Arterial & Venous Ulcers
Neuropathic Ulcers
Burns
Pressure Ulcers
Other
100
A 50-year-old patient presents with a shallow ulcer on the medial aspect of the lower leg. The wound has irregular edges, moderate exudate, and dark, hyperpigmented skin surrounding it. Which of the following is the MOST likely diagnosis?
A. Diabetic ulcer
B. Arterial ulcer
C. Venous ulcer
D. Pressure ulcer
A. Diabetic ulcers are more common on the feet and plantar surfaces.
B. Arterial ulcers occur in areas with poor circulation, typically on the toes or lateral aspect of the lower leg, with pale, cold skin.
C. This is the correct answer. Venous insufficiency ulcers typically occur on the medial aspect of the lower leg, often around the ankle, and are associated with irregular edges, hyperpigmentation, and chronic swelling due to venous stasis.
D. Pressure ulcers are usually located over bony prominences, not in the lower leg.
100
A patient is being evaluated by a physical therapist for a diabetic ulcer that penetrates the subcutaneous tissue, extending into the subcutaneous fat and fascia but without any gangrene or osteomyelitis present. The physical therapist documents the severity of the ulcer. Which of the following classifications would BEST describe the wound using the Wagner Ulcer Grade Classification System?
A. Grade 2
B. Grade 3
C. Grade 4
D. Grade 5
A. This is the correct answer. As a physical therapist, you should always document depth and shape of the ulcer. Grade 2 on the Wagner Scale is defined as a deep ulcer penetrating into the subcutaneous tissue, but without gangrene. The Wagner scale is commonly used to classify diabetic ulceration.
B. Grade 3 is defined as a wound extending into the bone and tendon with osteomyelitis present.
C. Grade 4 is defined as a wound with a small (size of 1 digit) amount of gangrene.
D. Grade 5 is defined as a wound with a large amount of gangrene, indicating the need for amputation of the involved limb.
100
A patient sustains a burn injury after spilling hot coffee on their forearm. On examination, the skin appears red, moist, and blistered, and the patient reports significant pain. What is the MOST appropriate classification of this burn?
A. Superficial burn
B. Superficial partial-thickness burn
C. Deep partial-thickness burn
D. Full-thickness burn
A. These burns only effect the epidermis and do not cause blisters; furthermore, they cause minimal pain rather than significant pain.
B. This is the correct answer. SPT burns are very painful, cause blisters, and appear bright pink or red and are moist.
C. DPT burns are only painful to pressure as most nerve endings are gone. Furthermore, they have broken blisters as opposed to intact blisters.
D. Full-thickness burns are not painful at all and appear white, charred, or tanned as opposed to red.
100
You are performing an evaluation on a patient in the hospital for a T6 SCI. During your evaluation, you note the patient has a reddened area on the sacrum that is not blanchable, however, the skin is intact. Which of the following is most likely?
A. The reddened area is not a cause for concern
B. It is likely a stage I pressure ulcer
C. It is likely a stage 2 pressure ulcer
D. It is likely a deep tissue injury
A. The reddened area is likely a pressure ulcer as it is not blanchable.
B. This is the correct answer. A stage I pressure ulcer presents as a reddened area of intact skin that is not blanchable.
C. A stage 2 pressure ulcer does not have intact skin as it is a partial-thickness wound.
D. A deep tissue injury presents as maroon/purple appearance rather than reddened.
100
A physical therapist is treating a patient with a unilateral rash wrapping around their right side beneath the scapula. The rash appears pink/silvery white and the patient reports the rash is painful. What is the MOST appropriate infection control precaution for the therapist?
A) Droplet precautions
B) Contact precautions
C) Airborne precautions
D) Airborne and contact precautions
The correct answer is: D
The patient is likely presenting with Herpes Zoster, which can be spread through contact. Furthermore, the varicella zoster virus causes herpes zoster, which is airborne. So, the most appropriate infection control precaution is airborne precautions.
200
A 65-year-old patient with a history of peripheral arterial disease (PAD) presents with a non-healing ulcer on the dorsum of their foot. The patient's ankle-brachial index (ABI) is 0.5. Which of the following interventions is the MOST appropriate?
A. Apply high-compression bandaging to improve circulation
B. Encourage walking and refer for vascular consultation
C. Elevate the limb above heart level to reduce edema
D. Perform sharp debridement to remove necrotic tissue
A. Compression therapy is contraindicated in severe arterial insufficiency due to the risk of further ischemia.
B. This is the correct answer. An ABI of 0.5 indicates moderate to severe arterial insufficiency; walking programs can help improve collateral circulation in PAD; vascular consultation is necessary to assess for potential revascularization procedures.
C. Elevation can worsen symptoms by reducing perfusion.
D. Sharp debridement is contraindicated in patients with severe ischemia due to poor healing potential.
200
A patient with diabetes presents with a chronic wound on the plantar surface of the foot. The wound is large, with a necrotic base, and has no signs of infection. The patient has absent pulses in the foot and decreased sensation in the affected area. Which of the following assessments is MOST important to determine the severity of the ulcer?
A. Ankle-brachial index (ABI)
B. Blood glucose levels
C. Complete blood count (CBC)
D. Wound culture
A. This is the correct answer. ABI is crucial to assess peripheral arterial disease, which is common in patients with diabetes and can impair wound healing.
B. Blood glucose levels affect wound healing, but ABI is key to assessing vascular compromise in this case.
C. A CBC can be useful to check for signs of infection but does not directly assess vascular status.
D. A wound culture is helpful for identifying infection but is less useful without addressing the vascular component.
200
A 45 year old male presents to the burn unit with partial thickness burns over the entire right arm, entire left arm, front of head, and front of chest. Which of the following values BEST approximates the percentage of his body that is burned?
A. 31.5%
B. 36%
C. 40.5%
D. 45%
This question requires knowledge of the rule of nines: entire right arm = 9%, entire left arm = 9%, front of head = 4.5%, front of chest = 18%. Total = 40.5%. Therefore the correct answer is C.
200
You are treating a patient with a pressure ulcer to their right foot. Upon assessment, you notice it is covered by a dry eschar cap. Which of the following best classifies this type of ulcer?
A. Stage 2
B. Stage 3
C. Stage 4
D. Unstageable
A. Stage 2 ulcers involve partial-thickness skin loss, appearing as a shallow open wound, blister, or abrasion, with a red or pink wound bed, and the surrounding skin may be discolored and painful.
B. Stage 3 ulcers involve full-thickness skin loss, extending into the subcutaneous tissue layer, where fat may be visible, but bone, tendon, or muscle is not exposed.
C. Stage 4 ulcers involve full-thickness skin and tissue loss, exposing bone, muscle, or tendons, and may show signs of infection like pus, odor, and redness.
D. This is the correct answer. Ulcers are considered unstageable if the extent of tissue damage cannot be confirmed because it is obscured by slough or eschar.
200
A patient reports a mole that has changed shape and color over the past few months. Which of the following criteria would MOST concern a clinician for malignant melanoma?
A. Symmetrical shape, well-defined border, uniform color
B. Asymmetry, irregular borders, color variation, diameter > 6 mm, evolving changes
C. Red, scaly lesion with central ulceration
D. Pearly, raised nodule with central telangiectasia
A. This is describing a benign mole.
B. This is the correct answer. A mole that is asymmetrical with irregular borders, color variation, evolving changes, and a diameter of greater than 6 mm is potentially describing melanoma.
C. This is describing a squamous cell carcinoma, which often presents as a scaly or ulcerated lesion.
D. This is describing a basal cell carcinoma, which appears as a pearly nodule with visible blood vessels (telangiectasia).
300
A patient presents with a painful, deep ulcer located on the toe. The wound base is pale, dry, and the surrounding skin is cool to the touch. Which of the following signs is MOST consistent with this type of wound?
A. Decreased pulses and hair loss on the affected leg
B. Swelling and hyperpigmentation around the ulcer
C. Presence of a large amount of wound exudate
D. Warmth and redness surrounding the ulcer
A. This is the correct answer. Decreased pulses and hair loss are typical of arterial insufficiency, which is caused by poor circulation and vascular compromise.
B. Swelling and hyperpigmentation are more typical of venous insufficiency ulcers.
C. Excessive wound exudate and warmth/redness are more commonly seen with venous ulcers or infection rather than arterial insufficiency.
300
A patient with a diabetic foot ulcer has been experiencing persistent wound drainage and elevated temperature. Upon further assessment, the patient shows signs of bone pain and swelling in the affected foot. What is the MOST likely complication?
A. Charcot foot
B. Osteomyelitis
C. Peripheral neuropathy
D. Venous stasis ulcer
A. Charcot foot is characterized by joint destruction due to neuropathy but typically does not present with bone pain and infection signs.
B. This is the correct answer. Osteomyelitis is a bone infection commonly associated with diabetic foot ulcers, especially when there is persistent drainage and signs of bone pain.
C. Peripheral neuropathy leads to loss of sensation but does not directly cause bone infection.
D. Venous stasis ulcers occur typically on the lower legs and are not associated with diabetes or bone infection.
300
You are treating a patient for a burn to their chest as seen below. While assessing the burn, you noticed it is not blanchable and the patient denies pain. Based on the appearance of the burn, what is the best classification?
A. Superficial Partial Thickness
B. Deep Partial Thickness
C. Full Thickness
D. Subdermal
A. SPT burns appear bright pink/red with intact blisters and moderate edema. These burns are very painful and still have normal blanching.
B. DPT burns appear mixed red/waxy white with broken blisters and severe edema. While these burns are not painful, they are still blanchable just with slow capillary refill.
C. This is the correct answer. Full thickness burns appear white, charred, or tanned and dry/leathery. These burns are not painful and are not blanchable.
D. Subdermal burns appear charred and involves muscles and nerves.
300
A 72-year-old patient with limited mobility presents with a stage 2 pressure ulcer on the sacrum. The wound bed is pink and moist with periwound skin that appears soft, white, and fragile. Which of the following factors is the MOST likely contributor to the presentation of the periwound area in this patient?
A. Dehydration
B. Inadequate protein intake
C. Incontinence
D. Excessive friction
A. Dehydration of a wound will likely lead to desiccation, which presents as cracked with dry/flaky edges. Furthermore, the wound bed is hard or crusty.
B. While inadequate protein intake can impair wound healing, it does not directly cause maceration.
C. This is the correct answer. Incontinence can lead to excessive moisture in a wound bed, which can cause maceration. Maceration presents as soft, white, friable/fragile skin.
D. Excessive friction does not directly lead to maceration. Rather, maceration is caused by excessive moisture/exudate.
300
A patient presents with vesicular rash of the forehead, upper eyelid, and the side of the nose. The patient reports burning pain along the rash as well as decreased vision. Which cranial nerve is MOST likely affected?
A. Cranial Nerve III
B. Cranial Nerve V
C. Cranial Nerve VII
D. Cranial Nerve X
A. CN III is commonly affected by herpes zoster; however, symptoms associated with CN III involvement are eye movement difficulties and pain around the eyes.
B. This is the correct answer. Herpes zoster commonly affects CN V, which can cause loss of vision.
C. CN VII is not commonly affected by herpes zoster and would not present with loss of vision.
D. CN X is not commonly affected by herpes zoster and would not present with loss of vision.
400
A patient with venous insufficiency is at high risk of developing venous ulcers. Which of the following is the MOST effective prevention strategy?
A. Wearing compression stockings and keeping the legs in a dependent position
B. Regular application of moisturizers to the legs
C. Use of topical antibiotics on the legs
B. Wearing compression stockings and elevating the legs
A. Keeping the legs in a dependent position will worsen the venous insufficiency as this makes it harder for blood to return to the heart.
B. Moisturizers can help with skin care, but compression therapy is more effective in preventing ulcer formation.
C. Topical antibiotics are used for infections, not for ulcer prevention.
D. Elevating the legs will help encourage blood to return to the heart and can help decrease the development of ulcers.
400
A patient presents with a chronic ulcer that is round and has a punched-out appearance. It also appears deep with yellow drainage. The surrounding area is callused. Which of the following locations is the MOST likely location of this ulcer?
A) On the dorsal surface of the foot
B) On the heel
C) On the plantar surface of the foot
D) Over the medial malleolus
A. This location is most likely to be from an arterial ulcer; this ulcer is likely a neuropathic/diabetic ulcer.
B. Heel ulcers are more common in patients with pressure-related issues or those immobile, but they are less frequent in diabetic neuropathic ulcers.
C. This is the correct answer. Diabetic ulcers often develop on the plantar surface of the foot, particularly on the weight-bearing areas, such as the metatarsal heads.
D. Ulcers over the medial malleolus are typically due to venous insufficiency; in this case, the ulcer is likely neuropathic/diabetic.
400
A patient with a superficial partial-thickness burn to the anterior thigh is being treated in an outpatient clinic. The wound is moist, painful, and has intact blisters. What is the MOST appropriate initial dressing choice?
A. Hydrocolloid dressing
B. Silver sulfadiazine cream with a non-adherent dressing
C. Alginate dressing
D. Transparent film dressing
A. Hydrocolloid dressings are typically used for wounds with minimal exudate, but not ideal for burns with blisters as it may cause further maceration or trauma upon removal.
B. This is the correct answer. Silver sulfadiazine cream with a non-adherent dressing is the best choice because silver sulfadiazine has antimicrobial properties to prevent infection, and a non-adherent dressing protects the wound while allowing for moist healing.
C. Alginate dressings are used for moderate-to-heavy exudate wounds, but superficial partial-thickness burns typically have mild to moderate exudate and do not require a highly absorptive dressing.
D. Transparent film dressings do not provide sufficient absorption or antimicrobial protection, and may lead to excessive moisture accumulation, delaying healing.
400
A patient with a stage 3 pressure ulcer on the sacrum has moderate necrotic tissue and slough present in the wound bed. The wound care team wants to use a method that removes necrotic tissue while preserving viable tissue. Which of the following debridement techniques is the MOST appropriate choice?
A. Wet-to-dry dressing changes
B. Sharp debridement with a scalpel
C. Whirlpool therapy
D. Scrubbing the wound with gauze
A. Wet-to-dry dressing is a form of non-selective debridement, so it would not be appropriate in this case.
B. This is the correct answer. Sharp debridement is a form of selective debridement and allows for removal of necrotic tissue while preserving healthy granulation tissue.
C. Whirlpool therapy is a form of non-selective debridement, so it would not be appropriate in this case.
D. Scrubbing the wound with gauze is a form of non-selective debridement, so it would not be appropriate in this case.
400
A 55-year-old patient presents with a dark, irregularly shaped lesion on the upper back that he reports has become progressively itchy and painful. The lesion is asymmetrical, has an uneven border, and contains multiple shades of brown and black. The patient states that the lesion has increased in size over the past few weeks. What is the MOST likely diagnosis?
A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Malignant melanoma
D. Actinic keratosis
A. Basal cell carcinoma typically presents as ivory in appearance or as a reddened area of eczema. It usually has a rolled border with an indented center or it appears as a thickened area of skin. It is slow-growing.
B. Squamous cell carcinoma does have poorly defined margins, but it appears more as a red flat area, ulcer, or nodule.
C. This is the correct answer. Malignant melanomas are darker in appearance, typically black, blue, or red. It also has uneven borders and appears asymmetrical. Malignant melanomas tend to grow rapidly and can present with itching, burning, or pain.
D. Actinic keratosis is a precancerous scaly lesion caused by sun damage, not a dark lesion. It is typically flat and round.
500
A patient is being assessed for peripheral arterial disease. The therapist performs the rubor of dependency test by having the patient elevate their legs for 1-2 minutes, then quickly lowers them to the resting position. Which of the following findings is MOST indicative of arterial insufficiency?
A. Rapid return of the foot to a normal color
B. A delayed return of the foot to a normal color (i.e., more than 30 seconds)
C. Minimal color change in the skin during elevation
D. The foot becomes reddish or rubor within 10-15 seconds after lowering
A. This is a normal response which would indicate no arterial insufficiency.
B. This is the correct answer. The rubor of dependency test assesses the arterial supply to the lower extremities. In patients with arterial insufficiency, delayed return of the foot to a normal color (more than 20 seconds) indicates poor circulation.
C. Minimal color change during elevation is typically still associated with normal arterial flow.
D. Redness (rubor) within 10-15 seconds (D) is more indicative of venous congestion, which occurs in venous insufficiency, not arterial insufficiency.
500
A patient with a diabetic foot ulcer has a moderate amount of exudate and the wound bed is granulating. What is the MOST appropriate dressing choice to promote healing?
A. Hydrofiber dressing
B. Transparent film dressing
C. Hydrocolloid dressing
D. Calcium alginate
A. Hydrofiber dressings are used for wounds with excessive exudate.
B. Transparent film dressings are better for wounds with no or very minimal exudate.
C. This is the correct answer. Foam is ideal for wounds with moderate exudate.
D. Calcium alginate is used for wounds with excessive exudate.
500
You are treating a patient with a burn to their left arm. Upon examination, you notice the burn appears red, has broken blisters, and is severely swollen. When you press on the burn, you note that capillary refill time is 4 seconds. Which of the following BEST classifies this type of burn?
A. Superficial
B. Superficial Partial Thickness
C. Deep Partial Thickness
D. Full Thickness
A. This type of burn is red, but does not have blisters and has minimal edema. Furthermore, capillary refill is normal.
B. This type of burn is red, but has moderate edema, intact blisters, and normal capillary refill.
C. This is the correct answer. DPT burns have broken blisters, appear red, have slowed capillary refill, and severe edema.
D. This type of burn appears white, charred, or tanned, dry, and has no capillary refill as opposed to slowed.
500
You have been treating a patient with a stage II pressure ulcer. Originally, the wound had large amounts of exudate and you applied a hydrofiber dressing. Now, you notice the wound has improved and has minimal exudate. What dressing choice is MOST appropriate for the ulcer at its current stage?
A. Change to a hydrocolloid dressing
B. Continue using the hydrofiber dressing
C. Change to a transparent film
D. Change to foam and gauze
A. This is the correct answer. Hydrocolloids and hydrogels are appropriate for wounds with minimal exudate.
B. Hydrofiber dressings are for wounds with excessive exudate. Now that the wound has improved and has minimal exudate, this type of dressing is no longer needed.
C. Transparent film is used for wounds with no to very little exudate as they have no absorption abilities. This wound still has some exudate, so this is not an appropriate dressing yet.
D. Foam is used for wounds with moderate exudate. This wound has minimal exudate, so foam would be too absorptive for this wound.
500
A patient presents with redness, swelling, and warmth on the right lower leg. The patient also reports a low-grade fever and the borders of the affected area are poorly defined. Which of the following is the MOST likely diagnosis?
A) Stasis dermatitis
B) Contact dermatitis
C) Cellulitis
D) Venous insufficiency ulcer
A. Stasis dermatitis is typically bilateral, with scaling and hyperpigmentation, and is related to venous insufficiency.
B. Contact dermatitis presents with itching and well-defined redness, usually in response to an irritant or allergen, rather than infection, so a fever would not be expected.
C. This is the correct answer. Cellulitis is a bacterial skin infection that presents as warm, red, swollen skin with poorly defined borders and often includes fever.
D. Venous ulcers are open wounds, usually found on the medial lower leg, often associated with chronic venous insufficiency.