Quiz Question (10-12)
A 25 year-old African-American man is referred with a shallow ulcer above his lateral malleolus. He demonstrates other healed wounds throughout his legs. The correct diagnosis is: a. Sickle cell disease b. Crohn's disease c. PAD d. Behçet syndrome
a
A patient has a fungating wound that fails to improve with appropriate care. The patient has had this wound for 25 years secondary to osteomyelitis. You request a biopsy of the wound. The biopsy is likely to confirm your suspicion of: a. Marjolin's ulcer b. Kaposi's sarcoma c. Cutaneous T cell lymphoma d. Mycosis fungoides
a
A patient is referred to PT in an acute care hospital with symmetric blistering and open wounds on the breast, buttocks, and belly. She is obese and has been recently discharged following treatment of atrial fibrillation with warfarin. The most likely cause of the wound is: a. Warfarin b. Calciphylaxis c. Tobacco use d. Obesity
a
A patient is referred to you with a shallow open wound in her inguinal area. Her history reveals current complaints of joint pain, mouth ulcers as depicted above, and uveitis. The most likely cause is: a. Behçet syndrome b. Pyoderma gangrenosum c. Warfarin d. Gout
a
A woman with a BMI of 60 has limited mobility due to recovery from septic shock. What is the most promising means of preventing pressure ulcers on her low back and sacrum? a. Place her on an air fluidized bed b. Alternate supine, placing a wedge under the right and left side every two hours c. Massage the at risk areas and apply zinc oxide skin protectant to them d. Have her roll herself from side to side each hour
a
Appropriate treatment for the patient with the distal leg ulcer is: a. Autolytic debridement b. Immediate sharp debridement c. Pulsed lavage d. Whirlpool
a
When is the only time you will give a prognosis of good, fair, etc? a. Filling out the initial Medicare plan of care b. Discussing a patient with a family member or other healthcare provider c. Any time you document d. In any of your courses here
a
The skin over the sacrum of a patient with multiple system organ failure seems to have turned purple, then black over the past two days. The patient's skin injury is most likely due to: a. Imminent death b. Shearing due to a new bed c. Development of ascites d. Kidney failure
a
What are the wound care indications for hyperbaric oxygen? a. Diabetic ulcers and graft/flap salvage b. Arterial disease if bypass is not an option c. Any slow healing wound d. Bends and gas gangrene
a
What are typical parameters for ES for wound healing? a. HVPC with 100 Hz and about 100 V, but below motor response b. Polarity depending on wound, amplitude of 100 mV and 12 Hz frequency c. DC with greatest amplitude tolerable and 5 Hz d. IFC with alternating current
a
What growth factor is available commercially to aid wound healing? a. Platelet derived growth factor b. Epidermal growth factor c. Keratinocyte growth factor d. Transforming growth factor B
a
What is the indication for regranex? a. Diabetic ulcers that are debrided, have good circulation and slow healing b. Diabetic ulcers that are slow to heal and contain necrotic tissue c. Diabetic ulcers with diminished blood flow d. Any slow healing wound
a
What is the most direct method of placing electrodes for electrical stimulation for wound healing? a. Hydrogel gauze in wound and large dispersive electrode at at distance determined by the size of the wound b. Positive electrode attached with kinesiotape and dry needles for the negative electrode c. Inferior and superior with a larger electrode on the superior to start d. Left and right of the wound with equally sized adhesive electrodes
a
What should the polarity be for electrical stimulation for wound heallng? a. Nobody has ever shown any definitive evidence that polarity matters b. Positive always c. Negative always d. Switch from positive to negative depending on nature of wound
a
Which areas of the body are known to have more difficulty healing with reasonable tissue characteristics? a. Olecranon, tibial crest, dorsum of hand and foot b. Olecranon, chin, buttock c. Dorsum of hand and deltoid d. Olecranon, palm, sole, patella
a
Which scar mobilization technique is the most effective for an immobile, mature scar, but at the cost of pain to the patient and several visits? a. Rolling b. Massage c. Plucking d. Kinesiotaping
a
Which type of scarring has the greatest tendency to bridge structures and cause substantial tissue shortening? a. Burn b. Garden variety c. Hypertrophic d. Keloid
a
Why must you document the patient's response to patient education? a. All of these b. You could lose your job if you are sued based on a bad outcome of home care if patient education is not documented correctly c. A patient could successfully sue for neglect if home care results in a bad outcome without documentation of patient education d. You must document inability of the patient to perform home care to extend visits beyond a clean and stable wound bed
a
Why must you track your supplies in an inpatient wound care setting? a. You will run out of supplies if you do not b. Medicare requires it c. All answers are correct d. You are reimbursed for the cost of all supplies
a
A patient has a wound that is slow to heal, in part, because of maceration. The dressing used in the most absorbent possible, but maceration continues due to the excessive drainage. What is the best choice to protect the surrounding skin? a. Use skin prep b. Use an ointment with zinc oxide, dimethicone, or petrolatum c. Use commercial lotion with a high water content d. Refer to another provider with more experience with drainage problems
b
A patient is referred to you with small wounds on the right foot. He recently had angioplasty of the popliteal artery secondary to atherosclerosis. The skin on his foot is mottled and the skin on his toes is largely purple. The term commonly used to describe the condition of the foot is: a. Gas gangrene b. Trash foot c. Wet gangrene d. Buerger's disease
b
Another PT tells you about a patient you are taking over for her. She says that the patient is expected to have a clean, granulated wound bed ready for grafting by the end of the week. This statement is an example of: a. Educated guess b. Prognosis c. Diagnosis d. Etiology
b
In addition to size of wound, response to treatment, prognosis, and what skilled services are needed, what else must be documented for a Medicare plan of care? a. Which sharp instruments or debridement tools will be used b. Medical necessity and physician's signature c. Number of visits and CPT codes to be used d. Your entry level PT degree
b
What general characteristics do Langer's lines tend to display? a. Run parallel to line of muscle pull below the skin b. Run perpendicular to line of muscle pull below the skin c. Run from 3:00 to 9:00 on the trunk and 12:00 to 6:00 on the extremities d. They are random
b
What interventions will Medicare pay you to perform as a physical therapist? a. Autolytic debridement b. Selective debridement and compression bandaging c. Dressing changes d. Time spent with the patient
b
What is the most important aspect of CMS Tag F314 regarding hospital-acquired pressure ulcers? a. Medicare will only cover treatment of pressure ulcers in nursing homes, SNF, and the like b. Patients admitted to acute care hospitals need to be thoroughly inspected and risk assessed for pressure ulcers upon admission c. Medicare will only cover the cost of treating a hospital-acquired pressure ulcer if the patient has a high risk of developing one based on the Braden or Norton scale d. Medicare can revoke your license if your patient develops a pressure ulcer
b
Which elements of the wound's size must be reported to Medicare? a. Widest dimension and depth b. Length, width, depth c. Cross-sectional area and volume d. Volume
b
Which modality is indicated for its bacteriocidal and fungicidal effects? a. Ultrasound b. Ultraviolet C c. Infrared d. Diathermy
b
Which of these scarring phenomena are the same? a. Burn and keloid b. None; they all have differences in their characteristics c. Hypertrophic and keloid d. Burn and hypertrophic
b
Why should you explain the etiology of a wound to a patient? a. It is a Medicare requirement b. It helps the patient understand the importance of elements of home care such as offloading and compression c. To show how smart you are d. It increases the payment allowed by Medicare
b
A form of lymphoma in the skin: a. Melanoma b. Spongiform Bobicus c. Cutaneous T cell lymphoma d. Kaposi's sarcoma
c
A scar moves perpendicularly in one direction about 2-3 mm, but bunches up when you try to move it parallel or perpendicularly in the other direction. This should be scored as: a. 0/3 b. 2/3 c. 1/3 d. 3/3
c
For a wound to heal the best, what direction of cut should be made if the incision is performed in the skin midway between the umbilicus and pubis? a. Horizontal b. On a curve from inferior to superior and back (frowney face) c. On a curve from superior to inferior and back (smiley face) d. Vertical
c
For an individual with an area of poor healing resulting in loss of range of motion, what options is most likely to correct it? a. Hotpack, ultrasound and daily stretching b. Ultrasound and stretching 10 min daily in a PT clinic c. Z plasty d. Kinesiotape, dry needling, and incense
c
What is a problem with having multiple documentation forms for different etiologies of wounds? a. Different clinicians may chose different forms for the same patient b. Having to find the different forms on the EHR c. All of these d. The etiology may not be known
c
What is the benefit of modern EHR for wound documentation? a. Faster entry of information b. Ease of navigation of the EHR c. Ability to upload photos of wounds throughout the course of an episode of care d. All parties will read the daily notes on a regular basis
c
What single criterion is used to determine level of payment for debridement provided by a PT in a PT clinic? a. Cost of dressing materials b. Time spent with the patient c. Surface area of the wound in multiples of 20 square cm d. Cost of equipment
c
Which modality has the greatest amount of high level research indicating its effectiveness in wound healing? a. US b. Infrared light c. HVPC d. LASER
c
Which of the following are commonly missed in documentation? a. Size and color b. Color and odor c. Site of the wound and pain d. Drainage and dressing materials
c
Which of the following qualifies for payment by CMS when performed by a physical therapist in a PT clinic? a. Dressing materials b. Dressing change c. Selective debridement d. Office visit to inspect the progress of the wound
c
Which type of scar is characterized by extending beyond the site of injury, returning with excision and is more common in people of the Subsaharan African descent? a. Sisyphusian b. Hypertrophic c. Keloid d. Burn
c
Who is the most important member of the wound care team? a. Nurse b. Family members of the patient c. Physical therapist d. Physician e. Patient
c
"The patient's wound is slow to heal due to critical contamination and is at risk for systemic infection" is an example of: a. Diagnosis b. Prognosis c. Plan of care d. Medical necessity
d
A patient presents with a non-healing ulcer that has become larger with treatment. It has undermined violaceous edges. The patient has a history of diabetes and Crohn's disease. The cause of the wound is: a. Neuropathy b. Erythema nodosum c. Behçet's syndrome d. Pyoderma gangrenosum
d
A scar fails to move in any direction. This scar is given the score of: a. ⅓ b. ⅔ c. 3/3 d. 0/3
d
A wound with the same cause as that in the question with the large ulcers on the back became progressively worse with sharp debridement, so a graft was placed. The graft is begin to deteriorate. This situation describes the phenomenon of: a. Intertrigo b. Deterioratum profundum c. Necrotizing fasciitis d. Pathergy
d
Actinic keratosis is a precursor to: a. fungoides b. Melanoma c. Basal cell CA d. Squamous cell CA
d
An 80-year-old woman with terminal cancer and 2-4 weeks of life expectancy has a combination of wet and dry gangrene with a very foul odor. What is the primary consideration of the treatment plan? a. Amputation b. Immediate sharp debridement to remove the source of the odor c. No treatment plan should be developed d. Use of topical antibiotics and kitty litter or charcoal to minimize the odor
d
In which setting can payment reflect the use of higher cost technology? a. Nursing home b. Outpatient PT c. Acute care PT d. Freestanding physician-directed wound clinic
d
To expedite entry of wound information, the director of the department has asked the EHR vendor to incorporate a flow chart she used when she started the department in the last millennium. What is likely to be a difficult part of using this form? a. The terminology is likely to be out of date b. The flow of the information fits the director's thought process, but not that of anyone else c. So many blanks are irrelevant, that most people will skip over what might be important to some patients d. All of these are correct
d
Under what circumstances will an office visit to a physical therapist for wound management be paid by CMS? a. The PT has a DPT degree in a state such as Virginia that allows direct access with such qualifiers b. The patient is seen in a clinic supervised by a physician c. A physician writes orders for the visit d. PT is working as under a physician's NPI with the physician present in the office suite
d
What characteristics lead to poor healing even with closure? a. Stretch over bony prominences b. Stretch over prominent tendons/leaders c. Being perpendicular to Langer's lines d. All of these
d
What is the most important element of patient education at discharge when a wound is still open? a. How to wrap a bandage b. How to fill out the patient satisfaction survey c. How often to change a dressing d. When to seek help from physician, urgent care, or ER
d
What is the most likely cause of pressure ulcers in a neonatal ICU? a. Prematurity b. Lack of body fat c. Hypothermia d. Medical devices
d
