, Question 1
Which of the following best explains why a wound with a high bacterial
bioburden but no overt signs of infection may still fail to progress through the
inflammatory phase?
A. Bacteria directly inhibit collagen synthesis by downregulating
TGF-beta.
B. Persistent neutrophil activation releases proteases that degrade growth
factors and extracellular matrix.
C. Biofilm formation physically blocks oxygen diffusion to the wound
bed.
D. Toll-like receptor signaling suppresses macrophage polarization to M2
phenotype.
Correct Answer: B - Persistent neutrophil activation releases
proteases that degrade growth factors and extracellular matrix.
RATIONALE
In critical colonization, sustained neutrophil influx releases matrix
metalloproteinases (MMPs) and elastase that degrade growth factors
and newly formed matrix, impairing healing without classic infection
signs. While biofilm and TLR signaling contribute, the primary
mechanism of stalled inflammation is protease-mediated destruction.
Question 2
A patient with a chronic venous leg ulcer has an ankle-brachial index (ABI) of
0.7. Which intervention is most appropriate?
A. Initiate high-compression multilayer bandaging.
B. Apply Unna boot with moderate compression.
C. Refer for vascular evaluation before any compression.
D. Use intermittent pneumatic compression at high pressure.
Correct Answer: C - Refer for vascular evaluation before any
compression.
Page 2
, RATIONALE
An ABI of 0.7 indicates significant arterial insufficiency (normal
>0.9). Compression therapy is contraindicated and requires vascular
assessment to avoid worsening ischemia. High or moderate
compression could cause tissue necrosis.
Question 3
Which of the following is the most accurate statement regarding the use of
negative pressure wound therapy (NPWT) in an infected wound?
A. NPWT is contraindicated in all infected wounds.
B. NPWT can be used after adequate debridement and infection control.
C. NPWT should be applied with continuous high pressure to clear
bacteria.
D. NPWT increases bacterial load by creating a warm, moist
environment.
Correct Answer: B - NPWT can be used after adequate
debridement and infection control.
RATIONALE
NPWT is not absolutely contraindicated in infection; it may be used
after debridement and with appropriate antimicrobial therapy to
promote granulation. It does not clear bacteria by pressure alone and
can be used with instillation (NPWTi) for infected wounds.
Question 4
Which of the following best describes the mechanism by which hyperbaric
oxygen therapy (HBOT) promotes healing in a diabetic foot ulcer?
A. It directly kills anaerobic bacteria by oxidative burst.
B. It increases oxygen tension in hypoxic tissue, enhancing fibroblast
proliferation and angiogenesis.
C. It reduces blood glucose levels through increased insulin sensitivity.
Page 3
, D. It stimulates osteoclast activity to resolve osteomyelitis.
Correct Answer: B - It increases oxygen tension in hypoxic tissue,
enhancing fibroblast proliferation and angiogenesis.
RATIONALE
HBOT increases dissolved oxygen in plasma, raising tissue oxygen
tension in hypoxic areas, which supports fibroblast function, collagen
synthesis, and angiogenesis. It also enhances neutrophil killing, but
the primary healing mechanism is improved oxygenation.
Question 5
A wound exhibits a pale, dry, adherent eschar with no signs of infection.
Which debridement method is most appropriate according to current evidence?
A. Sharp surgical debridement to bleeding tissue.
B. Autolytic debridement with hydrocolloid dressing.
C. Enzymatic debridement with collagenase.
D. Mechanical debridement with wet-to-dry dressings.
Correct Answer: B - Autolytic debridement with hydrocolloid
dressing.
RATIONALE
For a stable, dry eschar without infection or ischemia, autolytic
debridement is preferred as it is selective and non-invasive. Sharp
debridement is indicated for infected or unstable eschar. Wet-to-dry is
non-selective and painful.
Question 6
Which of the following is a key distinction between a pressure injury and a
moisture-associated skin damage (MASD)?
A. Pressure injuries are always full-thickness.
B. MASD results from prolonged exposure to moisture and lacks tissue
ischemia.
Page 4
Which of the following best explains why a wound with a high bacterial
bioburden but no overt signs of infection may still fail to progress through the
inflammatory phase?
A. Bacteria directly inhibit collagen synthesis by downregulating
TGF-beta.
B. Persistent neutrophil activation releases proteases that degrade growth
factors and extracellular matrix.
C. Biofilm formation physically blocks oxygen diffusion to the wound
bed.
D. Toll-like receptor signaling suppresses macrophage polarization to M2
phenotype.
Correct Answer: B - Persistent neutrophil activation releases
proteases that degrade growth factors and extracellular matrix.
RATIONALE
In critical colonization, sustained neutrophil influx releases matrix
metalloproteinases (MMPs) and elastase that degrade growth factors
and newly formed matrix, impairing healing without classic infection
signs. While biofilm and TLR signaling contribute, the primary
mechanism of stalled inflammation is protease-mediated destruction.
Question 2
A patient with a chronic venous leg ulcer has an ankle-brachial index (ABI) of
0.7. Which intervention is most appropriate?
A. Initiate high-compression multilayer bandaging.
B. Apply Unna boot with moderate compression.
C. Refer for vascular evaluation before any compression.
D. Use intermittent pneumatic compression at high pressure.
Correct Answer: C - Refer for vascular evaluation before any
compression.
Page 2
, RATIONALE
An ABI of 0.7 indicates significant arterial insufficiency (normal
>0.9). Compression therapy is contraindicated and requires vascular
assessment to avoid worsening ischemia. High or moderate
compression could cause tissue necrosis.
Question 3
Which of the following is the most accurate statement regarding the use of
negative pressure wound therapy (NPWT) in an infected wound?
A. NPWT is contraindicated in all infected wounds.
B. NPWT can be used after adequate debridement and infection control.
C. NPWT should be applied with continuous high pressure to clear
bacteria.
D. NPWT increases bacterial load by creating a warm, moist
environment.
Correct Answer: B - NPWT can be used after adequate
debridement and infection control.
RATIONALE
NPWT is not absolutely contraindicated in infection; it may be used
after debridement and with appropriate antimicrobial therapy to
promote granulation. It does not clear bacteria by pressure alone and
can be used with instillation (NPWTi) for infected wounds.
Question 4
Which of the following best describes the mechanism by which hyperbaric
oxygen therapy (HBOT) promotes healing in a diabetic foot ulcer?
A. It directly kills anaerobic bacteria by oxidative burst.
B. It increases oxygen tension in hypoxic tissue, enhancing fibroblast
proliferation and angiogenesis.
C. It reduces blood glucose levels through increased insulin sensitivity.
Page 3
, D. It stimulates osteoclast activity to resolve osteomyelitis.
Correct Answer: B - It increases oxygen tension in hypoxic tissue,
enhancing fibroblast proliferation and angiogenesis.
RATIONALE
HBOT increases dissolved oxygen in plasma, raising tissue oxygen
tension in hypoxic areas, which supports fibroblast function, collagen
synthesis, and angiogenesis. It also enhances neutrophil killing, but
the primary healing mechanism is improved oxygenation.
Question 5
A wound exhibits a pale, dry, adherent eschar with no signs of infection.
Which debridement method is most appropriate according to current evidence?
A. Sharp surgical debridement to bleeding tissue.
B. Autolytic debridement with hydrocolloid dressing.
C. Enzymatic debridement with collagenase.
D. Mechanical debridement with wet-to-dry dressings.
Correct Answer: B - Autolytic debridement with hydrocolloid
dressing.
RATIONALE
For a stable, dry eschar without infection or ischemia, autolytic
debridement is preferred as it is selective and non-invasive. Sharp
debridement is indicated for infected or unstable eschar. Wet-to-dry is
non-selective and painful.
Question 6
Which of the following is a key distinction between a pressure injury and a
moisture-associated skin damage (MASD)?
A. Pressure injuries are always full-thickness.
B. MASD results from prolonged exposure to moisture and lacks tissue
ischemia.
Page 4
