CWS Certified Wound Specialist 4 — Questions and Answers
Question 1: Which cell type is primarily responsible for wound contraction during the proliferative phase?
- Neutrophils
- Macrophages
- Myofibroblasts (Correct answer)
- Keratinocytes
Correct answer: Myofibroblasts
Myofibroblasts, differentiated from fibroblasts under TGF-β stimulation, contain actin microfilaments that generate the contractile force to close wounds.
Question 2: A patient with a diabetic foot ulcer has a probe-to-bone test that is positive. What does this most likely indicate?
- Peripheral arterial disease
- Osteomyelitis (Correct answer)
- Charcot neuroarthropathy
- Deep vein thrombosis
Correct answer: Osteomyelitis
A positive probe-to-bone test (ability to reach bone with a sterile probe) has a high positive predictive value for osteomyelitis in diabetic foot ulcers.
Question 3: Which negative pressure wound therapy (NPWT) setting is most commonly used for general wound management?
- -50 mmHg continuous
- -75 mmHg intermittent
- -125 mmHg continuous (Correct answer)
- -200 mmHg continuous
Correct answer: -125 mmHg continuous
The standard NPWT setting of -125 mmHg continuous has the most evidence supporting wound healing, perfusion improvement, and exudate management.
Question 4: In periwound skin assessment, maceration is best described as:
- Dry, flaky skin resulting from low exudate
- White, soft, waterlogged skin caused by excess moisture (Correct answer)
- Reddened skin from pressure or friction
- Dark discoloration from hemosiderin deposition
Correct answer: White, soft, waterlogged skin caused by excess moisture
Maceration occurs when periwound skin is excessively exposed to moisture, causing it to become white, soft, and fragile, increasing the risk of wound enlargement.
Question 5: Which condition is a contraindication to the use of negative pressure wound therapy?
- Venous leg ulcer with moderate exudate
- Dehisced surgical wound
- Wound with exposed untreated osteomyelitis (Correct answer)
- Pressure injury with granulating tissue
Correct answer: Wound with exposed untreated osteomyelitis
Untreated osteomyelitis is a contraindication to NPWT because the therapy could spread infection further into bone and surrounding tissue without addressing the underlying infection.
Question 6: A wound that has not decreased in area by at least 40-50% after 4 weeks of optimal treatment is best described as:
- A healing wound on a normal trajectory
- A stalled or chronic wound requiring reassessment (Correct answer)
- A wound in the inflammatory phase
- A wound ready for skin grafting
Correct answer: A stalled or chronic wound requiring reassessment
Failure to achieve ≥40-50% wound area reduction in 4 weeks is a validated predictor of non-healing and signals the need to reassess the treatment plan.
Question 7: Which type of hyperbaric oxygen therapy (HBOT) indication has the strongest evidence in wound care?
- Stage 2 pressure injuries
- Wagner Grade 3-4 diabetic foot ulcers (Correct answer)
- Acute surgical wounds
- Venous leg ulcers
Correct answer: Wagner Grade 3-4 diabetic foot ulcers
Wagner Grade 3-4 diabetic foot ulcers have the strongest level of evidence for HBOT, with studies showing reduced amputation rates and improved healing.
CWS Certified Wound Specialist 4
Which cell type is primarily responsible for wound contraction during the proliferative phase?