Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 3 — Questions and Answers
Question 1: A patient with systemic lupus erythematosus (SLE) develops painful digital ulcers and skin necrosis. Antiphospholipid antibodies are detected. Which mechanism best explains this wound presentation?
- Autoimmune neutrophil infiltration of dermis
- Hypercoagulability causing thrombotic occlusion of microvasculature (Correct answer)
- Complement-mediated direct tissue destruction
- Immune complex deposition causing vasodilation
Correct answer: Hypercoagulability causing thrombotic occlusion of microvasculature
Antiphospholipid syndrome promotes a hypercoagulable state leading to thrombosis of small and medium vessels, resulting in ischemic ulcers and digital necrosis.
Question 2: Epidermolysis bullosa (EB) wounds are best managed with which primary dressing consideration?
- Adhesive hydrocolloid dressings to maintain occlusion
- Non-adherent, silicone-based dressings to minimize trauma at removal (Correct answer)
- Wet-to-dry gauze for mechanical debridement
- Zinc oxide paste bandages
Correct answer: Non-adherent, silicone-based dressings to minimize trauma at removal
EB skin is extremely fragile; non-adherent silicone dressings prevent the trauma of dressing removal, which can shear new epithelium and create additional wounds.
Question 3: A patient with chronic hepatitis C presents with palpable purpura, arthralgias, and lower extremity ulcers. Serum immunofixation shows a type II cryoglobulin. The underlying wound etiology is:
- Venous insufficiency
- Cryoglobulinemic vasculitis (Correct answer)
- Pyoderma gangrenosum
- Diabetic microangiopathy
Correct answer: Cryoglobulinemic vasculitis
Hepatitis C-associated cryoglobulinemia causes immune complex deposition in vessel walls, triggering small vessel vasculitis that produces purpura and ulceration.
Question 4: Necrobiosis lipoidica diabeticorum (NLD) most commonly presents in which anatomical location?
- Dorsum of the hand
- Pretibial area of the lower leg (Correct answer)
- Medial ankle
- Plantar foot
Correct answer: Pretibial area of the lower leg
NLD classically appears on the pretibial surface as waxy, yellow-brown plaques with a violaceous border that may ulcerate in the center.
Question 5: A clinician suspects a factitious wound (dermatitis artefacta) in a patient with a geometric wound pattern that does not fit any known vascular distribution. The most important next step in management is:
- Aggressive debridement
- Immediate skin grafting
- Psychiatric evaluation and a non-confrontational therapeutic approach (Correct answer)
- High-dose systemic corticosteroids
Correct answer: Psychiatric evaluation and a non-confrontational therapeutic approach
Factitious wounds are self-inflicted; addressing the underlying psychiatric condition and building patient trust is essential before any wound intervention.
Question 6: Which of the following best distinguishes vasculitic ulcers from venous leg ulcers on clinical examination?
- Vasculitic ulcers are painless and located on the gaiter area
- Vasculitic ulcers are typically multiple, punched-out, and extremely painful (Correct answer)
- Vasculitic ulcers have irregular sloping edges and surrounding hemosiderin staining
- Vasculitic ulcers respond promptly to compression therapy
Correct answer: Vasculitic ulcers are typically multiple, punched-out, and extremely painful
Vasculitic ulcers are typically multiple, have punched-out edges, and are severely painful, reflecting ischemia from inflamed and occluded small vessels.
Question 7: A patient develops a painful, non-healing ulcer on the lower leg following initiation of hydroxyurea therapy for polycythemia vera. The most likely diagnosis is:
- Arterial ulcer from drug-induced vasospasm
- Hydroxyurea-induced leg ulcer (Correct answer)
- Venous ulcer exacerbated by polycythemia
- Pressure injury from bedrest
Correct answer: Hydroxyurea-induced leg ulcer
Hydroxyurea can cause a specific form of drug-induced leg ulcer through mechanisms including impaired wound healing, endothelial dysfunction, and altered blood rheology.
Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 3
A patient with systemic lupus erythematosus (SLE) develops painful digital ulcers and skin necrosis.
Antiphospholipid antibodies are detected.
Which mechanism best explains this wound presentation?