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October 19, 2021
Submitted by M. Mark Melin, MD, FACS, RPVI, FACCWS, FAPWCA

Choose the false statement about scurvy;

A. A severe problem of sailors during the great explorations of the 15th and the 16th century
B. considered a disease of the past only
C. results in altered collagen synthesis causing blood-vessel fragility, bleeding gums, gingival hypertrophy
D. People living in social isolation and affected by psychiatric disorders (such as autism and anorexia nervosa), alcohol abuse disorders, or malabsorption (especially caused by digestive surgery) are at increased risk of scurvy
E. The most common laboratory finding of scurvy is normochromic normocytic anemia

More about scurvy here

Show Answer

The correct answer is B.

October 19, 2021
Submitted by M. Mark Melin, MD, FACS, RPVI, FACCWS, FAPWCA

A Martorell Ulcer is defined as:
A. Venous ulcer with malignant transformation
B. Traumatic ulcer with secondary infection by maggots
C. An atypical pressure ulcer that develops in paraplegic patients
D. Hypertensive leg ulcer, rare, progressive, painful, necrotic ulceration
E. Predominantly identified in the pediatric population


Show Answer

The correct answer is D.

October 12, 2021
Submitted by M. Mark Melin, MD, FACS, RPVI, FACCWS, FAPWCA

58 year old female with a history of metastatic renal cell to lungs and right femur (successful prior surgical management 2 year prior) presents with a 3 month history of new right thigh wounds.

The most appropriate next step:

A. Apply amniotic graft
B. Levine culture and start oral antibiotics
C. Apply neomycin
D. Obtain Moh’s surgical consult
E. Biopsy wounds


Show Answer

The correct answer is E.

October 5, 2021
Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

Based on this wound, which instrument should be selected? 

Show Answer

The correct answer is C.

September 28. 2021
Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA.

All of the following are appropriate patients for hyperbaric oxygen therapy referral except:

A. 78-year-old male with hematuria 3 years post radiation for prostate cancer
B. 47-year-old female with non-healing VLU of 3 months duration and acute cellulitis
C. 65-year-old male with T2 diabetes and chronic midfoot ulceration with + probe to bone
D. 50-year female with cyanosis of a TRAM flap 2 days post-op


Show Answer

The correct answer is B.

September 21. 2021
Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA.

A positive Stemmer sign is diagnostic for:

A. Osteomyelitis
B. Venous Hypertension
C. Lymphedema
D. Lipedema
E. Melanoma


Show Answer

The correct answer is C.

September 14. 2021
Submitted by 
Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS

This demonstrates which wound characteristic?

A. Tunneling
B. Undermining
C. Depth
D. Epiboly
E. Necrotic Margin



Show Answer

The correct answer is B.

September 7, 2021
Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA.

According to the TIME principle of wound bed preparation, what barrier to wound healing does M represent?

Show Answer

The correct answer is Moisture Imbalance.

August 31. 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS.  Image provided by Selvam J. Watts from Chennai, India. 

Which is true regarding darker skin tones?

A. People with darker skin tones develop higher stage pressure ulcers.
B
. Consider variances in skin tone color when assessing skin.
C. The perceptions of people with dark skin tones are under-examined.
D. Current skin assessment protocols are less effective for people who have darker skin tones
E. All the above 

Show Answer

The correct answer is E.

August 24, 2021
Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS

The BEST description of the wound base is:

A. Filiform Fibrin
B. Edematous Carboxymethylcellulose
C. Free Range Myiasis
D. Ascariasis Diabetica


Show Answer

The correct answer is C.

August 17, 2021
Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA. 

In the Proliferative stage of acute wound healing, tissue regeneration relies primarily on the activity of this cell:

A. Macrophage
B. Fibroblast
C. Neutrophil
D. Protease

Show Answer

The correct answer is B.

August 10, 2021
Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

This presentation should raise suspicion for which of the following?

A. Preauricular cellulitis
B. Anterior Extension of Ulcerative Mastoiditis
C. Atypical Ulceration
D. Fulminant Otitis Externa


Show Answer

The correct answer is C.

August 3, 2021
Submitted by Mark Melin, MD, FACS, RPVI, FACCWS.

Micronized Purified Flavonoid Fraction (MPFF) are beneficial in treating venous leg ulcerations due to:

A. Improvement of lymphatic tone
B. Improved red blood cell deformability
C. Decreased ICAM and VCAM biomarkers
D. All of the above
E. A and C


Show Answer

The correct answer is E.

July 27, 2021

Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

The most likely etiology of this presentation is?

A. Acute Venous Congestion
B. Infected Diabetic Foot Ulcer
C. Acute Traumatic Hemorrhage
D. Acute Arterial Ischemia
E. COVID Complications


Show Answer

The correct answer is D.

July 20, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What type of factors determine what method of debridement is most effective?

A. Wound presentation and evaluation
B. Economic factors
C. Patient history and examination
D. Previous wound history
E. A, B, D
F. All the above



Show Answer

The correct answer is F.

July 13, 2021
Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Is this an adequate ulcer debridement?

A. Yes

B. No, only periwound callus was removed and there is still non-viable tissue in the wound bed



Show Answer

The correct answer is B.

July 6, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA.

When applying a total contact cast, which of the following is true:

A. Substance abusers will develop an injection-related wound within a one-year period.
B. Education about substance abuse, skin issues, and wound care is vital in helping the user and healthcare staff.
C. Compassion is lacking for this wound population.
D. All of the above.


Show Answer

The correct answer is D.

June 29, 2021
Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

When applying a total contact cast, which of the following is true:

A. The foot should be perpendicular to the leg
B. The foot should be plantarflexed on the leg
C. The cast should come above the fibular head
D. The cast should be as tight as possible


Show Answer

The correct answer is A.

June 22, 2021
Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

This patient already has an amputation of their hallux Which of the following is the most important for this patient right now?

A. Perform debridement
B. Perform non-invasive vascular studies
C. X-ray
D. Test for COVID-19


Show Answer

The correct answer is C.

June 15, 2021
Submitted by 
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

This patient already has an amputation of their hallux and 1st metatarsal head. Which surgical procedure is now most appropriate?

A. Removal of 2nd metatarsal head
B. Removal of 3rd metatarsal head
C. Removal of 4th metatarsal head
D. Removal of all remaining metatarsal heads


Show Answer

The correct answer is D.

June 8, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What type of wound presents with characteristics of a scale-like skin that resembles a crocodile hide, and can often result in amputation and death?

A. Russian Magic NF
B. Krokodil Skin Induced Necrosis
C. Desomorphine Fasciitis
D. Croc-NSFI

Show Answer

The correct answer is B.

June 1, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What factors should be considered when selecting a wound dressing?

A. Dressing technology
B. Size
C. Absorbency
D. Bacteriostatic properties
E. Multifunctionality
F. Anti-biofilm properties
G. A, B, D
H. B, D
I. All the above

Show Answer

The correct answer is I.

May 25, 2021
Submitted by Elizabeth Faust, MSN, CRNP, CSWS, CWOCN-AP, DAPWCA

A skilled provider should always debride necrotic tissue.

A. True
B. False

Show Answer

The correct answer is B.

May 4, 11, and 18, 2021
Submitted by Charles A. Andersen, MD, FACS, MAPWCA

A 62-year-old diabetic male presents to the hospital wound care clinic with pain in his right foot and wounds on his toes. The patient states that he has been having pain in his calf with ambulation for the past two years. His pain initially occurred after ambulating two blocks and was relieved by rest. Over the past six months, his walking distance has gradually decreased, now the patient states he can only walk a few feet and has pain at night — relieved by hanging his foot over the side of the bed. He now has wounds involving his toes.

Part 1: Many patients especially patients with diabetes have very significant PAD have no symptoms.

A. True
B. False

Part 2: Because the patient has diabetes he probably has small vessel disease and should be taken to the OR for a BK Amputation.

A. True
B. False

Part 3: The pain he is experiencing at night is neuropathy.

A. True
B. False

Part 4: The gangrenous toes are a result of “Diabetic Small Vessel Disease”.

A. True
B. False

Part 5: The patient should have an arteriogram performed with the goal to attempt revascularization.

A. True
B. False

Part 6: Revascularization is indicated to facilitate a TMA vs. a BKA amputation.

A. True
B. False


Show Answers

The correct answers are: Part 1 is A. Part 2 is B. Part 3 is B. Part 4 is B. Part 5 is A. Part 6 is A.

April 27, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

Which type of debridement methods can be used in biofilm management?

A. BEAMS
B. Conservative sharp debridement
C. Autolysis
D. All the above

Show Answer

The correct answer is D.

April 20, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

A chronic wound can be defined as:

A. A wound with slow progression that is interrupted by only intrinsic factors.
B. A wound that has a slow progression through the healing phases, delayed or stalled healing due to intrinsic and extrinsic factors that impact on the individual and their wound.
C. Chronic non-healing wounds are wounds that have failed to progress through a timely sequential of repairment.

Show Answer

The correct answer is B.

April 13, 2021

Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS

This open wound shows granulation tissue developing on exposed bone. What is BEST explanation for this physiology?

A. Indicates the presence of malignancy
B. Suggests active osteomyelitis
C. Occurs only with an intact viable periosteum
D. Represents a genetic aberranc
E. Likely due to prior grafting with CTP

Show Answer

The correct answer is C.

April 6, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What types of skin manifestations have been reported in frontline workers due to wearing PPE for extended periods of time?

A. Acne, rash
B. Aggravation of dermatoses
C. Skin breakdown nasal bridge, ears, and face
D. All the above

Show Answer

The correct answer is D.

March 30, 2021
Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA

Patient is a 90-year-old female with a non-contributory PMH who initially presented to the outpatient wound department with a trauma-induced right anterior leg wound in January of 2017. Non-invasive arterial testing demonstrated and right ABI of 1.07, a TBI of .48 and mild dampening of the pulse volume tracings. The wound required six months of compression and local care, including cellular and/or tissue-based products (CTP) to heal. The patient returned two months after initial discharge complaining that the wound appeared healed but was still painful and somewhat pruritic. Venous reflux study was negative and she was referred to her PCP for follow-up. The patient again returned to the outpatient wound department in August of 2020 after suffering mild trauma to the same location as the previously healed wound. After four months of care the wound appeared healed only to have the patient return one month later in January of 2021 stating the wound had gradually reappeared.

A. Compression therapy
B. Repeat non-invasive arterial studies
C. Wound biopsy
D. Debridement and CTP application(s)


  

Show Answer with Explanation

The correct answer is C. Biopsy revealed squamous carcinoma and patient was referred to plastic surgeon for wide excision.

March 23, 2021
Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

Wounds connected with infection can include:

A. Necrotizing Fasciitis
B. Fournier’s gangrene
C. Actinomycosis
D. Cellulitis
E. All the above

Show Answer

The correct answer is E.

March 16, 2021

Submitted by Richard E. Schlanger, MD, PhD, FAPWCA, CWSP, FACS

This is a 58-year-old gentleman who is a truck driver by trade. He reported to his local emergency room because of general malaise, joint pain and a swollen left shoulder. According to the admission record, there were no unusual findings including no injuries, cuts and bruises. Over the next 12 hours the patient declined fairly quickly becoming hypotensive, tachycardic and required pressor support. He was transported by air to a medical center and taken emergently to the OR because of skin changes and loss of pulse and sensation. At the time of surgery most of the distal vessels were thrombosed and the muscle look like it was “cooked".

The most likely diagnosis is:

A. Septic emboli
B. Soft tissue necrosis
C. Compartment syndrome
D. Rattlesnake bite


Show Answer with Explanation

The correct answer is D. This was a rattlesnake bite. The key to the diagnosis was the cooked muscle appearance and the rapid onset of thrombosis and neurovascular loss. These can be seen in compartment syndrome and in some cases with septic emboli, but there is a diagnostic event (such as a crush injury) or a heart defect (such as atrial thrombosis and an arrhythmia). The emergency room physicians did not see the two puncture marks just below his thumb on his left hand.

March 9, 2021

Submitted by Nancy Collins, PhD, RDN, LD, NWCC, FAND

Patients with wounds should consume a food high in vitamin C every day. Which food is best to meet this goal?

A. Fresh orange
B. Bowl of oatmeal
C. Grilled skinless chicken breast
D. Bran muffin

Show Answer

The correct answer is A.

March 2, 2021

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What type of preventional goals should be considered in patients at risk for pressure injury wounds?

A. Risk management
B. Nutritional management
C. Medical devices
D. Interventional methods
E. Skin management
F. All the above
G. 1, 4, 5


Show Answer

The correct answer is F.

February 23, 2021
Submitted by F
rank Aviles Jr, PT, CWS, FACCWS, CLT-LANA, ALM, AWCC, DAPWCA, MLD/CDT Instr

70 year old patient presents to your clinic with left lower extremity swelling. Hx of prolonged standing, fall sustained 4 months prior, and limited mobility.

Based on your assessment, which treatment intervention is recommended:

A. Diuretics
B. Compression
C. Pumps
D. Complete Decongestive Therapy
E. Venous ablation


Show Answer

The correct answer is D.

February 16, 2021
Submitted by F
rank Aviles Jr, PT, CWS, FACCWS, CLT-LANA, ALM, AWCC, DAPWCA, MLD/CDT Instr

70 year old patient presents to your clinic with left lower extremity swelling. Hx of prolonged standing, fall sustained 4 months prior, and limited mobility.

Based on the presentation, what could be the cause of the swelling:

A. Cardiac related condition
B. Chronic venous insufficiency
C. Primary lymphedema
D. Secondary lymphedema
E. Lipedema

Show Answer

The correct answer is D.

February 9, 2021
Submitted by 
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

This patient presents with color changes to their toes after extended cold exposure. What is the most appropriate treatment?

A. Femoral - popliteal artery bypass
B. Forefoot amputation
C. Sharp debridement
D. Hyperbaric oxygen


Show Answer

The correct answer is D.

February 2, 2021
Submitted by Nancy Collins, PhD, RDN, LD, NWCC, FAND

A patient is diagnosed with heart failure and a wound and must follow a specific diet. Which spices are okay for the patient to use daily?

A. Onion salt and garlic powder
B. Ginger and bay leaves
C. Sea salt and pepper
D. Garlic salt and nutmeg

Show Answer

The correct answer is B.

January 26, 2021
Submitted by 
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

What is the most appropriate surgical procedure to offload this 5th toe #ulcer?

A. Remove the head of the 5th toe proximal phalanx
B. Remove the 5th metatarsal head
C. Flexor tenotomy
D. Extensor tenotomy


Show Answer

The correct answer is A.

January 12, 2021
Submitted by Nancy Collins, PhD, RDN, LD, NWCC, FAND

All of the following are needed for strong bones except:

A. Calcium
B. Magnesium
C. Thiamine
D. Vitamin D

Show Answer

The correct answer is C.

January 5, 2021
Submitted by 
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

What is the most appropriate modality to offload this plantar 1st metatarsal head diabetic foot ulcer?

A. Surgical shoe
B. Total contact cast
C. Forefoot wedge shoe
D. Rearfoot wedge shoe


Show Answer

The correct answer is B.

December 29, 2020
Submitted by Nancy Collins, PhD, RDN, LD, NWCC, FAND

What is the medical term to mean an age related shift in body composition that is a major cause of frailty and loss of independence in the elderly? 

A. Cachexia
B. Sarcopenia
C. Anorexia
D. Obesity

Show Answer

The correct answer is B.

December 22, 2020
Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA

If subscribing to the Angiosome Concept of Endovascular Therapy, which of the six angiosomes of the foot supplies the most direct flow to this wound on the right lateral malleolus and what primary vessel does that angiosome originate from?

A. Anterior perforating; Peroneal
B. Lateral plantar; Posterior tibial
C. Dorsalis pedis; Anterior tibial
D. Calcaneal branch; Peroneal

Show Answer with Explanation

The correct answer is A. An angiosome is an anatomic unit of tissue (consisting of skin, subcutaneous tissue, fascia, muscle, and bone) fed by a source artery and drained by specific veins. Direct revascularization of source arteries supplying a target angiosome (wound area) may be more successful for complete wound healing than indirect revascularization. In the case presented, the anterior lateral malleolus angiosome is directly supplied by the anterior perforating branch of the peroneal artery and therefore would be the target artery for revascularization.

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