Leg Ulcer Management

Question 1

Compression therapy is the mainstay of venous ulcer treatment.

Answer 1

T

Question 2

Bacterial colonisation of chronic wounds always adversely affects healing.

Answer 2

F

Question 3

Moist wound healing is better than dry wound healing.

Answer 3

T

Question 4

Venous insufficiency is the most common cause of leg ulcers.

Answer 4

T

Question 5

Up to 50% of patients with chronic venous insufficiency have a history of leg injury.

Answer 5

T

Question 6

Venous ulcers that are not complicated by infection typically have minimal exudate.

Answer 6

F Exude copious exudates – yellowish fibrinopurulent, irregularly-shaped adherent exudates may be seen at the base of the ulcer

Question 7

Risk factors for arterial ulcers include diabetes, smoking, hyperlipidaemia, hypertension, obesity and age.

Answer 7

T

Question 8

Venous ulcers will often be associated with hair loss, atrophy, cold surrounding skin, and thickened toenails.

Answer 8

F Arterial ulcers.

Question 9

Capillary refill time in the setting of venous ulcers is usually prolonged.

Answer 9

F Arterial ulcers,

Question 10

Immobility is necessary for pressure ulcer development

Answer 10

T

Question 11

Impaired nutritional states along with low albumin and immobility can lead to epidermal moisture and vapour loss which leads to breakdown of the stratum corneum barrier

Answer 11

T

Question 12

Arterial ulcers are usually located over pressure points, such as the toes and ankles, and are sharply demarcated with little granulation tissue and a punched-out appearance.

Answer 12

T

Question 13

Arterial ulcers often have a necrotic-appearing wound base.

Answer 13

T

Question 14

Arterial ulcers demonstrate the 6 P’s – pulseless, pain, pallor, poikilothermia, punched-out defect, pressure point location

Answer 14

T

Question 15

The most characteristic lesion of the diabetic foot is a mal perforans ulceration.

Answer 15

T

Question 16

Neuropathic ulcers most characteristically develop over the pressure points of the 2nd and 3rd metatarsal heads, and the great toes.

Answer 16

F 1st and 5th metatarsal heads, and great toes.

Question 17

Venous ulcer pain is often described as a burning pain

Answer 17

T

Question 18

Pain is more common with venous disease.

Answer 18

F Arterial disease.

Question 19

Claudication and rest pain are characteristic of arterial ulcers

Answer 19

T

Question 20

An ankle-brachial index (ABI) of 1.5 or higher is normal.

Answer 20

F 1.0 – 1.3

Question 21

ABI of 0.4 or less may indicate severe arterial disease.

Answer 21

T

Question 22

Neuropathic ulcers are typically a punched-out defect with a thick surrounding callus.

Answer 22

T

Question 23

Probing of sinuses and deep ulcers is not a sensitive method for detecting bone infection.

Answer 23

F Is highly sensitive.

Question 24

Care must be taken in using compression in patients with chronic heart failure – compression of the lower extremities can lead to an increase in preload volume and exacerbate their condition.

Answer 24

T

Question 25

The Unna boot is a moist zinc oxide-impregnated paste bandage that hardens to inelasticity.

Answer 25

T

Question 26

Multi-layer compression bandages provide no benefit over single-layer bandage systems.

Answer 26

F Multi-layer are superior.

Question 27

The overall standard composition of multilayer compression bandages is: a wool or cotton layer, one or two elastic wraps, and a self-adherent wrap to hold all the layers in place and to maintain the proper position of the bandage on the leg.

Answer 27

T

Question 28

Multilayer compression provide pressures of 60-80mmHg at the ankle and 30mmHg below the knee.

Answer 28

F 40-45mmHg at the ankle, 17mmHg below knee.

Question 29

Aspirin has been associated with improved healing speed for venous ulcers.

Answer 29

T Via its anti-inflammatory action and its action on haemostatic mechanisms.

Question 30

Pentoxifylline should not be used as an adjuvant to compression therapy.

Answer 30

F Effective adjuvant – 800mg tds.

Question 31

In an acute wound, infection risk is greatest during the first 72-96hours after injury.

Answer 31

F 48-72hrs.

Question 32

Detection of microorganisms from chronic leg wounds typically represents infection.

Answer 32

F Colonisation.

Question 33

Predisposing factors for infection and colonised wound response include advancing age, diabetes, immune compromise, obesity, impaired circulation, malnutrition and remote infection.

Answer 33

T

Question 34

Topical antibiotics should be used for leg ulcers.

Answer 34

F Use is controversial.

Question 35

A moist wound environment induces acute wounds to re-epithelialize up to 40% faster than air-exposed wounds.

Answer 35

T

Question 36

Debridement is the process of removing necrotic, devitalised tissue and foreign matter from a wound.

Answer 36

T

Question 37

Regarding wound dressings for leg ulcers, hydrogels (eg Intrasite) are semitransparent, soothing, and do not adhere to wounds.

Answer 37

T

Question 38

Regarding wound dressings for leg ulcers, alginates (eg. Kaltostat) are not absorbent or haemostatic.

Answer 38

F Are absorbent and haemostatic.

Question 39

Regarding wound dressings for leg ulcers, alginates are best for highly exudative wounds, and partial or full-thickness wounds.

Answer 39

T

Question 40

Regarding wound dressings for leg ulcers, hydrocolloids (eg Duoderm) are transparent, create a bacterial barriers and adhere without a secondary dressing.

Answer 40

F This is true for film dressings (eg Opsite, Tegaderm).

Question 41

Regarding wound dressings for leg ulcers, hydrocolloids are indicated for partial- or full-thickness wounds, and stages 1-4 pressure ulcers.

Answer 41

T

Question 42

Regarding wound dressings for leg ulcers, alginates require a secondary dressing.

Answer 42

T

Question 43

Regarding wound dressings for leg ulcers, foams (eg Allevyn) are absorbent and conform to body contours.

Answer 43

T

Question 44

Large wounds with a great amount of necrotic debris are particularly poor candidates for surgical debridement.

Answer 44

F Good candidates.

Question 45

Surgical debridement is the treatment of choice for fulminant infection.
.

Answer 45

T

Question 46

Mechanical debridement can be performed by applying wet-to-dry dressings, whirlpool baths and high-pressure irrigation

Answer 46

T

Question 47

Wet-to-dry debridement does not affect viable wound tissue.

Answer 47

F Lifts away viable tissue within the wound.

Question 48

Autolytic debridement involves using occlusive and semiocclusive dressings to promote a moist environment to accelerate the autolytic process.

Answer 48

T

Question 49

Dressings suitable for autolytic debridement include hydrocolloids, hydrogels, alginates, and transparent films.

Answer 49

T

Question 50

Autolytic debridement is typically more painful than wet-to-dry debridement.

Answer 50

F

Question 51

Biosurgical debridement involves the application of maggots.

Answer 51

T

Question 52

Enzymatic debridement is slower than autolytic debridement.

Answer 52

F

Question 53

Enzymatic debridement commonly uses topical preparations of collagenase and papainurea.

Answer 53

T

Question 54

The most common cause of graft failure is infection of the ulcer bed.

Answer 54

T

Question 55

Lipodermatosclerosis does not affect ulcer healing.

Answer 55

F Poor prognostic factor.

Question 56

Regarding graft types; epidermal grafts include cultured epidermal autografts and allografts

Answer 56

T

Question 57

Regarding graft types; dermal replacements include integra

Answer 57

T

Question 58

Regarding graft types; composite grafts include apligaf

Answer 58

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