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Burns for FRCS (Plast)

Burns follows the patient from the scene to reconstruction. Assessment covers burn depth and estimation of total body surface area (TBSA), and referral to a specialised burn service under the National Burn Care Referral Guidance. Resuscitation covers formula-based fluid calculation, titration to urine output and the harms of over-resuscitation. Critical care covers inhalation injury, carbon monoxide and cyanide toxicity, and escharotomy. Burn surgery covers early excision, grafting, skin substitutes and donor sites, and burn reconstruction covers contractures and hypertrophic scarring. Chemical and electrical burns each have their own priorities, from calcium gluconate for hydrofluoric acid to cardiac monitoring and rhabdomyolysis after high-voltage injury. Many questions hinge on a number — a percentage, a time from injury, a urine output — so precise working matters.

134 questions in the bank · 6 topics Updated 3 October 2026
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Topics in this domain

  • Burn assessment (depth & TBSA)19
  • Burn resuscitation19
  • Burns critical care & inhalation24
  • Burn surgery (debridement/grafting)24
  • Burn reconstruction23
  • Chemical & electrical burns25

What the paper tends to test

  • Expect TBSA and fluid calculations that test the detail: excluding erythema, timing from injury and adjustments for children.
  • The paper tends to test inhalation injury and toxicity: carbon monoxide, cyanide and when to secure the airway.
  • Expect referral questions based on the National Burn Care Referral Guidance thresholds and special areas.
  • Chemical and electrical injury questions usually turn on the specific first-line treatment or monitoring.
  • Burn surgery questions test timing of excision, choice of graft or substitute, and donor site management.

Classic traps and discriminators

  • Erythema is not counted in TBSA; including it overestimates the burn and drives over-resuscitation.
  • Formula volumes are timed from the moment of injury, not from arrival: half is given in the first 8 hours from injury. Time lost before arrival has to be made up, and the formula is only a starting point for titration to urine output.
  • Pulse oximetry reads falsely normal in carbon monoxide poisoning, so use co-oximetry. Hydroxocobalamin is the first-line antidote for suspected cyanide toxicity after smoke inhalation.
  • Referral criteria include burns of 2% TBSA or more in children and 3% or more in adults, all full-thickness and circumferential burns, special areas, chemical and electrical injury, suspected non-accidental injury and any burn not healed within two weeks.
  • Hydrofluoric acid burns need copious irrigation followed by calcium gluconate, with monitoring for hypocalcaemia and arrhythmia.

Free burns practice questions

From the free sample — original, referenced, with the full explanation. Rate your confidence first.

16Burns·Burn resuscitation
medium

A 70 kg man is 4 hours into resuscitation for a 40% TBSA flame burn. His urine output over the last hour was 12 mL, he is tachycardic at 120/min, his haematocrit is rising and his serum lactate is climbing; his blood pressure is maintained. The prescribed resuscitation and maintenance fluids are being delivered exactly as calculated.

What is the most appropriate management?

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17Burns·Burns critical care & inhalation
medium

A 34-year-old man is rescued from a house fire in an enclosed room. He has burns to the face, singed nasal hair and carbonaceous sputum, and his voice has become hoarse; there is progressive swelling of the lips and neck. He maintains oxygen saturations of 99% on high-flow oxygen and has no stridor.

What is the most appropriate management?

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Free revision notes

Burns assessment and resuscitation: depth, TBSA, referral and fluids

Burn depth, TBSA (rule of nines, Lund–Browder), UK referral, Parkland fluids, urine targets, inhalation injury, CO, cyanide and escharotomy for FRCS (Plast).

Read · 6 min

Burns questions, answered

When does the clock start for burn fluid resuscitation?

At the time of injury. Half the calculated volume is given in the first 8 hours from injury, so a patient who arrives late needs that time accounted for, followed by titration to urine output.

Is erythema included in TBSA?

No. Only partial- and full-thickness burns are counted. Including erythema is a classic error that overestimates burn size and fluid requirement.

What is the first-line treatment for cyanide toxicity after smoke inhalation?

Hydroxocobalamin, alongside high-flow oxygen. Suspect cyanide after an enclosed-space fire when the lactate is high and the acidosis persists despite adequate resuscitation.

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