Question 31#

The following are formulae specifically for calculating nutritional requirements and supplementation after burn injury except for:

A. Curreri formula

Harris-Benedict formula. All except the Harris-Benedict formula specifically calculate nutritional requirements after burns. The HarrisBenedict formula calculates basal calorific requirements. However, it can still be used in the calculation of nutritional requirements by multiplying the basal requirements by a stress factor which usually ranges between 1.2 and 1.8 depending on severity of burn. The Curreri formula was developed retrospectively based upon just nine cases. 

Question 32#

The following fluid rescucitation is suitable for a 12kg child with 8% burns: 

A. 46ml of human albumin solution

384ml per 24 hours for Parkland’s formula of crystalloid.

Question 33#

Which one answer is true regarding osteomyelitis in the lower limb? 

A. The commonest causative organism overall is Streptococcus pyogenes

A common causative organism in relation to joint replacements is a common skin commensal. A common causative organism in relation to joint replacements is Staphylococcus epidermidis. The commonest organism overall is S. aureus. Pairolero discussed osteomyelitis of the sternum. The incidence of infection in severe tibial fractures using antibiotic prophylaxis is reduced from 24% to 4%.

References:
1. Patzakis MJ Wilkins J. Moore TM. Use of antibiotics in open tibial fractures. Clin Orthop Relat Res 1983; 178: 31-5.

Question 34#

The best modality for diagnosis of osteomyelitis is:

A. MRI

Bone biopsy. Imaging modalities may show subtle changes early in the course of osteomyelitis, but often does not. Bone biopsy provides not only a definitive diagnosis of infection, but differentiates from other causes including tumours.

Question 35#

In the context of acute trauma, permissive hypotension: 

A. Has been universally embraced in the context of acute trauma management by ATLS®

Involves withholding fluid resuscitation in acute trauma in order to avoid overall blood loss and coagulopathy, which may improve prognosis in patients not in extremis. Although not universally accepted, some trauma centres are moving towards acceptance of the concept of permissive hypotension. This concept allows moderate hypotension in the context of acute trauma because early aggressive fluid resuscitation can increase overall blood loss and causes clotting abnormalities. It is yet to be embraced by ATLS® at the time of writing (2009).