4. DDopamine
Answer and explanation in LearnFree account
Question 11 · Hard
On day 6 in the burns ward, a 32-year-old man with 35% deep partial and full-thickness burns develops fever, confusion and ileus. Parts of the wound have turned from pink to dark brown-black with a greenish tinge and early separation of the eschar, and there is focal haemorrhage under it. How is invasive burn wound infection best confirmed?
1. ASurface swab culture of the discoloured area
2. BBlood culture alone
3. CQuantitative culture and histology of wound biopsy
4. DSerum procalcitonin
Answer and explanation in LearnFree account
Question 12 · Medium
A 24-year-old man is brought to casualty after a fall from a height with a fracture-dislocation of the cervical spine. He has flaccid paralysis of all four limbs, BP 78/40 mmHg, pulse 50/min, and warm, pink peripheries. FAST is negative and there is no external bleeding. What type of shock is this?
1. ANeurogenic shock
2. BSpinal shock
3. CSeptic shock
4. DHypovolaemic shock
Answer and explanation in LearnFree account
Question 13 · Easy
A 35-year-old man with 45% burns is in the burns ward on day 4. He vomits coffee-ground material and his haemoglobin falls. Endoscopy shows multiple shallow gastric and duodenal erosions. What is this acute ulcer called?
1. ACushing ulcer
2. BDieulafoy lesion
3. CCurling ulcer
4. DMarjolin ulcer
Answer and explanation in LearnFree account
Question 14 · Medium
A 40-year-old electrician has a burn on the front of the right leg from burning petrol. The area is white and leathery, dry, painless to pinprick, and does not blanch on pressure. Hair pulls out easily. After resuscitation, what is the definitive treatment of this area?
1. ADaily saline soaks and observation
2. BLeave to heal by secondary intention
3. CEarly tangential excision and skin grafting
4. DSilver sulfadiazine dressings until healed
Answer and explanation in LearnFree account
Question 15 · Easy
A vascular surgeon at a medical college hospital is about to anastomose a femoral artery bypass graft. Which suture material is the standard choice for the anastomosis?
1. ASilk
2. BPolyglactin 910
3. CPolypropylene
4. DChromic catgut
Answer and explanation in LearnFree account
Question 16 · Medium
A 60 kg man is brought to the casualty of a district hospital 30 minutes after a kerosene stove burst, with deep partial-thickness burns over 30% of his body surface area. Using the Parkland formula (4 mL/kg/% TBSA), what is his total Ringer lactate requirement for the first 24 hours after the burn?
1. A3600 mL
2. B4800 mL
3. C9600 mL
4. D7200 mL
Answer and explanation in LearnFree account
Question 17 · Medium
A 28-year-old man in the burns ICU has circumferential full-thickness burns of the chest and upper abdomen. Over 6 hours of fluid resuscitation he becomes restless, with shallow breathing, rising peak airway pressures on the ventilator and a rising PaCO2. What is the most appropriate next step?
1. AIncrease the tidal volume
2. BBedside escharotomy of the chest
3. CBronchoscopy for inhalation injury
4. DStart IV furosemide
Answer and explanation in LearnFree account
Question 18 · Medium
A 26-year-old lineman touched an 11 kV line. He has a small charred entry wound on the right palm and an exit wound on the left foot, but the right forearm is tense and very painful on passive finger extension. His urine is dark brown and the dipstick is positive for blood, with no red cells on microscopy. What causes the urine change?
1. AHaematuria from renal contusion
2. BMyoglobinuria from muscle necrosis
3. CBilirubinuria from liver injury
4. DHaemoglobinuria from haemolysis
Answer and explanation in LearnFree account
Question 19 · Hard
A 70 kg adult is kept nil by mouth after a bowel resection and needs IV maintenance fluid only. Using the 4-2-1 rule for hourly maintenance, what infusion rate should be prescribed?
1. A280 mL per hour
2. B140 mL per hour
3. C70 mL per hour
4. D110 mL per hour
Answer and explanation in LearnFree account
Question 20 · Medium
A 70 kg man with 35% burns is on Ringer lactate by the Parkland formula, with a urinary catheter in place. What hourly urine output shows adequate resuscitation in this adult?
1. AAbout 70-100 mL per hour
2. BAbout 10-20 mL per hour
3. CAbout 35-50 mL per hour
4. DAbout 150-200 mL per hour
Answer and explanation in LearnFree account
Question 21 · Medium
A 14-month-old boy is brought to casualty with scalds from boiling milk over his head, neck and chest. The duty doctor wants the most accurate estimate of burned area for this child. Which method should be used?
1. ARule of fives
2. BLund and Browder chart
3. CWallace adult rule of nines
4. DPalm (1%) method
Answer and explanation in LearnFree account
Question 22 · Hard
A 50 kg woman with 40% deep burns from a kitchen fire reaches the medical college hospital 3 hours after the burn, having received no IV fluid on the way. The team uses the Parkland formula (4 mL/kg/% TBSA). At what rate should Ringer lactate run until 8 hours after the burn?
1. A500 mL per hour
2. B400 mL per hour
3. C1000 mL per hour
4. D800 mL per hour
Answer and explanation in LearnFree account
Question 23 · Easy
A 9-year-old girl has scattered patches of scald over the trunk and limbs after a pot of hot tea tipped over. To estimate the area of small, irregular burns quickly, roughly what share of total body surface area does the patient's own palm with the fingers represent?
1. A9%
2. B0.5%
3. C1%
4. D5%
Answer and explanation in LearnFree account
Question 24 · Medium
A 34-year-old woman is brought to casualty after her saree caught fire. She has deep partial-thickness burns over the entire front of the trunk, the whole right upper limb and the perineum. Using the rule of nines, what is the burned area?
1. A36%
2. B19%
3. C27%
4. D28%
Answer and explanation in LearnFree account
Question 25 · Medium
In the burns unit, the resident explains fluid resuscitation to a new intern with four statements: 1. The first 8 hours are counted from the time of the burn, not from arrival. 2. Areas of simple erythema (superficial burns) are included in the TBSA. 3. Half of the calculated 24-hour volume is given in the first 8 hours. 4. Colloid is the fluid of choice in the first 8 hours. Which statements are correct?
1. A1 and 3 only
2. B1, 3 and 4 only
3. C3 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account

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Burns, wounds, shock and fluid management

A 30-year-old man was rescued from a burning godown after 20 minutes in a closed, smoke-filled room. He has facial burns, singed nasal hairs, soot in the mouth, carbonaceous sputum and a hoarse voice that is getting worse. SpO2 is 97% on oxygen. What is the most appropriate next step?

A 30-year-old woman had a clean laparotomy wound closed 4 days ago. Fibroblasts in the healing wound are laying down new collagen. Which collagen type predominates in this early granulation tissue, before it is remodelled?

In the plastic surgery OT, a split-thickness skin graft is being harvested from a burn patient's thigh to cover a granulating wound. Which instrument is classically used to cut the graft freehand?

After an emergency midline laparotomy in a 50-year-old man, the surgeon closes the linea alba with a continuous mass closure. To reduce the risk of burst abdomen and incisional hernia, what ratio of suture length to wound length should be used?

A 64-year-old woman with faecal peritonitis from a perforated sigmoid diverticulum has been fluid-resuscitated in the surgical ICU. A pulmonary artery catheter has been placed. Which haemodynamic profile is expected in this phase of her shock?

A 65-year-old man, living alone on a diet of rice and dal with no fruit or vegetables, has a laparotomy wound that keeps breaking down. He also has bleeding gums, perifollicular haemorrhages and corkscrew hairs. Which step of wound healing is defective?

A family of four is found drowsy in a closed room where a charcoal brazier had been kept burning overnight in winter. The father has headache, confusion and vomiting; his pulse oximeter reads 99% on room air. Which test confirms the diagnosis?

A 58-year-old man with duodenal ulcer perforation and generalised peritonitis is in the surgical ICU before surgery. After 30 mL/kg of Ringer lactate and antibiotics, his BP is 82/44 mmHg (MAP 57 mmHg), his peripheries are warm, and lactate is 4.6 mmol/L. Which vasopressor should be started first?

A 24-year-old man is brought to casualty after a fall from a height with a fracture-dislocation of the cervical spine. He has flaccid paralysis of all four limbs, BP 78/40 mmHg, pulse 50/min, and warm, pink peripheries. FAST is negative and there is no external bleeding. What type of shock is this?

A 35-year-old man with 45% burns is in the burns ward on day 4. He vomits coffee-ground material and his haemoglobin falls. Endoscopy shows multiple shallow gastric and duodenal erosions. What is this acute ulcer called?

A 40-year-old electrician has a burn on the front of the right leg from burning petrol. The area is white and leathery, dry, painless to pinprick, and does not blanch on pressure. Hair pulls out easily. After resuscitation, what is the definitive treatment of this area?

A vascular surgeon at a medical college hospital is about to anastomose a femoral artery bypass graft. Which suture material is the standard choice for the anastomosis?

A 28-year-old man in the burns ICU has circumferential full-thickness burns of the chest and upper abdomen. Over 6 hours of fluid resuscitation he becomes restless, with shallow breathing, rising peak airway pressures on the ventilator and a rising PaCO2. What is the most appropriate next step?

A 70 kg adult is kept nil by mouth after a bowel resection and needs IV maintenance fluid only. Using the 4-2-1 rule for hourly maintenance, what infusion rate should be prescribed?

A 70 kg man with 35% burns is on Ringer lactate by the Parkland formula, with a urinary catheter in place. What hourly urine output shows adequate resuscitation in this adult?

A 14-month-old boy is brought to casualty with scalds from boiling milk over his head, neck and chest. The duty doctor wants the most accurate estimate of burned area for this child. Which method should be used?

A 50 kg woman with 40% deep burns from a kitchen fire reaches the medical college hospital 3 hours after the burn, having received no IV fluid on the way. The team uses the Parkland formula (4 mL/kg/% TBSA). At what rate should Ringer lactate run until 8 hours after the burn?

A 9-year-old girl has scattered patches of scald over the trunk and limbs after a pot of hot tea tipped over. To estimate the area of small, irregular burns quickly, roughly what share of total body surface area does the patient's own palm with the fingers represent?

A 34-year-old woman is brought to casualty after her saree caught fire. She has deep partial-thickness burns over the entire front of the trunk, the whole right upper limb and the perineum. Using the rule of nines, what is the burned area?