Case Studies & Self-Assessment

✅ Correct answer: 4 points. Site forefoot 0, ischemia 0 (pulse palpable), neuropathy 1, infection 1 (local erythema ≤2 cm = mild infection still scores 1), area ≥1 cm² scores 1, depth to tendon 1 → 0+0+1+1+1+1 = 4. A score ≥3 falls in the poorer-prognosis group. (Monteiro-Soares 2023)

✅ Correct answer: Offloading. IWGDF Offloading 2023 explicitly states that first-line care for plantar ulcers is a non-removable knee-high offloading device; no dressing can replace offloading. Mild infection is managed with oral antibiotics plus debridement — silver dressings are not core therapy. (Bus 2023, DOI:10.1002/dmrr.3647)

✅ Correct answer: Stage 3 — full-thickness loss with visible fat but no exposed fascia/tendon/bone. Slough covers only part of the wound and depth can be determined, so it is not Unstageable. (EPUAP/NPIAP/PPPIA 2019)

✅ Correct answer: Calcium alginate. Specific guideline statements: Stage 3–4 with moderate exudate → calcium alginate; low exudate → hydrogel; moderate-to-heavy → foam. Dry gauze is not moist wound healing. Also never forget the core measures: offloading + support surfaces + nutrition. (EPUAP 2019; Gould 2024)

✅ Correct answer: ABI. Every lower-leg ulcer requires exclusion of significant arterial disease before compression, to avoid compression worsening ischemia. Venous ultrasound guides later intervention planning — it is not the safety gate before compression. (Marston 2016; WOCN)

✅ Correct answer: Compression therapy (multilayer bandaging / compression stockings). Combine with highly absorbent dressings for exudate management and periwound skin protection; after healing, long-term compression stockings prevent recurrence (C5→C6r risk). Antibiotics only for infection; walking engages the calf muscle pump and is actually beneficial. (Franks 2016; Lurie 2020)

✅ Correct answer: Revascularization assessment. WIfI I3 (ABI <0.40), severe ischemia: stable dry necrosis should be kept dry and protected; before perfusion is restored, debridement or hydrogel-promoted autolysis can enlarge the necrosis and convert it to wet gangrene; compression is contraindicated. (Federman 2024; Conte 2019 GVG)

✅ Correct answer: Pyoderma gangrenosum. Clues: inflammatory bowel disease + severe pain + violaceous undermined borders + worsening after debridement (pathergy phenomenon). Necrotizing fasciitis presents with toxic appearance and rapid systemic deterioration; calciphylaxis is mostly seen in dialysis patients. (Maverakis 2020)

✅ Correct answer (the incorrect option): Aggressive debridement. Debriding active Pyoderma gangrenosum triggers pathergy and enlarges the ulcer — this case worsening after outside-hospital debridement is classic. Correct approach: biopsy for diagnosis, immunomodulation, atraumatic wound care. (Isoherranen 2019 EWMA)

✅ Correct answer: Tdap, no TIG. Contaminated puncture wound = high-risk wound; primary series ≥3 doses completed with the last dose 5–10 years ago → booster vaccine, no TIG (TIG is only for high-risk wounds with "<3 doses or unknown history"). Adults who have never received Tdap should preferentially get Tdap. (CDC)

✅ Correct answer: Irrigation + exploration + leave open. A contaminated deep puncture wound is high infection risk: irrigate thoroughly, confirm no retained foreign body (imaging if needed), and do not perform tight primary closure. For plantar punctures, beware of Pseudomonas osteomyelitis — return promptly if worsening. (Nicks 2010; WHO)

✅ Correct answer: Severe infection. Fever + tachycardia = systemic inflammatory response (SIRS ≥2 criteria) → severe by IWGDF/IDSA definition: admission, IV antibiotics, surgical evaluation for drainage/debridement and deep cultures. (Senneville 2023)