1|P a g e
EMORY WOUND EXAM 1 PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS ALREADY A GRADED WITH EXPERT
FEEDBACK|NEW AND REVISED
1. A 78-year-old patient presents with a full-thickness wound over the sacrum that
extends into subcutaneous tissue without exposure of fascia or muscle. According
to the revised National Pressure Injury Advisory Panel (NPIAP) staging system,
which stage is this?
A) Stage 2 pressure injury
B) Stage 3 pressure injury
C) Stage 4 pressure injury
D) Unstageable pressure injury
*Rationale: Stage 3 involves full-thickness tissue loss with visible subcutaneous
fat, but fascia, muscle, tendon, ligament, or bone are not exposed. Stage 2 is
partial thickness. Stage 4 exposes bone or muscle. Unstageable has
slough/eschar.*
2. A diabetic patient has a chronic ulcer on the plantar aspect of the first metatarsal
head. Which clinical finding most strongly suggests underlying osteomyelitis?
A) Erythema extending 2 cm from the wound edge
B) Probe-to-bone test positive with a metallic grating sensation
C) Purulent drainage with foul odor
D) Periwound maceration
Rationale: A positive probe-to-bone test (palpating hard, gritty bone) has high
specificity for osteomyelitis in diabetic foot ulcers. Erythema and purulence
suggest infection but not necessarily bone involvement.
3. When assessing a venous leg ulcer, which physical examination finding is most
characteristic?
A) Dependent rubor with pallor on elevation
B) Hemosiderin staining and lipodermatosclerosis of the gaiter area
C) Toe gangrene and absent pedal pulses
D) Deep, punched-out appearance with well-defined borders
Rationale: Venous insufficiency causes hemosiderin deposition (brown
,2|P a g e
discoloration) and lipodermatosclerosis (fibrotic, indurated skin) in the medial
gaiter region. Option A describes arterial insufficiency; option C describes
critical limb ischemia; option D is typical of neuropathic ulcers.
4. A patient with a sacral pressure injury has 100% yellow slough covering the
wound bed. The wound edges are rolled (epibole). Which intervention should be
prioritized?
A) Apply a hydrocolloid dressing to promote autolysis
B) Perform sharp debridement to remove nonviable tissue and disrupt epibole
C) Initiate topical antimicrobial ointment
D) Obtain a wound culture before any debridement
Rationale: Removal of devitalized tissue and epibole is essential to convert a
chronic wound to an acute healing state. Sharp debridement is most efficient.
Autolysis is slow and ineffective against thick slough and epibole.
5. Which laboratory value is most critical to monitor in a patient with a non-
healing wound receiving negative pressure wound therapy (NPWT) and who has a
history of congestive heart failure?
A) Hemoglobin A1c
B) Serum albumin and prealbumin
C) White blood cell count
D) Creatinine kinase
Rationale: NPWT removes protein-rich exudate; patients with heart failure are
at risk for fluid shifts and malnutrition. Albumin/prealbumin guide nutritional
support, which is essential for healing. Other labs are relevant but not the most
critical in this context.
6. A wound culture from a chronic leg ulcer grows >10^5 CFU/g
of Staphylococcus aureus with no signs of systemic infection. The wound is
stalled but not worsening. What is the most appropriate next step?
A) Oral clindamycin for 14 days
B) Implement biofilm-based wound care (e.g., sharp debridement, topical
antiseptic)
C) Apply mupirocin ointment twice daily
D) No treatment; colonization does not require therapy
Rationale: High bacterial burden with biofilm is a common cause of healing
failure without overt infection. Debridement and topical agents (e.g., cadexomer
,3|P a g e
iodine, silver) disrupt biofilm. Systemic antibiotics are not indicated without
spreading infection.
7. An 82-year-old nursing home resident has an unstageable pressure injury over
the coccyx with a dry, intact black eschar. The patient is terminally ill with a life
expectancy of weeks. Which action is most appropriate?
A) Aggressive sharp debridement to expose the wound bed
B) Maintain dry, intact eschar as a natural cover and focus on comfort
C) Apply enzymatic debriding agent daily
D) Use wet-to-dry dressings to soften the eschar
Rationale: For terminally ill or palliative patients, a stable, dry, intact eschar on
the heel or coccyx should not be debrided. It acts as a biological cover.
Aggressive interventions cause pain and bleeding without benefit.
8. Which topical agent is contraindicated in a patient with a known iodine allergy
and thyroid disease?
A) Silver sulfadiazine cream
B) Cadexomer iodine dressing
C) Medical-grade honey
D) Sodium hypochlorite solution
Rationale: Cadexomer iodine releases iodine, which can be absorbed
systemically, potentially exacerbating thyroid disease and causing allergic
reactions in iodine-sensitive patients.
9. A patient presents with a shallow, irregularly shaped ulcer with a violaceous,
undermined border located on the lateral malleolus. What is the most likely
etiology?
A) Arterial insufficiency ulcer
B) Venous leg ulcer
C) Pyoderma gangrenosum
D) Calciphylaxis
Rationale: Venous ulcers typically occur over the medial or lateral malleolus,
are shallow, have irregular borders, and are surrounded by hemosiderin
staining. Pyoderma gangrenosum has a violaceous, undermined border but is
often painful and associated with inflammatory bowel disease. Calciphylaxis
presents with reticulated purpura and necrosis.
10. Which dressing is most appropriate for a moderate-to-heavily exuding diabetic
foot ulcer with no signs of infection and healthy granulation tissue?
, 4|P a g e
A) Dry gauze
B) Calcium alginate dressing
C) Hydrocolloid wafer
D) Non-adherent silicone mesh
Rationale: Calcium alginate absorbs moderate to heavy exudate, forms a gel,
and maintains a moist environment. Dry gauze adheres to granulation tissue;
hydrocolloid is for low exudate; silicone mesh alone is not absorbent.
11. According to the Wagner-Meggitt classification, a diabetic foot ulcer with
exposed tendon but no bone involvement or abscess is classified as:
A) Grade 1
B) Grade 2
C) Grade 3
D) Grade 4
Rationale: Wagner Grade 2: ulcer penetrates to tendon or capsule, no bone
involvement. Grade 1: superficial. Grade 3: deep abscess or osteomyelitis. Grade
4: forefoot gangrene.
12. A patient on long-term corticosteroid therapy develops a superficial surgical
site infection. Which factor most significantly impairs wound healing in this
patient?
A) Decreased fibroblast proliferation and collagen synthesis
B) Impaired epithelial migration
C) Inhibition of inflammatory phase and neovascularization
D) Reduced platelet aggregation
Rationale: Corticosteroids suppress inflammation, macrophage function, and
angiogenesis, leading to delayed healing. While they also affect fibroblasts (A),
the primary mechanism is early-phase inhibition.
13. When using a handheld Doppler to assess ankle-brachial index (ABI), the cuff
is placed on the ankle. Which vessel is most commonly auscultated for the ankle
pressure?
A) Dorsalis pedis and peroneal
B) Posterior tibial and dorsalis pedis
C) Sural and anterior tibial
D) Lateral plantar and medial plantar
Rationale: Standard ABI protocol uses the posterior tibial and dorsalis pedis
arteries. The higher of the two pressures is used for calculation.
EMORY WOUND EXAM 1 PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS ALREADY A GRADED WITH EXPERT
FEEDBACK|NEW AND REVISED
1. A 78-year-old patient presents with a full-thickness wound over the sacrum that
extends into subcutaneous tissue without exposure of fascia or muscle. According
to the revised National Pressure Injury Advisory Panel (NPIAP) staging system,
which stage is this?
A) Stage 2 pressure injury
B) Stage 3 pressure injury
C) Stage 4 pressure injury
D) Unstageable pressure injury
*Rationale: Stage 3 involves full-thickness tissue loss with visible subcutaneous
fat, but fascia, muscle, tendon, ligament, or bone are not exposed. Stage 2 is
partial thickness. Stage 4 exposes bone or muscle. Unstageable has
slough/eschar.*
2. A diabetic patient has a chronic ulcer on the plantar aspect of the first metatarsal
head. Which clinical finding most strongly suggests underlying osteomyelitis?
A) Erythema extending 2 cm from the wound edge
B) Probe-to-bone test positive with a metallic grating sensation
C) Purulent drainage with foul odor
D) Periwound maceration
Rationale: A positive probe-to-bone test (palpating hard, gritty bone) has high
specificity for osteomyelitis in diabetic foot ulcers. Erythema and purulence
suggest infection but not necessarily bone involvement.
3. When assessing a venous leg ulcer, which physical examination finding is most
characteristic?
A) Dependent rubor with pallor on elevation
B) Hemosiderin staining and lipodermatosclerosis of the gaiter area
C) Toe gangrene and absent pedal pulses
D) Deep, punched-out appearance with well-defined borders
Rationale: Venous insufficiency causes hemosiderin deposition (brown
,2|P a g e
discoloration) and lipodermatosclerosis (fibrotic, indurated skin) in the medial
gaiter region. Option A describes arterial insufficiency; option C describes
critical limb ischemia; option D is typical of neuropathic ulcers.
4. A patient with a sacral pressure injury has 100% yellow slough covering the
wound bed. The wound edges are rolled (epibole). Which intervention should be
prioritized?
A) Apply a hydrocolloid dressing to promote autolysis
B) Perform sharp debridement to remove nonviable tissue and disrupt epibole
C) Initiate topical antimicrobial ointment
D) Obtain a wound culture before any debridement
Rationale: Removal of devitalized tissue and epibole is essential to convert a
chronic wound to an acute healing state. Sharp debridement is most efficient.
Autolysis is slow and ineffective against thick slough and epibole.
5. Which laboratory value is most critical to monitor in a patient with a non-
healing wound receiving negative pressure wound therapy (NPWT) and who has a
history of congestive heart failure?
A) Hemoglobin A1c
B) Serum albumin and prealbumin
C) White blood cell count
D) Creatinine kinase
Rationale: NPWT removes protein-rich exudate; patients with heart failure are
at risk for fluid shifts and malnutrition. Albumin/prealbumin guide nutritional
support, which is essential for healing. Other labs are relevant but not the most
critical in this context.
6. A wound culture from a chronic leg ulcer grows >10^5 CFU/g
of Staphylococcus aureus with no signs of systemic infection. The wound is
stalled but not worsening. What is the most appropriate next step?
A) Oral clindamycin for 14 days
B) Implement biofilm-based wound care (e.g., sharp debridement, topical
antiseptic)
C) Apply mupirocin ointment twice daily
D) No treatment; colonization does not require therapy
Rationale: High bacterial burden with biofilm is a common cause of healing
failure without overt infection. Debridement and topical agents (e.g., cadexomer
,3|P a g e
iodine, silver) disrupt biofilm. Systemic antibiotics are not indicated without
spreading infection.
7. An 82-year-old nursing home resident has an unstageable pressure injury over
the coccyx with a dry, intact black eschar. The patient is terminally ill with a life
expectancy of weeks. Which action is most appropriate?
A) Aggressive sharp debridement to expose the wound bed
B) Maintain dry, intact eschar as a natural cover and focus on comfort
C) Apply enzymatic debriding agent daily
D) Use wet-to-dry dressings to soften the eschar
Rationale: For terminally ill or palliative patients, a stable, dry, intact eschar on
the heel or coccyx should not be debrided. It acts as a biological cover.
Aggressive interventions cause pain and bleeding without benefit.
8. Which topical agent is contraindicated in a patient with a known iodine allergy
and thyroid disease?
A) Silver sulfadiazine cream
B) Cadexomer iodine dressing
C) Medical-grade honey
D) Sodium hypochlorite solution
Rationale: Cadexomer iodine releases iodine, which can be absorbed
systemically, potentially exacerbating thyroid disease and causing allergic
reactions in iodine-sensitive patients.
9. A patient presents with a shallow, irregularly shaped ulcer with a violaceous,
undermined border located on the lateral malleolus. What is the most likely
etiology?
A) Arterial insufficiency ulcer
B) Venous leg ulcer
C) Pyoderma gangrenosum
D) Calciphylaxis
Rationale: Venous ulcers typically occur over the medial or lateral malleolus,
are shallow, have irregular borders, and are surrounded by hemosiderin
staining. Pyoderma gangrenosum has a violaceous, undermined border but is
often painful and associated with inflammatory bowel disease. Calciphylaxis
presents with reticulated purpura and necrosis.
10. Which dressing is most appropriate for a moderate-to-heavily exuding diabetic
foot ulcer with no signs of infection and healthy granulation tissue?
, 4|P a g e
A) Dry gauze
B) Calcium alginate dressing
C) Hydrocolloid wafer
D) Non-adherent silicone mesh
Rationale: Calcium alginate absorbs moderate to heavy exudate, forms a gel,
and maintains a moist environment. Dry gauze adheres to granulation tissue;
hydrocolloid is for low exudate; silicone mesh alone is not absorbent.
11. According to the Wagner-Meggitt classification, a diabetic foot ulcer with
exposed tendon but no bone involvement or abscess is classified as:
A) Grade 1
B) Grade 2
C) Grade 3
D) Grade 4
Rationale: Wagner Grade 2: ulcer penetrates to tendon or capsule, no bone
involvement. Grade 1: superficial. Grade 3: deep abscess or osteomyelitis. Grade
4: forefoot gangrene.
12. A patient on long-term corticosteroid therapy develops a superficial surgical
site infection. Which factor most significantly impairs wound healing in this
patient?
A) Decreased fibroblast proliferation and collagen synthesis
B) Impaired epithelial migration
C) Inhibition of inflammatory phase and neovascularization
D) Reduced platelet aggregation
Rationale: Corticosteroids suppress inflammation, macrophage function, and
angiogenesis, leading to delayed healing. While they also affect fibroblasts (A),
the primary mechanism is early-phase inhibition.
13. When using a handheld Doppler to assess ankle-brachial index (ABI), the cuff
is placed on the ankle. Which vessel is most commonly auscultated for the ankle
pressure?
A) Dorsalis pedis and peroneal
B) Posterior tibial and dorsalis pedis
C) Sural and anterior tibial
D) Lateral plantar and medial plantar
Rationale: Standard ABI protocol uses the posterior tibial and dorsalis pedis
arteries. The higher of the two pressures is used for calculation.
