NAWCCB DWC Diabetic Wound Certified

Which statement best summarizes the pathogenesis of diabetic peripheral neuropathy?

• AHyperglycemia drives interacting metabolic, oxidative, and microvascular nerve injury
• BExcess insulin chronically overstimulates Schwann-cell growth receptors
• CAutoimmunity selectively destroys peripheral myelin in typical diabetes
• DHigh HDL concentrations interrupt distal axonal transport in the feet

Which feature distinguishes weight-bearing plantar skin from thin dorsal foot skin?

• AIt lacks an epidermis over pressure-bearing areas
• BIt has a thick stratum corneum adapted to friction and pressure
• CIt is lined by mucosa instead of keratinized epithelium
• DIt contains hair follicles at every plantar pressure point

Which articulations form the Lisfranc, or tarsometatarsal, joint complex?

• AThe talus with the tibia and fibula
• BThe metatarsal bases with the cuneiforms and cuboid
• CThe calcaneus with the talus only
• DThe proximal phalanges with the metatarsal heads

Which diabetes-associated process can directly reduce oxygen delivery at a wound edge?

• ARetinal microaneurysms reducing visual acuity
• BProteinuria from diabetic glomerular injury
• CMicrovascular dysfunction impairing capillary exchange
• DAutonomic denervation reducing plantar sweating with dry skin

The dorsalis pedis artery is the continuation of which artery across the ankle?

• APosterior tibial artery
• BAnterior tibial artery
• CFibular or peroneal artery
• DPopliteal artery

A patient cannot perceive a 10-g monofilament at recommended plantar test sites. What does this support?

• AAn isolated mild proprioceptive deficit
• BLoss of protective sensation in the foot
• CSevere limb ischemia requiring revascularization
• DA normal age-related finding with no ulcer risk

What occurs during the windlass mechanism as the great toe dorsiflexes during push-off?

• AThe Achilles tendon detaches from the calcaneus
• BThe plantar aponeurosis relaxes and the arch flattens
• CThe plantar aponeurosis tightens and helps elevate the arch
• DThe subtalar joint becomes the only weight-bearing articulation

Bilateral absent Achilles reflexes in an older adult with diabetes should be interpreted how?

• AThey prove a central lesion at the L4 level
• BThey support peripheral neuropathy when concordant with other findings
• CThey establish occlusion of the anterior tibial artery
• DThey localize an isolated lesion to the tarsal tunnel

Where does the Achilles tendon insert?

• AThe neck of the talus
• BThe posterior calcaneal tuberosity
• CThe navicular tuberosity
• DThe base of the fifth metatarsal

Which motion at the first metatarsophalangeal joint is needed for normal late-stance push-off?

• AGreat-toe dorsiflexion or extension
• BFixed plantarflexion of the great toe
• CIsolated inversion of the calcaneus
• DLocked flexion of the interphalangeal joint

A neuropathic patient has a unilateral hot, swollen, erythematous foot with intact skin. What is the safest interpretation?

• ACellulitis is confirmed and requires immediate broad-spectrum antibiotics
• BDeep venous thrombosis is excluded because swelling is confined to the foot or ankle
• CActive Charcot neuro-osteoarthropathy is suspected, while mimics must be excluded
• DGout is confirmed by the absence of an open plantar wound

Which structure produces most of the nail plate?

• AThe nail bed alone
• BThe nail matrix
• CThe hyponychium
• DThe lateral nail fold

Which description corresponds to Wagner grade 2?

• AA superficial ulcer limited to skin
• BA deep ulcer reaching tendon, capsule, or joint
• CA deep ulcer with abscess or osteomyelitis of deeper tissue
• DLocalized gangrene involving the forefoot

What does University of Texas grade II, stage C denote?

• AA superficial ulcer accompanied by ischemia
• BA wound reaching tendon or capsule with ischemia
• CA wound reaching bone with clinical infection only
• DAn intact pre-ulcerative site with infection and ischemia

What is first-choice offloading for a neuropathic plantar forefoot or midfoot ulcer without a contraindication?

• AA removable knee-high walker worn when convenient
• BA non-removable knee-high offloading device
• CA custom therapeutic shoe used during all activity
• DA felted foam insole without supportive footwear

Which finding makes a diabetes-related foot infection moderate rather than mild?

• ASuperficial erythema extending no more than 2 cm
• BErythema extending at least 2 cm or infection reaching deeper tissue
• CSystemic instability attributable to the foot infection
• DA clinically uninfected ulcer with a positive surface culture alone

A patient with a foot ulcer has an ABI of 0.55. What conclusion is justified?

• ANormal perfusion has been demonstrated
• BMild arterial disease can be ignored during healing
• CPeripheral artery disease is likely and needs vascular evaluation
• DMedial calcification has made the ABI noncompressible

Which bedside test is especially useful when ankle arteries appear noncompressible in diabetes?

• AA repeat ABI using progressively higher cuff pressure
• BToe pressure with a toe-brachial index
• CComputed tomographic angiography as the first bedside test
• DA venous duplex examination for reflux

Which TcPO2 result is a severe ischemia finding that should prompt urgent vascular consideration in a foot ulcer?

• AA transcutaneous oxygen pressure of 55 mmHg
• BA transcutaneous oxygen pressure of 40 mmHg
• CA transcutaneous oxygen pressure below 30 mmHg
• DA transcutaneous oxygen pressure above 60 mmHg

How does a total contact cast principally offload a plantar ulcer?

• AIt abolishes all ankle movement with a rigid sole
• BIt redistributes plantar load and transfers some load to the cast walls
• CIt compresses edema until capillary flow increases
• DIt immobilizes only the subtalar joint during stance

Who most clearly benefits from pressure-relieving therapeutic footwear after a plantar ulcer heals?

• AEvery person with diabetes regardless of foot risk
• BA person with prior plantar ulceration and loss of protective sensation
• COnly a person whose previous lesion involved forefoot gangrene
• DA person with intact sensation and no deformity or callus

How should glycemic control be interpreted in relation to diabetic foot-ulcer healing?

• AAn A1C of exactly 7.0% guarantees normal wound repair
• BWorsening hyperglycemia can impede repair, but no single A1C cutoff predicts healing
• CEvery ulcer fails to heal once A1C rises above 8.0%
• DA1C has no relation to infection risk or tissue repair

What perioperative glucose range does the ADA recommend for most adults with diabetes?

• A70 to 110 mg/dL throughout the procedure
• B100 to 180 mg/dL before, during, and after surgery
• C180 to 250 mg/dL until oral intake resumes
• DAny value below 250 mg/dL without active monitoring

What is the best approach to protein intake for a patient with a diabetic foot ulcer?

• APrescribe 0.8 g/kg/day to every patient with an open ulcer
• BIndividualize intake after nutrition and kidney-function assessment
• CPrescribe at least 2.5 g/kg/day despite renal comorbidity
• DRestrict protein to reduce postprandial glucose excursions

Why is vitamin C biologically important to collagen formation?

• AIt directly activates insulin receptors on fibroblasts in wound tissue
• BIt supports hydroxylation of proline and lysine residues
• CIt substitutes for vascular endothelial growth factor
• DIt blocks every matrix metalloproteinase in the wound

When is zinc supplementation most defensible during diabetic wound care?

• AWhenever serum albumin is below the laboratory range
• BWhen zinc deficiency is documented or strongly suspected clinically
• CWhenever A1C remains above an individualized target
• DWhen wound surface area exceeds an arbitrary size threshold

A foot ulcer has ABI 0.35 and toe pressure 25 mmHg. What is the priority?

• AApply a non-removable cast and defer perfusion review
• BObtain urgent vascular specialist assessment for possible revascularization
• CBegin hyperbaric oxygen before evaluating arterial anatomy
• DApply sustained compression without further arterial testing

Which smoking effect is relevant to delayed wound repair?

• ATobacco affects large arteries but never local tissue oxygenation
• BNicotine-related vasoconstriction and carbon-monoxide exposure reduce oxygen delivery
• CHealing benefits cannot begin until two years after smoking cessation
• DCarbon monoxide impairs oxygen transport only when PAD is already present

Why are plantar metatarsal areas common sites of neuropathic ulceration?

• AThey are protected from repetitive loading during gait
• BThey sustain repetitive pressure and shear that may go unnoticed with LOPS
• CThey receive no arterial blood whenever diabetes is present
• DThey are the only foot regions exposed to shoe seams

What should a patient with diabetes and LOPS be taught about callus care?

• APare callus with a razor and inspect afterward
• BSeek care from an appropriately trained professional
• CUse a blade only when the callus is painless
• DApply a chemical corn remover until tissue softens during home care

Which nail-care instruction is appropriate for an at-risk diabetic foot?

• ACut deeply into each corner to round the nail
• BCut straight across and gently file sharp edges
• CSoak the feet for twenty minutes before trimming
• DAsk an untrained relative to cut difficult nails

When suspected diabetic foot osteomyelitis remains uncertain after initial studies, which imaging test is recommended?

• AComputed tomography solely because it uses radiation
• BMagnetic resonance imaging of the affected foot
• CDuplex ultrasonography of the venous system
• DDual-energy x-ray absorptiometry of the hip

Which specimen best identifies a pathogen when diabetic foot osteomyelitis is suspected?

• AA serum CRP specimen collected after antibiotics
• BA superficial swab from drainage on the dressing
• CAn aseptically obtained bone sample for culture
• DA monofilament sample from adjacent intact skin

Which event characterizes the hemostasis phase immediately after tissue injury?

• AVasoconstriction and formation of a platelet-fibrin clot
• BReplacement of granulation tissue by a mature scar
• CPeak fibroblast collagen deposition and angiogenesis
• DComplete epithelial closure before coagulation begins

When does the 2023 IWGDF/IDSA guideline explicitly support empiric antipseudomonal therapy?

• AFor every chronic ulcer in a temperate climate after four weeks, even without infection o…
• BFor moderate or severe infection in Asia or North Africa after recent affected-site isola…
• CFor every moderate infection occurring in a temperate climate
• DWhenever a sterile probe contacts bone through the ulcer

Which history most strongly supports including empiric MRSA coverage for a foot infection?

• AA wound culture has not yet resulted
• BPrevious MRSA infection or colonization with relevant local risk
• CHospital admission for any mild foot infection
• DA single elevated inflammatory marker

Which cellular sequence is typical of the inflammatory phase of wound healing?

• ANeutrophils arrive early, followed by macrophages that coordinate cleanup and repair
• BFibroblasts immediately replace the wound with fully remodeled type I collagen
• CKeratinocytes complete closure before leukocytes enter the wound
• DScar contraction begins only after all inflammatory signaling has permanently stopped

What feature distinguishes a Syme ankle disarticulation from a transtibial amputation?

• APreservation of the entire tibia and fibula without shortening
• BUse of the heel pad to create an end-bearing residual limb
• CPreservation of subtalar inversion and eversion
• DRetention of all metatarsal bones for push-off