Which burn pattern is LEAST likely to appear in a lightning strike victim?

The presence of circumferential full-thickness burns on the chest is least likely to be associated with a lightning strike victim due to the nature of electrical burns. Lightning strikes typically produce high-voltage electrical currents that travel rapidly through the body, causing injury primarily at the entry and exit points of the current, rather than producing the profound and consistent tissue damage seen in full-thickness burns.

In contrast, a feathery, "fern-like" pattern is characteristic of certain electrical injuries, including those from lightning. This pattern results from the way electrical energy travels through the skin and does not reflect a traditional thermal burn. Burn marks from metal contact often occur in lightning strike injuries, especially if the individual is wearing metal items that can conduct electricity. Burns that resemble cigarette burns might also occur due to the electrical current’s localized heating effect, but they are not as definitive as the other patterns associated with lightning strikes or electrical injuries.

Overall, the likelihood of experiencing circumferential full-thickness burns specifically on the chest area from a lightning strike is minimal compared to these other burn patterns, making it the least expected finding in such cases.