This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Wounds, Tissue Repair & Scars, Subject name: Surgery
Increase in energy expenditure by 100% over normal, or two times greater than normal, is seen in a patient with which of the following? 
Select and explain. 
A. Pyloric obstruction from chronic duodenal ulcer, B. Fractured femur, C. Perforated diverticulitis of colon, D. Severe thermal burns of more than 30% total body surface area (BSA)
D: Severe thermal burns of more than 30% total body surface area (BSA)
Answer: D: Severe thermal burns of more than 30% total body surface area (BSA) 
Explanation: Resting energy expenditure is decreased following starvation (e.g., in the patient with pyloric obstruction) and increased after the stress of surgery, trauma, or sepsis. The increase in energy expenditure correlates with the severity of insult being 1.2 times greater after minor operation (e.g., right inguinal herniorrhaphy), 1.35 times greater after skeletal trauma (e.g., fractured femur), 1.6 times greater after major sepsis (e.g., perforated diverticulitis), and 2 times greater after severe thermal burns.