Question 1

A patient sustained burns to the anterior neck,right anterior axilla,and right antecubital fossa.Which one of the following contractures is MOST likely to occur?&#10;A)Neck flexion,right shoulder abduction,right elbow flexion&#10;B)Neck flexion,right shoulder adduction,right elbow extension&#10;C)Neck flexion,right shoulder adduction,right elbow flexion&#10;D)Neck lateral flexion,right shoulder abduction,right elbow flexion

Accepted Answer

The burn locations described in this question would result in the development of a neck flexion contracture, as well as a contracture of the right shoulder adduction and right elbow flexion. This is because the burn to the anterior neck would cause scar tissue formation, leading to a loss of mobility in the neck. Similarly, the burn to the right anterior axilla would cause a loss of mobility in the shoulder joint – specifically, in the form of adduction (moving the arm closer to the body). Finally, the burn to the right antecubital fossa would cause a loss of mobility in the elbow joint, specifically in the form of flexion (bending the arm). Therefore, the correct answer is C, which includes all three of these contractures.

Question 2

Which one of the following should be the MOST immediate burn team intervention for a patient who sustained circumferential full-thickness burns to the left leg 24 hours ago who presents with limited range of motion,yellow eschar on the wound,and decreased foot temperature?

A)Evaluation for escharotomy
B)Wound care to remove eschar
C)Passive range of motion to prevent contracture
D)Skin grafting to attain wound closure

A

Accepted Answer

Circumferential full-thickness burns can lead to compartment syndrome, which can cause decreased blood flow and subsequent tissue damage. The yellow eschar on the wound, decreased foot temperature, and limited range of motion are all signs of potential compartment syndrome. Therefore, immediate evaluation for escharotomy, a surgical procedure used to relieve pressure and improve blood flow, is necessary to prevent further tissue damage and potential loss of limb. The other interventions (B, C, and D) may be necessary at some point during treatment, but escharotomy takes priority in this acute situation.

Question 3

Which of the following is NOT a clinical sign of a superficial partial-thickness burn?&#10;A)Diminished sensation of deep pressure&#10;B)Tissue blanching with applied pressure&#10;C)Intact blisters over the injured area&#10;D)Spontaneous healing and minimal scarring

Accepted Answer

Diminished sensation of deep pressure is a clinical sign of a deep partial-thickness or a full-thickness burn, not a superficial partial-thickness burn. Tissue blanching with applied pressure, intact blisters, spontaneous healing, and minimal scarring are all characteristic clinical signs of a superficial partial-thickness burn.

Question 4

Upon evaluation of an African American patient 13 months after experiencing a deep partial-thickness burn to the upper back,the physical therapist notes extensive scar tissue.Which one of the following descriptors is MORE consistent with a keloid scar compared to a hypertrophic scar?

A)Raised greater than 2 mm above the surface of the skin and rigid
B)Extends beyond the boundaries of the initial injury
C)Contracts and pulls on the surrounding skin
D)Takes a prolonged amount of time to mature

Accepted Answer

Keloid scars are characterized by excessive growth beyond the boundaries of the initial injury, whereas hypertrophic scars remain within the original injury site. Option A describes both keloid and hypertrophic scars, as both can be raised and rigid. Option C describes hypertrophic scars, which can cause surrounding skin to contract, whereas keloid scars do not typically result in this type of tension. Option D is also not specific to either type of scar, as both can take a long time to mature.

Question 5

Which one of the following is the BEST physical therapy course of action for a patient who sustained superficial partial-thickness burns to bilateral hands and forearms and presents with good hand function,no limitation in range of motion,and good compliance with home exercise program?

A)Encouraging active use of hands and monitor range of motion
B)Splinting the hands at night to prevent contracture and allow active motion during the day
C)Fitting the patient with pressure garment gloves to use 23 to 24 hours each day
D)Splint in one hand while leaving the other hand free for function,alternating every 2 hours

Accepted Answer

Based on the patient's presentation of good hand function, no limitation in range of motion, and good compliance with home exercise program, the best course of action would be to encourage active use of hands and monitor range of motion. Splinting or pressure garment gloves may not be necessary and could potentially limit the patient's progress and function. Alternating splinting one hand while leaving the other hand free may also not be necessary or beneficial in this case.

Question 6

A patient underwent split thickness skin grafting to bilateral lower legs 5 days ago and is now cleared for mobility and ambulation.Which one of the following goals justifies the use of figure-of-eight pattern elastic bandages to the lower extremities prior to ambulation?

A)Prevent orthostatic hypertension.
B)Decrease pain in the dependent lower extremities.
C)Apply pressure for early scar management.
D)Support new grafts and promote venous return.Chapter 24: Burns

Accepted Answer

The figure-of-eight pattern elastic bandages are used to support the new grafts and promote venous return. This helps to prevent fluid buildup and improves circulation to the affected area. It also helps to minimize the risk of dislodging the grafts during ambulation.

Question 7

Which of the following processes does NOT occur during the proliferative stage of dermal healing?&#10;A)Wound contraction until it meets opposing forces&#10;B)Formation of granulation tissue&#10;C)Remodeling of collagen into parallel arrangement&#10;D)Increased tensile strength of the wound

Accepted Answer

The remodeling of collagen into a parallel arrangement occurs during the maturation phase of wound healing, not during the proliferative stage. During the proliferative stage, wound contraction and the formation of granulation tissue occur, which lead to the increased tensile strength of the wound.

Question 8

When evaluating a 17-year-old girl 4 months after burn injury to the anterior torso,the physical therapist notes that she has a hypertrophic scar on her sternum between her developed breasts.What is the BEST means of nonsurgical scar management in this area?

A)Silicone insert sheet material applied under pressure garment device
B)Pressure garment vest with posterior zipper
C)Scar massage in conjunction with range of motion exercises
D)Positioning the patient with torso extension and chest expansion

Accepted Answer

Silicone insert sheet material applied under pressure garment device has been shown to be an effective means of scar management in this area as it helps to soften and flatten hypertrophic scars. It also provides constant pressure to the area which helps decrease scar thickness and improve scar elasticity. Additionally, the silicone material helps to keep the area moisturized, which promotes a more favorable environment for scar healing.

Deck 24: Burns