OSCE Wound Care and Dressings 3 — Questions and Answers
Question 1: A patient develops periwound maceration. The BEST intervention is to:
- Apply a more absorbent dressing and use skin barrier cream periwound (Correct answer)
- Increase dressing change frequency only
- Apply antiseptic cream to the surrounding skin
- Switch to a hydrocolloid dressing over the wound and periwound area
Correct answer: Apply a more absorbent dressing and use skin barrier cream periwound
Managing maceration requires both increasing moisture absorption with a more absorbent dressing and protecting periwound skin with a barrier product.
Question 2: Which type of debridement uses the body's own enzymes and moisture to break down necrotic tissue?
- Sharp debridement
- Mechanical debridement
- Autolytic debridement (Correct answer)
- Enzymatic debridement
Correct answer: Autolytic debridement
Autolytic debridement harnesses the body's natural proteolytic enzymes and phagocytic cells, facilitated by moist wound dressings like hydrogels or hydrocolloids.
Question 3: A patient presents with a wound showing bright red, moist tissue that bleeds easily when touched. This describes:
- Slough tissue
- Eschar
- Granulation tissue (Correct answer)
- Epithelial tissue
Correct answer: Granulation tissue
Granulation tissue is healthy, vascular tissue that appears bright red, cobblestone-like, moist, and bleeds readily when touched during assessment.
Question 4: A diabetic patient has a neuropathic foot ulcer with a classic 'punched out' appearance and surrounding callus. The PRIORITY initial treatment is:
- Apply antimicrobial dressing immediately
- Debride the callus and offload pressure from the wound (Correct answer)
- Start oral antibiotics
- Apply compression bandaging
Correct answer: Debride the callus and offload pressure from the wound
Neuropathic diabetic foot ulcers require callus debridement to assess true wound depth and offloading to remove the causative pressure.
Question 5: When applying a wound dressing, you note the wound tunnel (sinus tract) extends 3 cm. The CORRECT approach is to:
- Pack the sinus loosely with appropriate material to prevent premature closure (Correct answer)
- Leave the sinus empty to drain freely
- Irrigate forcefully to collapse the tract
- Apply topical antibiotics directly into the sinus
Correct answer: Pack the sinus loosely with appropriate material to prevent premature closure
Tunnels must be gently packed loosely with appropriate material (ribbon gauze, alginate rope) to prevent abscess formation while allowing drainage.
Question 6: A patient's wound is described as 'critically colonized.' This means:
- Wound has systemic infection requiring IV antibiotics
- Bacterial burden is high enough to impair healing but not meeting criteria for infection (Correct answer)
- Normal bacterial presence that does not affect healing
- Wound is sterile and ready for closure
Correct answer: Bacterial burden is high enough to impair healing but not meeting criteria for infection
Critical colonization (also called local infection) involves a high bacterial burden that stalls healing, managed with topical antimicrobials rather than systemic antibiotics.
Question 7: Negative pressure wound therapy (NPWT/VAC) is contraindicated in which situation?
- Dehisced surgical wounds
- Wounds with untreated osteomyelitis (Correct answer)
- Large pressure ulcers
- Diabetic foot wounds
Correct answer: Wounds with untreated osteomyelitis
NPWT is contraindicated in wounds with untreated osteomyelitis, malignancy, exposed vessels/nerves, or non-enteric fistulas.
OSCE Wound Care and Dressings 3
A patient develops periwound maceration.
The BEST intervention is to: