Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 5 — Questions and Answers
Question 1: A patient with a known hypercoagulable state (Factor V Leiden mutation) presents with a painful lower leg ulcer. Biopsy shows fibrin thrombi in dermal vessels with minimal inflammation. This pattern is most consistent with:
- Pyoderma gangrenosum
- Livedoid vasculopathy (Correct answer)
- Calciphylaxis
- Leukocytoclastic vasculitis
Correct answer: Livedoid vasculopathy
Livedoid vasculopathy is characterized by fibrin thrombi in dermal capillaries with minimal inflammatory infiltrate, and is associated with hypercoagulable states.
Question 2: When treating calciphylaxis, sodium thiosulfate is used because it:
- Inhibits parathyroid hormone secretion
- Chelates calcium and has antioxidant properties, dissolving calcium deposits (Correct answer)
- Promotes phosphate excretion through the kidneys
- Directly vasodilates calcified arterioles
Correct answer: Chelates calcium and has antioxidant properties, dissolving calcium deposits
Sodium thiosulfate acts as a chelating agent that binds calcium to form soluble calcium thiosulfate, helping dissolve vascular calcium deposits in calciphylaxis.
Question 3: A wound clinician encounters a patient with sickle cell leg ulcers. Which treatment approach is CONTRAINDICATED due to risk of worsening ischemia?
- Hydroxyurea therapy
- High-pressure compression bandaging (Correct answer)
- Zinc supplementation
- Gentle moist wound healing dressings
Correct answer: High-pressure compression bandaging
High-pressure compression can further compromise already impaired microcirculation in sickle cell ulcers, worsening ischemia and pain.
Question 4: A patient with a history of ANCA-associated vasculitis presents with a new lower extremity ulcer. Which biopsy finding would confirm vasculitis as the etiology?
- Fibrin thrombi with minimal inflammation
- Fibrinoid necrosis of vessel walls with neutrophilic infiltration (Correct answer)
- Calcium deposits in the media of arterioles
- Dermal edema with hemosiderin deposits
Correct answer: Fibrinoid necrosis of vessel walls with neutrophilic infiltration
ANCA-associated vasculitis shows fibrinoid necrosis of vessel walls with a neutrophilic infiltrate on biopsy, confirming vessel wall inflammation as the wound cause.
Question 5: Which of the following atypical wound etiologies is most strongly associated with a history of bone marrow or organ transplantation?
- Pyoderma gangrenosum due to graft-vs-host disease (Correct answer)
- Calciphylaxis due to post-transplant mineral dysregulation
- Leishmania reactivation due to immunosuppression
- Sickle cell ulcer due to hemolysis
Correct answer: Pyoderma gangrenosum due to graft-vs-host disease
Graft-versus-host disease after bone marrow transplantation can manifest as skin involvement including pyoderma gangrenosum-like ulcerations.
Question 6: A patient presents with a painless ulcer on the perimalleolar area with a 'wet wood' odor and extensive undermining. They recently returned from West Africa. The most appropriate initial diagnostic step is:
- Venous duplex scan
- PCR testing of wound tissue for Mycobacterium ulcerans (Correct answer)
- ANCA panel and ANA titer
- Wound surface swab for MRSA
Correct answer: PCR testing of wound tissue for Mycobacterium ulcerans
The clinical presentation of painless, undermined ulceration with extensive subcutaneous destruction in a traveler from West Africa is classic for Buruli ulcer; PCR for M. ulcerans confirms the diagnosis.
Question 7: Which statement best describes the principle of pathergy in the context of atypical wounds?
- Wounds heal faster after minor trauma due to growth factor release
- Minor skin trauma triggers disproportionately large wound formation in susceptible patients (Correct answer)
- Wound infection spreads to adjacent skin following debridement
- Repeated trauma leads to protective callus formation
Correct answer: Minor skin trauma triggers disproportionately large wound formation in susceptible patients
Pathergy refers to an exaggerated inflammatory response to minor trauma, seen in pyoderma gangrenosum, where any wound insult can trigger massive ulcer expansion.
Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 5
A patient with a known hypercoagulable state (Factor V Leiden mutation) presents with a painful lower leg ulcer.
Biopsy shows fibrin thrombi in dermal vessels with minimal inflammation.
This pattern is most consistent with: