Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 4 — Questions and Answers
Question 1: A traveler returning from South America presents with a painless, crusted, nodular ulcer on the forearm that has not healed for 3 months. Tissue culture and smear reveal intracellular organisms. The most likely diagnosis is:
- Sporotrichosis
- Leishmaniasis (Correct answer)
- Buruli ulcer
- Mycobacterium marinum infection
Correct answer: Leishmaniasis
Cutaneous leishmaniasis causes a painless, slowly progressive ulcer ("volcano crater" appearance) caused by Leishmania protozoa transmitted by sandfly bites.
Question 2: Buruli ulcer caused by Mycobacterium ulcerans is best characterized by which clinical feature?
- Painful, rapidly spreading cellulitis
- Painless, undermined necrotic ulcer with extensive subcutaneous tissue destruction (Correct answer)
- Multiple satellite pustules around a central nodule
- Superficial erosion limited to the epidermis
Correct answer: Painless, undermined necrotic ulcer with extensive subcutaneous tissue destruction
M. ulcerans secretes mycolactone toxin that causes painless, extensive subcutaneous necrosis with characteristic undermined wound edges.
Question 3: When evaluating a suspected atypical wound, which diagnostic test provides the highest-yield information about the wound etiology?
- Surface wound swab culture
- Punch biopsy from the wound edge for histopathology and culture (Correct answer)
- Doppler ultrasound of leg veins only
- Wound pH measurement
Correct answer: Punch biopsy from the wound edge for histopathology and culture
A punch biopsy from the wound edge (not the necrotic center) provides tissue for histopathology and culture, which is essential for diagnosing atypical wound etiologies.
Question 4: A patient with rheumatoid arthritis develops multiple, small, punched-out leg ulcers with no signs of venous or arterial disease. The clinician considers rheumatoid vasculitis. Which lab finding would best support this diagnosis?
- Low serum ferritin
- Elevated rheumatoid factor and ANCA positivity (Correct answer)
- Thrombocytopenia and elevated D-dimer
- Elevated serum calcium
Correct answer: Elevated rheumatoid factor and ANCA positivity
Rheumatoid vasculitis affecting small vessels is associated with high-titer rheumatoid factor and may be ANCA-positive, supporting a systemic autoimmune cause.
Question 5: A fungating malignant wound is best described as:
- A wound infected with fungal organisms
- A wound arising from tumor infiltration through the skin causing ulceration, exudate, and malodor (Correct answer)
- A deep tissue pressure injury with fungal superinfection
- A wound in a patient who uses antifungal medications
Correct answer: A wound arising from tumor infiltration through the skin causing ulceration, exudate, and malodor
Fungating wounds occur when malignant cells infiltrate and proliferate through the skin, causing ulceration, heavy exudate, friable tissue, and malodor.
Question 6: Which of the following is the MOST important goal when managing a fungating malignant wound?
- Achieving complete wound closure
- Symptom management including odor, exudate, and pain control (Correct answer)
- Aggressive debridement to reduce tumor burden
- Promoting granulation tissue formation
Correct answer: Symptom management including odor, exudate, and pain control
Fungating malignant wounds are typically not healable; the primary goal is palliative symptom management to optimize patient comfort and quality of life.
Question 7: Pyoderma gangrenosum is most commonly associated with which underlying systemic condition?
- Chronic kidney disease
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis) (Correct answer)
- Systemic lupus erythematosus
- Type 1 diabetes mellitus
Correct answer: Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
Approximately 50% of pyoderma gangrenosum cases are associated with systemic diseases, with inflammatory bowel disease being the most common association.
Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 4
A traveler returning from South America presents with a painless, crusted, nodular ulcer on the forearm that has not healed for 3 months.
Tissue culture and smear reveal intracellular organisms.
The most likely diagnosis is: