NAWCCB AWCC Advanced Wound Care Certified

A patient with a lower-extremity ulcer has livedo reticularis, painful ulceration, and elevated creatinine. Which atypical wound etiology is most likely?

• APyoderma gangrenosum
• BCalciphylaxis
• CMarjolin's ulcer
• DVasculitic ulcer

A long-standing venous stasis ulcer in a 70-year-old patient develops raised, hardened edges with pearly margins. What is the priority next step?

• AIncrease compression therapy
• BApply silver dressing
• CPerform wound biopsy
• DInitiate pentoxifylline

Pyoderma gangrenosum (PG) is most reliably distinguished from necrotizing fasciitis by which feature?

• APresence of fever and leukocytosis
• BPathergy response and violaceous undermined wound edges
• CRapid wound spread over 24–48 hours
• DWound culture positive for polymicrobial organisms

A patient with rheumatoid arthritis develops a painful ulcer with palpable purpura on the lower leg. ANA, RF, and ANCA are elevated. What is the likely diagnosis?

• AArterial ulcer
• BVasculitic ulcer
• CDiabetic neuropathic ulcer
• DCalciphylaxis

Which ABI value range best indicates moderate peripheral arterial disease and warrants vascular surgery referral before compression therapy?

• A0.9–1.3
• B0.6–0.8
• C0.41–0.59
• D< 0.40

Toe-brachial index (TBI) is preferred over ABI in patients with diabetes or renal failure because:

• ATBI measures capillary refill more accurately
• BMedial arterial calcification falsely elevates ABI, making TBI more reliable
• CTBI requires no Doppler equipment
• DTBI is less painful for the patient

A TcPO2 value below which threshold indicates critical ischemia and predicts poor wound healing without revascularization?

• A60 mmHg
• B40 mmHg
• C20 mmHg
• D10 mmHg

Which imaging study is considered the gold standard for defining anatomy prior to lower-extremity revascularization surgery?

• ACT angiography
• BDuplex ultrasound
• CConventional (catheter-based) angiography
• DMR angiography

Sharp/surgical debridement is MOST appropriate for which clinical scenario?

• ADry eschar on a heel in a patient with severe PAD
• BStable, dry, necrotic toe in a diabetic without infection
• CWet gangrenous foot ulcer with cellulitis extending to the ankle
• DSloughy venous ulcer with adequate perfusion and no signs of infection

A patient with an infected diabetic foot ulcer has mild cellulitis (<2 cm), no systemic signs, and adequate perfusion. Per IDSA guidelines, which antibiotic route is most appropriate?

• AIV vancomycin for 4–6 weeks
• BOral amoxicillin-clavulanate
• COral trimethoprim-sulfamethoxazole only
• DIV piperacillin-tazobactam

Pseudomonas aeruginosa wound infection is best recognized clinically by which combination of findings?

• AFoul odor, yellow slough, and wound culture positive for gram-positive cocci
• BBlue-green exudate, fruity odor, and moist wound bed
• CBlack eschar, dry wound, and no exudate
• DRed periulcer skin and serosanguineous drainage

For a wound with suspected MRSA infection, which topical antimicrobial has the strongest evidence for reducing wound bioburden without promoting systemic resistance?

• AMupirocin ointment
• BCadexomer iodine
• CNeomycin sulfate
• DGentamicin sulfate

IV antibiotics are indicated over oral therapy in a diabetic foot infection when which finding is present?

• ACellulitis <2 cm with intact skin integrity
• BWound culture showing E. coli
• CDeep tissue involvement with systemic signs of sepsis
• DABI of 0.85

UHMS-approved hyperbaric oxygen therapy (HBOT) indications include all EXCEPT:

• AWagner grade 3 or higher diabetic foot ulcer
• BChronic refractory osteomyelitis
• CPressure injury stage 3 in a non-compromised host
• DNecrotizing soft tissue infection (as adjunct)

A patient is being evaluated for HBOT for a diabetic foot ulcer. Which finding is a CONTRAINDICATION to HBOT?

• AABI of 0.55
• BUntreated pneumothorax
• CHbA1c of 9.2%
• DCurrent use of insulin

The mechanism by which HBOT promotes wound healing in ischemic ulcers is primarily through:

• ADirect bactericidal effect on all wound pathogens
• BIncreased dissolved oxygen in plasma, stimulating angiogenesis and fibroblast function
• CReduction of wound exudate via osmotic effect
• DVasoconstriction reducing edema and improving perfusion

Cellular tissue products (CTPs) formerly called skin substitutes are best indicated for which wound type?

• AInfected diabetic foot ulcer with exposed bone
• BClean, non-infected neuropathic diabetic foot ulcer failing to progress after 4 weeks of…
• CVenous ulcer with heavy exudate and no peri-wound maceration
• DFull-thickness burn wound covering >30% BSA as standalone therapy

Becaplermin (PDGF) gel carries an FDA black-box warning for:

• AIncreased risk of systemic infection
• BIncreased risk of malignancy with ≥3 tubes used
• CSevere contact dermatitis
• DSystemic hypertension

Which CTP has the strongest clinical trial evidence (RCT) for venous leg ulcers and is bilayered, containing both epidermal and dermal components?

• AApligraf (bilayered living skin construct)
• BDermagraft (dermal scaffold only)
• COasis (porcine small intestine submucosa)
• DAmnion-chorion membrane

A patient with type 2 diabetes has a plantar metatarsal head ulcer, ABI 0.92, HbA1c 8.1%, and X-ray showing cortical erosion. What is the most critical next step?

• AApply a CTP immediately
• BOrder MRI to evaluate for osteomyelitis
• CInitiate HBOT
• DPerform sharp debridement and culture

Palliative wound care is most appropriately initiated when:

• AA wound fails to heal after 2 weeks of standard treatment
• BPatient's goals shift to comfort and healing is no longer the primary goal
• CInsurance denies coverage for advanced wound therapies
• DWound size exceeds 10 cm²

In palliative wound care, malodor from a fungating or necrotic wound is most effectively managed by:

• ADaily sharp debridement
• BTopical metronidazole gel
• CSystemic IV antibiotics
• DOcclusive hydrocolloid dressing

Which topical antimicrobial is MOST appropriate for a heavily colonized wound in a patient receiving palliative care where pain at dressing changes is a primary concern?

• AAcetic acid 0.5% soaks
• BSilver-containing atraumatic foam dressing
• CPovidone-iodine gauze packed tightly
• DDakin's solution gauze

The correct application technique for becaplermin gel to a diabetic foot ulcer includes:

• AApply gel, cover with non-adherent moist dressing, change every 12 hours
• BApply gel once daily, leave open to air for 12 hours, then cover with saline-moistened ga…
• CApply thick layer under occlusive film dressing changed every 7 days
• DApply to dry wound bed; avoid any secondary dressing

Silver sulfadiazine should be AVOIDED in which patient population?

• APatients with sulfonamide allergy or G6PD deficiency
• BPatients receiving systemic corticosteroids
• CPatients with venous insufficiency
• DPatients with diabetes mellitus

When documenting wound photography for legal and clinical purposes, which practice is MOST critical?

• AUse a personal smartphone with cloud backup for convenience
• BInclude a color/scale reference bar, patient identifier, date, and wound location in ever…
• CPhotograph wounds only at initial assessment to limit patient exposure
• DStore photos on shared clinic computers without password protection

Under HIPAA, wound photographs constitute which type of protected health information (PHI)?

• ADe-identified data if patient name is removed
• BPHI if they contain a full-face image or other identifiers linking to the individual
• CPublic health data exempt from HIPAA if used for education
• DPHI only if they include the patient's medical record number

Which CPT code describes sharp debridement of a wound without anesthesia for a total wound surface area of 20 cm²?

• A97597
• B97598
• C11042
• D11043

When billing an E/M code on the same day as wound debridement (97597), the provider must:

• ANever bill both on the same day
• BBill only the debridement code
• CDocument a separately identifiable E/M service and append modifier -25
• DBill only the E/M code

Negative pressure wound therapy (NPWT) is billed under HCPCS category:

• ACPT 97605–97608
• BICD-10-PCS
• CCPT 11040–11047
• DHCPCS Level II E-codes for DME

In a multidisciplinary wound care team, the advanced wound care clinician's PRIMARY leadership role is:

• AManaging all billing independently
• BPerforming all surgical procedures
• CCoordinating care across disciplines, setting treatment goals, and ensuring evidence-base…
• DProviding dietary counseling and nutritional supplements

Which lymphedema management intervention is considered the gold standard for reducing limb volume in advanced-stage lymphedema?

• AManual lymphatic drainage (MLD) alone
• BComplete decongestive therapy (CDT) combining MLD, compression, exercise, and skin care
• CDiuretics such as furosemide
• DElastic compression stockings as monotherapy

A patient with lymphedema develops a wound complicated by recurrent cellulitis. Which preventive measure has the highest evidence for reducing recurrent cellulitis episodes?

• ADaily povidone-iodine application
• BConsistent use of compression therapy and meticulous skin hygiene
• CProphylactic antifungal powder
• DDaily oral doxycycline

Which microvascular complication of diabetes MOST directly impairs wound healing at the cellular level?

• AMacroangiopathy causing large-vessel occlusion
• BAdvanced glycation end-products (AGEs) cross-linking collagen and impairing fibroblast fu…
• CAutonomic neuropathy reducing sweating
• DPeripheral motor neuropathy causing foot deformity

Total contact casting (TCC) is the gold-standard offloading for plantar DFU because:

• AIt is inexpensive and easy for patients to remove
• BIt prevents all weight-bearing activity
• CIt redistributes plantar pressure across the entire lower leg and cannot be self-removed,…
• DIt requires no follow-up appointments

In interpreting a randomized controlled trial (RCT) on a new CTP, a clinician notes a statistically significant result (p=0.03) but a wound area reduction of 0.5 cm². The MOST appropriate interpretation is:

• AThe CTP is clinically meaningful and should be adopted immediately
• BStatistical significance confirms clinical significance
• CThe result may be statistically significant but clinically insignificant; evaluate the mi…
• DThe study design is flawed because p>0.01

Level I evidence in wound care research is best represented by:

• AExpert consensus guidelines
• BSingle observational cohort study
• CSystematic review with meta-analysis of multiple RCTs
• DCase series with historical controls

The number needed to treat (NNT) is best defined as:

• AThe percentage of patients who respond to treatment
• BThe number of patients needed to enroll in a trial to detect significance
• CThe number of patients who must receive treatment for one additional patient to benefit c…
• DThe probability that a treatment is superior to placebo

Per NPIAP guidelines, which intervention is MOST effective for redistributing pressure on a sacral pressure injury in a bed-bound patient?

• ADonut-shaped ring cushion
• BReactive pressure-redistribution surface with low air-loss feature
• CStandard hospital foam mattress with q2h repositioning only
• DHeel suspension boot placed on the sacrum

CMS requires wound care documentation to support medical necessity. Which element is LEAST sufficient as a standalone justification?

• AWound measurements (length, width, depth) with date
• BWound etiology and duration
• CPhotograph of wound without clinical narrative
• DTreatment plan with frequency and goals

A diabetic foot ulcer patient with ABI 0.52 and non-healing wound is referred for revascularization. Post-procedure, TcPO2 rises to 45 mmHg. What is the appropriate next step in wound management?

• ABegin HBOT immediately
• BApply a CTP and total contact cast
• CContinue HBOT for 40 sessions before reassessment
• DAmputate the affected digit

Wound biofilm management differs from treating planktonic infection primarily because biofilm organisms:

• AAre more sensitive to systemic antibiotics
• BRequire lower antibiotic concentrations for eradication
• CAre up to 1000× more resistant to antibiotics due to protective matrix and metabolic dorm…
• DAre easily removed by standard saline irrigation

Which clinical sign MOST strongly indicates wound biofilm presence?

• AHigh fever and rigors
• BSlippery, shiny wound surface with recurrent breakdown despite standard care
• CPurulent drainage with positive culture for a single organism
• DWound pH >7.4

Enzymatic debridement using collagenase is CONTRAINDICATED when used with which wound care product?

• AHydrogel sheet
• BSilver sulfadiazine cream
• CSaline-moistened gauze
• DCalcium alginate

A patient with a chronic venous leg ulcer has a wound that has been present for 18 months and measures 8 × 6 cm. Per evidence-based criteria, which intervention is MOST appropriate if the wound showed <40% area reduction after 4 weeks of standard care?

• AContinue standard compression for another 4 weeks
• BRefer immediately for amputation
• CApply a bilayered living skin construct (CTP)
• DInitiate systemic corticosteroids

Charcot neuroarthropathy (CN) in a diabetic foot is BEST distinguished from osteomyelitis on plain radiograph by:

• APresence of periosteal reaction only in osteomyelitis
• BMidfoot joint destruction with bony fragmentation in CN vs cortical erosion adjacent to a…
• CNormal X-ray in CN with abnormal MRI only
• DAbsence of swelling in CN

In complex wound case management, which Braden Scale subscale is MOST predictive of pressure injury development?

• ANutrition
• BActivity
• CMoisture
• DSensory perception