Burns: electrical injury: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Burns: electrical injury

Sample item

A 35-year-old lineman has a high-voltage electrical injury, with a small entry wound on the hand and exit wound on the foot. Urine is dark red-brown, the dipstick is positive for blood, but microscopy shows no red cells. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Cardiac monitoring and aggressive fluids to maintain a high urine output, with fasciotomy if compartment syndrome develops

High-voltage current causes extensive deep muscle necrosis out of proportion to skin findings, releasing myoglobin that causes pigment nephropathy; red-brown urine with no red cells on microscopy points to myoglobinuria. Patients need ECG monitoring for arrhythmia and generous fluid resuscitation guided by urine output rather than by the skin area, plus early fasciotomy where needed.

Option by option

  • A. Discharge after the wound dressing

    Discharge risks arrhythmias, compartment syndrome and kidney injury.

  • B. Cardiac monitoring and aggressive fluids to maintain a high urine output, with fasciotomy if compartment syndrome develops (correct)

    Correct. Monitoring and aggressive fluids guided by urine output prevent arrhythmia and renal failure.

  • C. Restrict fluids to avoid overload

    Fluid restriction would precipitate pigment-induced renal failure.

  • D. Fluids calculated only by the visible skin burn area

    Surface area formulas greatly underestimate the fluid needs of deep electrical injury.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Cardiac monitoring and aggressive fluids to maintain a high urine output, with fasciotomy if compartment syndrome develops. High-voltage current causes extensive deep muscle necrosis out of proportion to skin findings, releasing myoglobin that causes pigment nephropathy; red-brown urine with no red cells on microscopy points to myoglobinuria.

Why is "Discharge after the wound dressing" not the answer?

Discharge risks arrhythmias, compartment syndrome and kidney injury.

Why is "Restrict fluids to avoid overload" not the answer?

Fluid restriction would precipitate pigment-induced renal failure.

Why is "Fluids calculated only by the visible skin burn area" not the answer?

Surface area formulas greatly underestimate the fluid needs of deep electrical injury.

What concept does this question test?

It tests Burns: electrical injury in General Surgery. Patients need ECG monitoring for arrhythmia and generous fluid resuscitation guided by urine output rather than by the skin area, plus early fasciotomy where needed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Burns: electrical injury?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.