{"id":3429,"date":"2024-03-20T19:06:00","date_gmt":"2024-03-20T19:06:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3429"},"modified":"2025-10-01T11:39:33","modified_gmt":"2025-10-01T19:39:33","slug":"usmle-step-1-question-of-the-day-rule-of-nines","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Rule of nines"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#B_36\" >B. 36%<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#A_27\" >A. 27%<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#C_45\" >C. 45%<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#D_54\" >D. 54%<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#E_63\" >E. 63%<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>The Rule of Nines is a method used in emergency departments to quickly estimate the extent of burns on a patient&#8217;s body. This USMLE\u00ae Step 1 Question of the Day will test your knowledge on this topic.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 25-year-old man is brought to the emergency department with severe burns on his body sustained in a house fire about an hour ago. His left lower leg was trapped under a burning beam, and as a result, he could not immediately escape from the house. Temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 120\/min, respirations are 20\/min, and blood pressure is 105\/55 mmHg. He is conscious but is moaning in pain. There is no singed hair on his face or nostrils, and he is breathing spontaneously. Physical examination shows 2nd-degree burns to the anterior chest, abdomen, and entire left leg. Which of the following most likely represents the total percentage of his whole body surface area involved in the burn according to the rule of nines?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. 27%<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. 36%<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. 45%<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. 54%<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. 63%<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_36\"><\/span>B. 36%<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_27\"><\/span>A. 27%<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Following the rule of 9&#8217;s, this patient\u2019s anterior chest (9% of TBSA) and abdomen (9% of TBSA), together with anterior (9% of TBSA) and posterior (9% of TBSA) parts of the left leg, constitute 36% involvement of the TBSA (9+9+9+9=36%)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_45\"><\/span>C. 45%<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;&nbsp;Following the rule of 9&#8217;s, this patient\u2019s anterior chest (9% of TBSA) and abdomen (9% of TBSA), together with anterior (9% of TBSA) and posterior (9% of TBSA) parts of the left leg, constitute 36% involvement of the TBSA (9+9+9+9= 36%)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_54\"><\/span>D. 54%<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Following the rule of 9&#8217;s, this patient\u2019s anterior chest (9% of TBSA) and abdomen (9% of TBSA), together with anterior (9% of TBSA) and posterior (9% of TBSA) parts of the left leg, constitute 36% involvement of the TBSA (9+9+9+9= 36%)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_63\"><\/span>E. 63%<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Following the rule of 9&#8217;s, this patient\u2019s anterior chest (9% of TBSA) and abdomen (9% of TBSA), together with anterior (9% of TBSA) and posterior (9% of TBSA) parts of the left leg, constitute 36% involvement of the TBSA (9+9+9+9= 36%)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has sustained 2nd-degree burns on different parts of his body (anterior chest and abdomen, left leg) after being trapped in a house fire. His vitals are unstable (increased body temperature, tachycardia, hypotension) due to fluid loss through the damaged skin and widespread cytokine activation. He needs urgent medical attention to avoid possible complications (e.g., infection, lactic acidosis) and death.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Management of burn patients (e.g., fluid resuscitation, antibiotics) depends on the severity of the burns and the total body surface area (TBSA) involved. Different methods are employed to assess the TBSA of a patient with burns (e.g., Lund-Browder charting, Palm method, etc.). One such method is known as the \u201cRule of Nines.\u201d It is one of the most expeditious methods to estimate TBSA in adults. It attributes 9% of the TBSA to each of the following areas: head, anterior chest, posterior chest, anterior abdomen, posterior abdomen, right arm, left arm, and anterior and posterior parts of the right and left legs each. The perineum is assigned 1% of the TBSA. Therefore in the above patient, his anterior chest (9%) and abdomen (9%), together with anterior (9%) and posterior (9%) parts of the left leg, constitute 36% (9+9+9+9) involvement of the TBSA.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"542\" height=\"790\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_d8a81d.png\" alt=\"wallace rule of nines estimated body surface are in children and adults\" class=\"wp-image-3431\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_d8a81d.png 542w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_d8a81d.png?resize=206,300 206w\" sizes=\"auto, (max-width: 542px) 100vw, 542px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Burn management is complex and requires careful consideration of fluids. The \u201cRule of 9&#8217;s\u201d can be used to estimate the total body surface area involved. This statistic is useful for calculating the total fluid resuscitation a burn patient will need in the first 24 hours following a burn injury.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Moore, R. A., Waheed, A., &amp; Burns, B. (2019). Rule of Nines. In StatPearls [Internet]. StatPearls Publishing.<\/li>\n\n\n\n<li>Monafo, W. W. (1996). Initial management of burns. New England Journal of Medicine, 335(21), 1581-1586.<\/li>\n\n\n\n<li>Wachtel, T. L., Berry, C. C., Wachtel, E. E., &amp; Frank, H. A. (2000). The inter-rater reliability of estimating the size of burns from various burn area chart drawings. Burns, 26(2), 156-170.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;________________________<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_dc355a.png\" alt=\"Osmosis sign up ad\" class=\"wp-image-3432\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_dc355a.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_dc355a.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.\u00a0<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Rule of Nines is a method used in emergency departments to quickly estimate the extent of burns on a patient&#8217;s body. This USMLE\u00ae Step 1 Question of the Day will test your knowledge on this topic. A 25-year-old man is brought to the emergency department with severe burns on his body sustained in a [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3430,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1366,1369,44],"tags":[],"class_list":["post-3429","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-questions","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Rule of nines - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-rule-of-nines\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Rule of nines - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"The Rule of Nines is a method used in emergency departments to quickly estimate the extent of burns on a patient&#8217;s body. 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