DPM Wound Care & Management 3 — Questions and Answers
Question 1: A patient with a Wagner Grade 3 diabetic foot ulcer most likely has which clinical finding?
- Superficial ulcer without subcutaneous involvement
- Deep ulcer penetrating to tendon or joint capsule
- Deep abscess or osteomyelitis (Correct answer)
- Gangrene of the forefoot
Correct answer: Deep abscess or osteomyelitis
Wagner Grade 3 indicates a deep ulcer complicated by abscess, osteomyelitis, or joint sepsis, distinguishing it from Grade 2 (tendon/capsule) and Grade 4 (gangrene).
Question 2: Which radiographic finding is most specific for osteomyelitis underlying a diabetic foot ulcer?
- Osteopenia on plain X-ray
- Cortical destruction on plain X-ray (Correct answer)
- Periosteal reaction on plain X-ray
- Soft tissue swelling on plain X-ray
Correct answer: Cortical destruction on plain X-ray
Cortical bone destruction on plain X-ray is the most specific radiographic finding for osteomyelitis, though MRI remains more sensitive overall.
Question 3: Negative pressure wound therapy (NPWT) is contraindicated in which wound type?
- Dehisced post-surgical wounds
- Wounds with untreated osteomyelitis (Correct answer)
- Diabetic foot ulcers with granulating base
- Wounds with moderate exudate
Correct answer: Wounds with untreated osteomyelitis
NPWT is contraindicated in wounds with untreated osteomyelitis because it can spread infection and does not substitute for adequate bone debridement and antibiotic therapy.
Question 4: Which organism is most commonly the primary pathogen in early, acute, non-limb-threatening diabetic foot infections?
- Pseudomonas aeruginosa
- Staphylococcus aureus (Correct answer)
- Bacteroides fragilis
- Enterococcus faecalis
Correct answer: Staphylococcus aureus
Staphylococcus aureus (including MRSA) is the predominant organism in acute, non-limb-threatening diabetic foot infections.
Question 5: A patient's wound shows 80% red granulation tissue and 20% yellow slough. Which treatment approach best accelerates healing?
- Dry gauze packing to absorb excess moisture
- Selective debridement of slough and moist wound dressing (Correct answer)
- Betadine-soaked dressings to prevent infection
- No intervention since the wound is predominantly granulating
Correct answer: Selective debridement of slough and moist wound dressing
Selective debridement of remaining slough combined with a moist wound dressing optimizes the healing environment and removes barriers to epithelialization.
Question 6: Which method is considered the gold standard for diagnosing osteomyelitis in the diabetic foot?
- Triple-phase bone scan
- Plain X-ray series
- Bone biopsy with culture and histology (Correct answer)
- MRI with gadolinium
Correct answer: Bone biopsy with culture and histology
Bone biopsy with culture and histopathology is the definitive gold standard for diagnosing osteomyelitis, identifying the causative organism and confirming necrotic bone.
Question 7: The 'probe-to-bone' test in a diabetic foot ulcer is considered positive when the probe contacts bone. What does a positive result strongly suggest?
- Charcot neuroarthropathy
- Deep space abscess
- Osteomyelitis (Correct answer)
- Arterial insufficiency
Correct answer: Osteomyelitis
A positive probe-to-bone test has a high positive predictive value for osteomyelitis in diabetic foot ulcers, especially when the ulcer overlies bony prominences.
DPM Wound Care & Management 3
A patient with a Wagner Grade 3 diabetic foot ulcer most likely has which clinical finding?