Thermal Burns and Severity Assessment
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Questions and Answers

What layer of the skin is affected in a deep partial thickness burn?

  • Epidermis and papillary dermis
  • Subcutaneous tissue and muscle
  • Epidermis, papillary dermis, and reticular dermis (correct)
  • Dermis and subcutaneous tissue

    • What is a characteristic of a third-degree burn?

  • Small blisters with no scarring
  • Painful with redness and swelling
  • Redness and blisters
  • Leathery white appearance and insensate (correct)

    • How long does it take to get a full-thickness burn from scalding water at 130 F (55 C)?

  • 5 seconds
  • 30 seconds (correct)
  • 1 minute
  • 1 second

    • What is a characteristic of a fourth-degree burn?

    <p>Black charred skin and affect underlying muscle or bone</p> Signup and view all the answers

    What is a characteristic of keloid scars?

    <p>They are raised and extend beyond the original area of injury</p> Signup and view all the answers

    What is the first step in treating burns?

    <p>Maintain adequate oxygenation</p> Signup and view all the answers

    What is the goal of fluid resuscitation in burn treatment?

    <p>Goal urine output 1 ml/kg/hr</p> Signup and view all the answers

    What percentage of pregnant women develop an intraoral PG in the first five months of pregnancy?

    <p>2%</p> Signup and view all the answers

    What is the most common distribution of pyogenic granuloma?

    <p>Lips, mouth, trunk, and toes</p> Signup and view all the answers

    What is another name for pyogenic granuloma?

    <p>Lobular capillary hemangioma</p> Signup and view all the answers

    What percentage of pyogenic granuloma cases are related to systemic medications?

    <p>30%</p> Signup and view all the answers

    What is the treatment option for pyogenic granuloma?

    <p>All of the above</p> Signup and view all the answers

    At what age do pyogenic granuloma peak in incidence?

    <p>Second and third decades of life</p> Signup and view all the answers

    What is the characteristic of pyogenic granuloma during its growth?

    <p>Rapid growth</p> Signup and view all the answers

    What is the usual appearance of pyogenic granuloma?

    <p>Solitary vascular papule or nodule with a glistening red to red-brown friable surface</p> Signup and view all the answers

    What is the temperature at which burns can occur in 6 hours?

    <p>111 degrees F (44 C)</p> Signup and view all the answers

    What is the primary factor in determining the severity of a burn?

    <p>Depth of the burn and the percent of body surface area involved</p> Signup and view all the answers

    What is the percentage of body surface area involved in the entire head and neck of an adult?

    <p>9%</p> Signup and view all the answers

    What type of burn only affects the epidermis?

    <p>First degree burn</p> Signup and view all the answers

    What is the characteristic of a second degree burn?

    <p>Affects the epidermis and part of the dermis</p> Signup and view all the answers

    What is the characteristic of a superficial partial thickness burn?

    <p>Involves the epidermis and superficial dermis</p> Signup and view all the answers

    What is the percentage of body surface area involved in the perineum of an adult?

    <p>1%</p> Signup and view all the answers

    What is the temperature at which burns can occur in 1 second?

    <p>140 degrees F (60 C)</p> Signup and view all the answers

    What is the possible underlying disease that can cause clubbing?

    <p>Lung cancer</p> Signup and view all the answers

    What is the characteristic of Koilonychia?

    <p>Upward curving of the distal nail plate</p> Signup and view all the answers

    What is the possible cause of Beau Lines?

    <p>Severe illness</p> Signup and view all the answers

    What is the characteristic of Muehrcke lines?

    <p>Transverse, white bands that run parallel to the lunula</p> Signup and view all the answers

    What is the treatment for Muehrcke lines?

    <p>Treating any underlying condition</p> Signup and view all the answers

    What is the characteristic of Terry Nails?

    <p>White discoloration of all but the most distal 2 mm of the nail bed</p> Signup and view all the answers

    What is the possible underlying disease that can cause Koilonychia?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    What is the possible underlying disease that can cause Beau Lines?

    <p>Severe illness</p> Signup and view all the answers

    What is the predominant treatment for angiosarcomas of the scalp and neck?

    <p>Surgery, may also use radiation therapy and chemotherapy</p> Signup and view all the answers

    What is the characteristic histopathological feature of angiosarcoma?

    <p>Poorly formed vascular spaces lined by endothelial cells with cytologic atypia</p> Signup and view all the answers

    What is the most common cause of onychomycosis?

    <p>Trichophyton rubrum</p> Signup and view all the answers

    What is the primary goal of treatment in acute paronychia?

    <p>To drain abscess</p> Signup and view all the answers

    What is the term for the separation of the nail from the nailbed?

    <p>Onycholysis</p> Signup and view all the answers

    What is the treatment of choice for dermatophyte onychomycosis?

    <p>Oral terbinafine</p> Signup and view all the answers

    What is the characteristic feature of clubbing?

    <p>Thickening of the nail bed's soft tissue, particularly in the proximal end</p> Signup and view all the answers

    What is the typical cause of subungual hematoma?

    <p>Trauma</p> Signup and view all the answers

    Study Notes

    Thermal Burns

    • Burns can occur at 111°F (44°C) within 6 hours, and at 140°F (60°C) within 1 second
    • The severity of a burn is judged by the depth of the burn and the percentage of body surface area (BSA) involved
    • Body surface area (rule of 9's) is calculated as follows:
      • Head and neck: 9%
      • Right arm: 9%
      • Left arm: 9%
      • Right leg: 18%
      • Left leg: 18%
      • Anterior torso: 18%
      • Posterior torso: 18%
      • Perineum: 1%
    • For infants up to 1 year old, the skin is still able to retain fluids, so only burns of second degree or worse are used to calculate BSA

    Degrees of Burns

    • First degree burn (superficial burn)
      • Affects only the epidermis
      • Painful, skin appears red or pink
      • Heals without sequelae as epidermis is regenerated
    • Second degree burn (partial thickness burn)
      • Affects epidermis and part of the dermis
      • May be subdivided into:
        • Superficial partial thickness burn: involves epidermis and superficial dermis
        • Deep partial thickness burn: involves epidermis, papillary dermis, and reticular dermis
      • Often see redness and blisters, painful, but may be less painful than expected due to nerve destruction
      • Heals with scarring, often treated with skin grafting to improve outcome
    • Third degree burn (full thickness burn)
      • Affects entire thickness of skin, including epidermis, dermis, and variable amount of subcutaneous tissue
      • Leathery white appearance, often insensate (not painful)
      • Generally requires skin grafting
    • Fourth degree burn
      • Affects entire thickness of skin, plus underlying muscle or bone
      • Black charred skin

    Treatment of Burns

    • Maintain adequate oxygenation
    • Evaluate airway for evidence of inhalation injury
    • Evaluate for carbon monoxide poisoning
    • Pain control
    • Wound care
    • Fluid resuscitation using the Parkland formula
    • Goal urine output: 1 ml/kg/hr

    Keloid Scars

    • Have raised areas and extend beyond the original area of an injury
    • May occur after severe burns or ear piercing

    Vascular Tumors

    • Pyogenic granuloma
      • AKA lobular capillary hemangioma
      • Benign vascular tumor
      • Peak incidence in second and third decades of life
      • Often develops at site of previous injury
      • Display rapid growth
      • Associated with trauma, systemic medications, and pregnancy
    • Angiosarcoma
      • Poorly formed vascular spaces lined by endothelial cells with cytologic atypia of nuclei
      • Reddish-brown maculopapular lesion
      • Plaque with crusting on forehead and anterior scalp
      • Poor prognosis: 5 and 10-year survival rates are 34% and 14%, respectively

    Nail Changes/Disorders

    • Acute paronychia
      • Superficial infection of the proximal and lateral nail folds adjacent to the nail plate
      • Most commonly caused by Staphylococcus aureus or Streptococcus pyogenes
      • Presents with red, swollen, and tender nail folds
      • May develop associated abscess
      • Treatment: topical antibiotics, warm soaks, oral antibiotics, and I&D for abscess
    • Onychomycosis
      • Fungal infection of nail due to dermatophyte, yeast, or nondermatophyte mold
      • Most common cause is Trichophyton rubrum
      • Presents with nail discoloration, subungual hyperkeratosis, splitting of nail, onycholysis, and/or nail plate destruction
      • Treatment: oral antifungal therapy, particularly terbinafine
    • Subungual hematoma
      • Blood under the nail, usually due to trauma
      • May cause throbbing pain
      • Treatment: drainage/trephination of fresh hematomas, or removal of nail if symptomatic
    • Clubbing
      • Thickening of the nail bed's soft tissue, particularly in the proximal end
      • Clinically diagnosed with an exam showing Schamroth sign
      • Associated with altered vasculature, and can be a sign of numerous underlying diseases
    • Koilonychia
      • Upward curving of the distal nail plate, resulting in a spoon-shaped nail
      • Associated with iron deficiency anemia, hemochromatosis, trauma, Raynaud disease, and other conditions
    • Beau lines
      • Horizontal grooves on the nail plate caused by an interruption of nail bed mitosis
      • Etiologies include severe illness, Reynaud disease, pemphigus, chemotherapy, and others
      • Treatment: no specific treatment other than treating any underlying condition
    • Muehrcke lines
      • Transverse, white bands that run parallel to the lunula across the entire width of the nail
      • Etiologies include hypoalbuminemia, nephrotic syndrome, liver disease, and malnutrition
      • Treatment: no specific treatment other than treating any underlying condition
    • Terry nails
      • Apparent leukonychia (white discoloration) of all but the most distal 2 mm of the nail bed
      • Etiologies include liver disease, malnutrition, and others

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    Burns, Vascular Tumors, and Nail Changes PDF

    Description

    This quiz covers the severity of thermal burns, including the time it takes for burns to occur at different temperatures and how to assess the severity of a burn based on its depth and body surface area involved.

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