MCQ bank · 35 questions · free
Skin, wounds & burns MCQs with answers
35 single-best-answer questions on burns, melanoma, skin cancer, abscesses, bites and wound care. Try each one, then open the answer to see the explanation, why the other options are wrong, and the guideline or trial behind it.
A 47-year-old woman has a pigmented lesion on her back that has grown over 6 months, with an irregular border and several colours. What is the correct way to make the diagnosis?
- Cryotherapy
- Wide local excision with a 2-cm margin straight away
- Shave biopsy
- Excision biopsy with a 2-mm clinical margin and a cuff of fat
- Punch biopsy of the darkest area
Show the answer and explanation
Answer: D. Excision biopsy with a 2-mm clinical margin and a cuff of fat. A suspected melanoma should be excised completely with a narrow margin so the pathologist can measure the full Breslow thickness, which determines staging, the wide local excision margin and whether sentinel node biopsy is offered.
Why not the others? Shave or partial biopsies may underestimate thickness. A wide excision before diagnosis disrupts lymphatic mapping for sentinel node biopsy.
References
Excision biopsy of a lesion on the thigh shows a melanoma with a Breslow thickness of 1.5 mm, without ulceration. Staging shows no spread. What is the next surgical step?
- No further surgery
- Wide excision with a 5-cm margin
- Elective lymph node dissection of the groin
- Wide local excision with a 1–2 cm margin, and sentinel lymph node biopsy offered
- Amputation
Show the answer and explanation
Answer: D. Wide local excision with a 1–2 cm margin, and sentinel lymph node biopsy offered. Excision margins are based on Breslow thickness: 0.5–1 cm for in-situ disease, 1 cm for tumours up to 1 mm, and 1–2 cm for 1–2 mm. Sentinel lymph node biopsy is offered for melanomas thicker than 0.8 mm, or thinner ones with ulceration, because it gives accurate staging and guides adjuvant therapy.
Why not the others? Wider margins do not improve survival. Routine lymph node dissection has been replaced by sentinel node biopsy.
References
A 26-year-old man has a 4-cm fluctuant abscess on his thigh with a small rim of redness. He is otherwise well, with normal observations. What is the treatment?
- Incision and drainage
- Warm compresses and review in 1 month
- MRI of the thigh
- Needle aspiration and intravenous antibiotics
- Oral antibiotics alone
Show the answer and explanation
Answer: A. Incision and drainage. Incision and drainage is the main treatment for a skin abscess. Antibiotics are added for systemic signs (fever, tachycardia), extensive cellulitis, immunosuppression, or failure of drainage, and they can modestly improve cure in larger abscesses.
Why not the others? Antibiotics alone do not reach a collection of pus.
References
A 22-year-old man has had three episodes of pilonidal abscess drained. He now has a chronic discharging sinus in the natal cleft and wants definitive surgery. Which principle reduces recurrence?
- Radiotherapy
- Repeated incision and drainage
- Excision with off-midline closure (for example a Karydakis or Bascom cleft-lift procedure)
- Excision with primary midline closure
- Antibiotics for 3 months
Show the answer and explanation
Answer: C. Excision with off-midline closure (for example a Karydakis or Bascom cleft-lift procedure). When a pilonidal wound is closed primarily, off-midline techniques that flatten the natal cleft heal faster and recur less often than midline closure. Leaving the wound open to heal is an alternative but takes weeks. Hair removal around the area may also help reduce recurrence.
Why not the others? A midline scar sits in the deepest, moistest part of the cleft and breaks down more often.
References
A 50-year-old man has a 7-cm, painless lump in his thigh that has grown over 4 months. It feels firm and lies deep to the fascia. What is the correct approach?
- Fine-needle aspiration and observe
- Incision and drainage
- Reassure, as most lumps are lipomas
- Excise it as a lipoma on the next minor operations list
- Urgent ultrasound, then MRI and image-guided core biopsy, with referral to a sarcoma centre before any excision
Show the answer and explanation
Answer: E. Urgent ultrasound, then MRI and image-guided core biopsy, with referral to a sarcoma centre before any excision. Features suggesting soft tissue sarcoma are size over 5 cm, growth, a position deep to the fascia, and pain. Such lumps must be imaged and biopsied in a way planned by the sarcoma team, because an unplanned “shelling out” leaves tumour behind and makes the definitive operation much larger.
Why not the others? Fine-needle aspiration is unreliable for sarcoma typing and grading.
References
A 45-year-old farmer has a deep laceration contaminated with soil. He cannot remember ever having a tetanus vaccination. What does he need, in addition to wound cleaning?
- Oral penicillin only
- A tetanus-containing vaccine and human tetanus immunoglobulin
- Vaccine only
- Nothing, if the wound is cleaned well
- Immunoglobulin only
Show the answer and explanation
Answer: B. A tetanus-containing vaccine and human tetanus immunoglobulin. A tetanus-prone wound in someone with incomplete or unknown immunisation needs both passive protection (human tetanus immunoglobulin, given at a different site) and active protection (a vaccine dose, then completing the course). Thorough cleaning and removal of dead tissue are also essential.
Why not the others? Antibiotics do not replace immunisation.
References
A dog bit a man on the back of his hand 6 hours ago, leaving several puncture wounds. What is the correct management?
- Irrigate and debride, leave the wound open or loosely approximated, give prophylactic co-amoxiclav, and check tetanus status
- Flucloxacillin alone
- Clean and discharge without review
- Close the wounds tightly with sutures
- No antibiotics because it is a small wound
Show the answer and explanation
Answer: A. Irrigate and debride, leave the wound open or loosely approximated, give prophylactic co-amoxiclav, and check tetanus status. Bite wounds to the hand carry a high risk of infection with mixed oral flora (including Pasteurella), so they are irrigated, debrided and usually not closed primarily. Prophylactic amoxicillin–clavulanate is recommended, and the hand is reviewed for joint or tendon involvement. Rabies risk is assessed according to the setting.
Why not the others? Flucloxacillin does not cover Pasteurella. Tight closure of a hand bite traps bacteria.
References
A 70-year-old man has a 1-cm well-defined nodular basal cell carcinoma on his upper back. What is the standard treatment?
- Surgical excision with about a 4-mm clinical margin
- Mohs micrographic surgery for every basal cell carcinoma
- Radiotherapy as first choice
- Chemotherapy
- Observation only
Show the answer and explanation
Answer: A. Surgical excision with about a 4-mm clinical margin. For a low-risk, well-defined basal cell carcinoma, standard surgical excision with a 4-mm margin clears the tumour in about 95% of cases. Mohs surgery is reserved for high-risk tumours (for example on the central face, recurrent, or with poorly defined edges).
Why not the others? Radiotherapy is useful for patients unfit for surgery, but it is not first choice on the trunk.
References
A child pulls a cup of hot tea onto her forearm. Her mother calls you 5 minutes later. What is the best first aid?
- Apply butter or toothpaste
- Pop any blisters immediately
- Cool the burn under cool running water for 20 minutes, remove clothing and jewellery, then cover with cling film
- Apply ice directly to the burn
- Cover with a tight dry bandage and wait
Show the answer and explanation
Answer: C. Cool the burn under cool running water for 20 minutes, remove clothing and jewellery, then cover with cling film. Cooling with cool running tap water for 20 minutes, ideally within 3 hours, reduces burn depth, pain and the need for grafting. The child should be kept warm. Cling film is a clean, non-adherent covering that allows assessment.
Why not the others? Ice causes vasoconstriction and further tissue damage, and home remedies contaminate the wound.
References
A 60-year-old man has a non-healing, raised ulcer with rolled edges that developed within an old burn scar on his leg 2 years ago. What is the next step?
- Antibiotics
- Biopsy of the ulcer edge, suspecting squamous cell carcinoma (Marjolin’s ulcer)
- Compression bandaging for 12 weeks
- Reassurance
- Skin graft without a biopsy
Show the answer and explanation
Answer: B. Biopsy of the ulcer edge, suspecting squamous cell carcinoma (Marjolin’s ulcer). A chronic, non-healing ulcer in a scar (burn, chronic osteomyelitis sinus or longstanding venous ulcer) may undergo malignant change, usually to squamous cell carcinoma. A biopsy from the edge confirms it. These tumours behave aggressively and need wide excision and nodal assessment.
Why not the others? Any chronic ulcer that changes appearance or does not heal with proper treatment should be biopsied.
References
A 19-year-old has had a recurrent ingrown toenail on the lateral side of the big toe, with three episodes of infection. What procedure gives the lowest recurrence?
- Antibiotics for every episode
- Cutting the nail in a V shape
- Total excision of the toe
- Simple nail avulsion without treating the matrix
- Partial nail avulsion (wedge resection) with chemical matricectomy using phenol
Show the answer and explanation
Answer: E. Partial nail avulsion (wedge resection) with chemical matricectomy using phenol. Removing the lateral strip of nail and destroying the matrix underneath with phenol prevents the edge from growing back and has a lower recurrence than avulsion alone. It is done under a digital (ring) block.
Why not the others? Simple avulsion lets the nail regrow with the same problem.
References
An immobile 84-year-old in a care home has a category 4 pressure ulcer over the sacrum with exposed bone and necrotic tissue. Which approach is correct?
- Massage over the bony prominence
- Pressure relief (specialist mattress, repositioning), nutrition, surgical debridement of necrotic tissue, and assessment for osteomyelitis
- Antibiotics alone
- Leave the necrotic tissue to separate without help
- Dressings only, with no change in positioning
Show the answer and explanation
Answer: B. Pressure relief (specialist mattress, repositioning), nutrition, surgical debridement of necrotic tissue, and assessment for osteomyelitis. Pressure ulcers heal only when pressure is relieved. Category 4 ulcers expose bone, tendon or muscle and need debridement of dead tissue, nutritional support and evaluation for underlying osteomyelitis. Flap reconstruction is considered in selected patients.
Why not the others? Massaging bony prominences damages the tissues.
References
A 28-year-old has recurrent painful nodules, abscesses and sinus tracts with scarring in both armpits and groins for 5 years, despite antibiotics. Which treatments are appropriate?
- Medical therapy such as adalimumab, combined with surgical excision of the affected areas (deroofing or wide excision) for persistent disease
- Oral steroids for life
- No treatment is available
- Repeated incision and drainage only
- Antifungal cream
Show the answer and explanation
Answer: A. Medical therapy such as adalimumab, combined with surgical excision of the affected areas (deroofing or wide excision) for persistent disease. This is hidradenitis suppurativa. It is treated with lifestyle changes (stopping smoking, weight loss), antibiotics, biologics such as adalimumab for moderate-to-severe disease, and surgery. Wide excision of sinus tracts has the lowest recurrence; incision and drainage only relieves acute pain.
Why not the others? Incision and drainage alone has almost universal recurrence.
References
A 25-year-old has a large, itchy keloid on her earlobe after piercing. She wants it removed. What do you advise?
- Nothing can be done
- Simple excision alone, which rarely recurs
- Excision combined with an adjuvant such as intralesional steroid (or radiotherapy) to reduce recurrence
- Laser alone always cures it
- Re-pierce the ear
Show the answer and explanation
Answer: C. Excision combined with an adjuvant such as intralesional steroid (or radiotherapy) to reduce recurrence. Keloids extend beyond the original wound and recur frequently after excision alone. Intralesional corticosteroid injection is first-line; when excised, adjuvant treatment (steroid injections, pressure earrings or radiotherapy) significantly reduces recurrence.
Why not the others? Hypertrophic scars stay within the wound and often improve with time.
References
A 30-year-old woman has a smooth, firm 1.5-cm lump on the back of her wrist that has appeared over 3 months. It transilluminates and is painless. What do you advise?
- Hit it with a book to rupture it
- Urgent MRI and biopsy for sarcoma
- Antibiotics
- Reassurance: this is a ganglion that often resolves; aspiration or excision only if symptomatic or for preference
- Steroid injection into the joint every month
Show the answer and explanation
Answer: D. Reassurance: this is a ganglion that often resolves; aspiration or excision only if symptomatic or for preference. Ganglions are benign, mucin-filled cysts arising from a joint capsule or tendon sheath. Many resolve without treatment. Aspiration is simple but often recurs, and surgical excision has lower recurrence but more complications.
Why not the others? Forcible rupture is outdated and can cause injury.
References
A man trapped in a house fire has full-thickness burns circling his chest. His ventilator pressures are rising and his chest is not expanding well. What is needed?
- Diuretics
- Higher ventilator pressures alone
- Urgent escharotomy to release the constricting burned skin
- A tighter chest dressing
- Bronchoscopy only
Show the answer and explanation
Answer: C. Urgent escharotomy to release the constricting burned skin. Full-thickness burned skin (eschar) is inelastic. When it encircles the chest, it restricts breathing; around a limb, it causes compartment syndrome. Escharotomy through the eschar releases the constriction and restores ventilation or blood flow.
Why not the others? Full-thickness burns are painless, but escharotomy still needs analgesia because the edges are sensitive.
References
A man rescued from a burning room has soot in his mouth, singed nasal hair, a hoarse voice and stridor. His face is burned. What is the priority?
- Early intubation by an experienced operator, before airway swelling makes it impossible
- Oral fluids
- Facial dressings first
- Nebulised salbutamol and observe
- Wait for blood gases to become abnormal
Show the answer and explanation
Answer: A. Early intubation by an experienced operator, before airway swelling makes it impossible. Signs of inhalation injury (soot, singed facial or nasal hair, hoarseness, stridor, burns to the face) predict rapid airway swelling, especially as fluid resuscitation begins. Early intubation secures the airway before it becomes impossible. Carbon monoxide and cyanide poisoning are also treated with high-flow oxygen.
Why not the others? Normal oxygen saturation does not exclude carbon monoxide poisoning.
References
An electrician touched a high-voltage line. He has small entry and exit wounds on his hand and foot but is awake. What is important in his assessment?
- Cardiac monitoring, checking for muscle damage (CK, myoglobinuria) and compartment syndrome, with fluids to protect the kidneys
- Skin grafting immediately
- Dressing the wounds only
- Discharge home because the skin wounds are small
- Oral analgesia and review in 1 week
Show the answer and explanation
Answer: A. Cardiac monitoring, checking for muscle damage (CK, myoglobinuria) and compartment syndrome, with fluids to protect the kidneys. High-voltage injuries cause deep tissue damage along the current path, out of proportion to the small skin wounds. Muscle destruction causes rhabdomyolysis and kidney injury, and swelling can cause compartment syndrome. Arrhythmias require cardiac monitoring.
Why not the others? The visible burn underestimates the injury.
References
A 40-year-old woman has partial-thickness scald burns covering 15% of her body surface area, including both hands. Which management is appropriate?
- Apply ice packs for 1 hour
- Antibiotics for every burn
- Leave blisters on the hands to dry out
- Discharge with dressings because she is young and well
- Referral to a specialised burns unit, with fluid resuscitation guided by urine output
Show the answer and explanation
Answer: E. Referral to a specialised burns unit, with fluid resuscitation guided by urine output. Criteria for referral to a burns centre include partial-thickness burns over about 10% of body surface in adults, burns to the face, hands, feet, genitalia or major joints, full-thickness burns, inhalation injury, and electrical or chemical burns. Hand burns need specialist care to preserve function.
Why not the others? Prophylactic antibiotics are not routinely recommended for burns.
References
A 72-year-old man has a 1.5-cm well-differentiated cutaneous squamous cell carcinoma on the back of his hand, without high-risk features. What is the recommended treatment?
- Cryotherapy as first-line for every SCC
- Observation
- Amputation
- Topical steroids
- Surgical excision with a clinical margin of about 4 mm (6 mm or more for high-risk tumours)
Show the answer and explanation
Answer: E. Surgical excision with a clinical margin of about 4 mm (6 mm or more for high-risk tumours). Surgical excision with histological margin assessment is the treatment of choice for cutaneous SCC. Low-risk tumours need about a 4-mm margin; high-risk tumours (larger, deeper, poorly differentiated, perineural invasion, immunosuppressed patients) need wider margins and consideration of nodal assessment.
Why not the others? Destructive treatments such as cryotherapy do not allow the margins to be checked.
References
A 35-year-old has an inflamed, painful, fluctuant swelling on the back at the site of a long-standing epidermoid (sebaceous) cyst. What is the best management?
- Leave it
- Squeeze it daily
- Incision and drainage now, then complete excision of the cyst wall later once the inflammation has settled
- Excise the whole cyst immediately while it is infected
- Antibiotics alone for 6 weeks
Show the answer and explanation
Answer: C. Incision and drainage now, then complete excision of the cyst wall later once the inflammation has settled. An infected epidermoid cyst is drained first. Trying to excise the capsule through inflamed tissue is difficult and leads to recurrence and poor healing. Once quiet, the whole cyst with its punctum is excised to prevent recurrence.
Why not the others? Antibiotics alone do not drain pus.
References
A 60-year-old has a dark brown-black streak in the nail of the big toe that has widened over a year and now extends onto the skin of the nail fold. What is the next step?
- Remove the nail and discard it
- Review in 2 years
- Reassurance; it is a bruise
- Urgent referral for nail matrix biopsy, suspecting subungual melanoma (Hutchinson’s sign)
- Antifungal treatment
Show the answer and explanation
Answer: D. Urgent referral for nail matrix biopsy, suspecting subungual melanoma (Hutchinson’s sign). A widening pigmented nail band, especially with pigment on the surrounding skin (Hutchinson’s sign), suggests subungual melanoma. Diagnosis needs a biopsy of the nail matrix. These melanomas are often diagnosed late and thicker.
Why not the others? A subungual haematoma grows out with the nail and has a history of trauma.
References
A 55-year-old has a red, hot, swollen, tender lower leg with fever, without a wound or abscess. Ultrasound has excluded DVT. What is the first-line treatment?
- Incision and drainage
- Oral flucloxacillin (or an alternative if allergic), marking the edge of the redness and elevating the leg
- Intravenous vancomycin for every case
- Steroid cream
- Compression bandaging
Show the answer and explanation
Answer: B. Oral flucloxacillin (or an alternative if allergic), marking the edge of the redness and elevating the leg. Non-purulent cellulitis is usually caused by streptococci or Staphylococcus aureus and is treated with oral flucloxacillin. Intravenous treatment is for severe systemic illness or failure to improve. Look for an entry point such as athlete’s foot or a leg ulcer.
Why not the others? Bilateral “cellulitis” is often venous eczema or lipodermatosclerosis.
References
A patient with Crohn’s disease has a rapidly enlarging, painful ulcer with a purple, undermined edge next to his ileostomy. Swabs show no consistent organism. What should be avoided?
- Biopsy of the edge to exclude other causes
- Treating the underlying inflammatory bowel disease
- Topical or systemic steroids
- Stoma nurse input
- Surgical debridement, because pyoderma gangrenosum worsens with trauma (pathergy)
Show the answer and explanation
Answer: E. Surgical debridement, because pyoderma gangrenosum worsens with trauma (pathergy). Peristomal pyoderma gangrenosum is an inflammatory, not infective, ulcer. Surgical debridement makes it worse. Treatment is topical or systemic immunosuppression (steroids, tacrolimus, anti-TNF) and control of the bowel disease.
Why not the others? Mistaking it for infection leads to repeated debridement and enlargement.
References
A 58-year-old smoker has a 3-cm hard, painless lump in the upper neck for 6 weeks. There is no infection. What is the correct first investigation?
- Incision and drainage
- Antibiotics for 6 weeks and review
- Urgent referral for ultrasound-guided FNA or core biopsy and a full head and neck examination, suspecting metastatic squamous cancer
- Open excision biopsy of the node as the first step
- Reassure
Show the answer and explanation
Answer: C. Urgent referral for ultrasound-guided FNA or core biopsy and a full head and neck examination, suspecting metastatic squamous cancer. A persistent neck lump in an adult, especially a smoker, may be a metastasis from a head and neck cancer. Ultrasound-guided needle biopsy is the first step, along with examination of the upper aerodigestive tract. Open biopsy of a metastatic squamous node can compromise later treatment.
Why not the others? Antibiotics delay the diagnosis.
References
A man has a small laceration over the knuckle of his dominant hand. He admits he punched someone in the mouth 2 days ago. The hand is now swollen and painful on movement. What is the management?
- Leave it alone
- Treat as a human bite (“fight bite”): X-ray, surgical exploration and washout of the joint and tendon, and co-amoxiclav
- Oral flucloxacillin only
- Steroid injection
- Close the wound with sutures and discharge
Show the answer and explanation
Answer: B. Treat as a human bite (“fight bite”): X-ray, surgical exploration and washout of the joint and tendon, and co-amoxiclav. A fight bite can carry oral bacteria (including Eikenella) into the metacarpophalangeal joint and extensor tendon, causing septic arthritis. Wounds are explored and washed out, left open, and treated with co-amoxiclav. X-ray looks for fractures or tooth fragments.
Why not the others? Small wounds over the knuckle hide deep injury when the fist is clenched.
References
A 45-year-old has a soft, mobile, painless 3-cm subcutaneous lump on the back that has been the same size for years. What do you advise?
- Liposuction is mandatory
- Antibiotics
- Urgent sarcoma referral for all lumps
- Biopsy every lipoma
- This is likely a lipoma: reassurance, with excision if it bothers the patient; imaging is needed only if it is large (over 5 cm), deep, growing or painful
Show the answer and explanation
Answer: E. This is likely a lipoma: reassurance, with excision if it bothers the patient; imaging is needed only if it is large (over 5 cm), deep, growing or painful. Small, superficial, soft, stable lumps are almost always lipomas. Features that suggest sarcoma include size over 5 cm, deep location, rapid growth and pain; these need imaging and specialist assessment before any excision.
Why not the others? Excising a large deep lump without imaging can compromise sarcoma treatment.
References
A patient has had complete excision of a stage III melanoma, with a positive sentinel node. Which adjuvant treatment is offered?
- Chemotherapy with dacarbazine
- No treatment is available
- Interferon for every patient
- Radiotherapy to the whole body
- Adjuvant immunotherapy (anti-PD-1 such as nivolumab or pembrolizumab), or targeted therapy (dabrafenib plus trametinib) if BRAF-mutant
Show the answer and explanation
Answer: E. Adjuvant immunotherapy (anti-PD-1 such as nivolumab or pembrolizumab), or targeted therapy (dabrafenib plus trametinib) if BRAF-mutant. Adjuvant anti-PD-1 therapy or BRAF/MEK inhibitors reduce recurrence after resection of stage III melanoma. Completion lymph node dissection is no longer routine after a positive sentinel node, as trials showed no survival benefit.
Why not the others? Older treatments such as interferon have been replaced.
References
A 68-year-old has a 1-cm basal cell carcinoma on the side of the nose with poorly defined edges. What is the preferred treatment?
- Simple excision with a 1-mm margin
- Observation
- Topical imiquimod
- Mohs micrographic surgery
- Cryotherapy
Show the answer and explanation
Answer: D. Mohs micrographic surgery. High-risk BCCs, such as those on the central face (nose, eyelids, lips), with poorly defined borders or recurrence, are best treated with Mohs surgery. It examines all margins during the procedure, giving the highest cure rate while preserving tissue.
Why not the others? Superficial treatments are for low-risk superficial BCCs.
References
A child has raised, red, itchy scars 3 months after a partial-thickness burn of the forearm that took 3 weeks to heal. What is the first-line treatment?
- Pressure garments and silicone gel or sheets, with massage and moisturising
- Nothing can help
- Antibiotics
- Radiotherapy
- Immediate excision of the scars
Show the answer and explanation
Answer: A. Pressure garments and silicone gel or sheets, with massage and moisturising. Burns that take more than about 2–3 weeks to heal often form hypertrophic scars. Silicone and pressure therapy are first-line, with intralesional steroids, laser or surgery for resistant scars. Scars mature over 12–18 months.
Why not the others? Early surgery on immature scars is usually avoided.
References
A 75-year-old has a leg ulcer that has not healed after 12 weeks of good compression therapy. The edge is raised and rolled. What should be done?
- Amputation
- Biopsy of the ulcer edge to exclude malignancy (such as squamous or basal cell carcinoma), and reassess for arterial disease
- Antibiotics
- Skin graft immediately
- Continue compression for another year
Show the answer and explanation
Answer: B. Biopsy of the ulcer edge to exclude malignancy (such as squamous or basal cell carcinoma), and reassess for arterial disease. Ulcers that do not heal with appropriate treatment, or that have atypical features (raised edges, unusual location, overgranulation), should be biopsied. Arterial disease and other causes such as vasculitis or pyoderma should also be considered.
Why not the others? Long-standing ulcers can become malignant, and malignancies can present as ulcers.
References
A 30-year-old has a red, very painful, fluctuant swelling along the side of a fingernail for 2 days. What is the treatment?
- Removal of the entire finger
- Steroid cream only
- Ignore it
- Drainage of the acute paronychia (lifting the nail fold or a small incision), with warm soaks; antibiotics if there is spreading infection
- Oral antifungals for 3 months
Show the answer and explanation
Answer: D. Drainage of the acute paronychia (lifting the nail fold or a small incision), with warm soaks; antibiotics if there is spreading infection. Acute paronychia is usually a staphylococcal or streptococcal infection of the nail fold. Once pus forms, it is drained. Chronic paronychia (lasting more than 6 weeks) is different and often related to irritant exposure and candida.
Why not the others? Antibiotics alone do not clear a collection of pus.
References
A man was bitten deeply on the hand by a stray dog in an area where rabies occurs. What is the correct management in addition to wound care?
- Vaccine only if the dog later dies
- Wait for symptoms of rabies
- Close the wound tightly and give no vaccine
- Antibiotics only
- Wash the wound thoroughly with soap and water for about 15 minutes, then rabies vaccine and rabies immunoglobulin into and around the wound (category III exposure), plus tetanus check
Show the answer and explanation
Answer: E. Wash the wound thoroughly with soap and water for about 15 minutes, then rabies vaccine and rabies immunoglobulin into and around the wound (category III exposure), plus tetanus check. Rabies is almost always fatal once symptoms appear, but post-exposure prophylaxis is highly effective. Immediate washing reduces viral load. Severe (category III) exposures need both rabies immunoglobulin and a vaccine course.
Why not the others? Waiting for symptoms is fatal.
References
A worker splashes hydrofluoric acid onto his hand. What is the specific treatment after copious irrigation?
- Warm compresses only
- Topical calcium gluconate gel, with monitoring of calcium and ECG, and further calcium if pain persists
- Apply butter
- Neutralise with sodium hydroxide
- No treatment needed if the skin looks normal
Show the answer and explanation
Answer: B. Topical calcium gluconate gel, with monitoring of calcium and ECG, and further calcium if pain persists. All chemical burns are irrigated with large volumes of water. Hydrofluoric acid penetrates deeply and binds calcium, causing severe pain, tissue destruction and potentially fatal hypocalcaemia. Calcium gluconate binds fluoride ions.
Why not the others? Neutralising agents generate heat and worsen the injury.
References
A 6-year-old has a clean, straight 2-cm laceration on the forehead with edges that come together easily. What is a good option for closure?
- Deep sutures under general anaesthesia
- Leave it open to heal by secondary intention
- Staples
- Delayed closure after 1 week
- Tissue adhesive (skin glue)
Show the answer and explanation
Answer: E. Tissue adhesive (skin glue). For small, low-tension, clean lacerations, tissue adhesive gives cosmetic results similar to sutures, with less pain and no need for removal. It is not used on wounds under tension, over joints, or in heavily contaminated wounds.
Why not the others? Glue is not placed inside the wound.
References