Integ Final Review: All Past Quiz Questions

At the junction between the epidermis and dermis

Where does a blister occur?

Stop debridement unless tissue is necrotic

A PT is performing debridement and reaches a shiny, dense, white layer. What is the appropriate action?

Thinning of the subcutaneous layer

An older adult reports feeling unusually cold. What age-related change is the cause?

80%

What percentage of the original tensile strength does new tissue have?

Decreased density of Langerhans cells in the epidermis

Which integumentary change contributes MOST to increased risk of infection in older adults?

Increased sweating

Which symptom would you NOT expect to find in an area of full-thickness burn that has healed?

Purpura

Spontaneous hemorrhages in the dermis of older adults are called...

Granulation

The base of the wound being evaluated is slightly moist, bumpy, and red colored. Similar to raw beef. What is this tissue called?

False

T/F: The presence of scarring indicates faulty healing

Epibole

The term for the process of re-epithelialization when edges roll over and prevent further migration

Dehiscence

The separation of wound margins due to insufficient collagen production or tensile strength is called...

Keyloid

What type of scar?

Maceration

Term for an over-saturated epidermis that becomes soft and white and easily damaged

Fascia

What is the "stop and think" layer?

Epidermis

What layer of skin is responsible for vitamin D metabolism?

Tendon

When examining a pt's wound, you notice regularly arranged white fibrous tissue. What structure is it?

Changing the wound dressing every four days

Which of the following is least likely to be a cause of chronic inflammation of a wound?

- Washing with soap and water

- Washing wound with rubbing alcohol

- Changing dressing every four days

- Changing dressing once every week

Generate contractile forces that draw wound edges together

How would you best describe the role of myofibroblasts in wound healing?

Tertiary intention

Total knee replacement five days post-op becomes infected and is surgically debrided. One week after the surgeon surgically closes the wound. This is type of wound closure is termed...

True

T/F: Older adults have diminished light touch

Pushes fluid out of capillaries

According to Starling's Law, hydrostatic pressure

Pull endothelial cells open during increased interstitial pressure

Lymphatic anchoring filaments function to:

Creating negative pressure in the thoracic duct

Diaphragmatic breathing assists lymph flow by:

Watersheds

Lymphatic territories are separated by:

Chronic inflammatory condition caused by lymphatic insufficiency

Lymphedema is best defined as which of the following?

- Accumulation of fluid due to arterial insufficiency

- Acute infection of lymph nodes

- Chronic inflammatory condition caused by lymphatic insufficiency

- Venous obstruction leading to swelling

Plasma proteins

Oncotic pressure is primarily generated by:

It decreases lymph transport rate

Removal of lymph nodes increases risk of lymphedema because:

Hypotension

Secondary lymphedema may be caused by all EXCEPT:

- Chronic venous insufficiency

- Hypotension

- Tumor obstruction

- Radiation therapy

Venous angle

The only direct connection between the lymphatic and venous systems is at the:

Thoracic duct

Which lymphatic duct drains into the left venous angle?

Right lymphatic duct

Which lymphatic duct drains into the right venous angle?

Internal jugular vein and subclavian vein

What two vessels join at the venous angle?

Lymphangion

What is the name of the vessel segment between two lymphatic valves?

Lymphatic capillaries

What is the smallest diameter vessel in the lymphatic system?

Venous angle

What structure connects the lymphatic system to the venous system?

Cisterna chyli

What structure forms the beginning of the thoracic duct?

Cysterna chyli

Dilated sac in upper abdomen that serves as the origin of the thoracic duct.

Tonsils

Which lymphoid structure captures and removes pathogens during inhalation?

Due to congenital or genetic abnormalities

Which of the following is a characteristic of primary lymphedema?

- Due to congenital or genetic abnormalities

- Caused by mechanical traction

- Only occurs after age 50

- Always unilateral

Production of red blood cells

Which of the following is NOT a function of lymph nodes?

- Biological filtration

- Production of red blood cells

- Phagocytosis of pathogens

- Immune surveillance

They drain dermis and subcutaneous tissue

Which of the following is TRUE about superficial lymphatic vessels?

- They lie below the fascia

- They drain dermis and subcutaneous tissue

- They drain deep tissues

- They lack anastomoses

Hydrostatic pressure

Which pressure pushes fluid out of the arterial capillary bed?

They contain smooth muscle and valves

Which statement about lymphatic collectors is TRUE?

- They are identical to lymph capillaries

- They lack valves

- They cannot transport fluid autonomically

- They contain smooth muscle and valves

Initial lymphatic capillaries

Which structure absorbs large molecules such as proteins and fats?

Arterial insufficency

A patient reports worsened wound pain when the leg is elevated and better when dependent. What is occurring?

Induration

A patient presents with hardened chronic edema and hardened periwound. What is the term for this presentation?

Bandage has reached end of life and should be changed

A wound dressing shows that it is struck through (soiled through full thickness of dressing). What does this indicate?

Epithelial

Tissue that is pink, translucent, and originates at the wound margins is __________ tissue

Epibole

Term for improperly healed wound edges that are rolled over

Keep wound area moist and moving

A wound exposes a healthy tendon. What is the best course of action?

Grid tracing

What is the most accurate method for measuring the surface area of an irregularly shaped wound?

Critical PMH and establish POC

What is the primary purpose of the subjective exam during an initial wound evaluation?

Callus

Hyperkeratotic tissue is also known as a...

Serosanguinous

Term for exudate that is thin, light pink, and blood tinged

Head to toe

When measuring a wound, the length is best defined as...

Purulent

What type of wound drainage is most associated with bacterial infection?

Venous insufficiency

Hemosiderin staining is a physical sign of

Excoriation

Term for injury to the skin due to thermal, chemical, or mechanical causes

Arterial ulcer

A patient with a deep, well-defined ulcer on the toe, faint pulses, and cool skin most likely has:

a.     Venous ulcer

b.     Arterial ulcer

c.     Pressure ulcer

d.     Diabetic neuropathic ulcer

Breakdown of hemoglobin

Hemosiderin staining in the periwound of venous ulcers is due to:

a. Breakdown of hemoglobin

b. Bruising

c. Fibrin accumulation

d. Fatty deposits

Active symptomatic ulcer is present

In the CEAP system, what does a clinical classification of C6s indicate?

a. Active symptomatic ulcer is present

b. Varicose veins

c. Lipodermatosclerosis is noted

d. Edema is present

Arterial perfusion

The ABI is used to assess:

a. Arterial perfusion

b. Capillary refill

c. Venous reflux

d. Lymphatic drainage

Age

Which is not included in CEAP classification:

a. Age

b. Anatomy

c. Etiology

d. Pathology

Compression therapy

What is the mainstay of treatment for venous ulcers?

a. Compression therapy

b. Topical steroids

c. Surgical debridement

d. Compression therapy

Ambulatory venous HTN

Which of the following is the most accepted theory?

a. Ambulatory venous HTN

b. Stasis theory

c. Fibrin cuff theory

d. Leukocyte theory

Peripheral arterial disease

The Rutherford classification is used to grade:

a. Lymphatic insufficiency

b. Ulcer exudate

c. Peripheral arterial disease

d. Venous reflux severity

Prevent backflow

What is the primary function of venous valves?

Propels blood upward

Using the muscle pump to aid venous return is beneficial because it...

Venous ulcer

A shallow, irregular wound with moderate to heavy exudate characterizes what type of ulcer?

Arterial ulcer

A deep, punched-out wound with a pale base and severe pain characterizes which type of ulcer?

shiny, cold skin with no hair

What are positive physical signs of an arterial ulcer?

Arteriosclerosis

What is common cause of arterial ulceration?

<0.7

An ABI of _______ is a contraindication for compression therapy

Sparse hair

What is a typical physical symptom in a limb with arterial insufficiency?

Proximal to medial malleolus

Where is the most common location of a venous ulcer?

Capillary refill

What test is most widely used at bedside for arterial perfusion?

Trendelenberg test

What test is used to differentiate between superficial and deep venous incompetence?

Arterial insufficiency

A patient lying supine elevates their legs for 30s and releases them. Color returns after 30s. What does this indiate?

Martorell's ulcer

What type of ulcer is present in the lower extremity, has pain out of proportion to the ulcer size, and is associated with uncontrolled hypertension?

The Unna boot creates a wet-to-dry effect that traumatizes tissue upon removal

A clinician applies an Unna boot directly over a venous ulcer without a primary dressing. Two days later, the patient reports severe pain during removal. Which principle explains this complication?

Perform a thorough vascular evaluation, including ABI and filling tests

A clinician evaluates a patient with a chronic arterial ulcer and notes trophic changes, brittle nails, and a cool distal temperature gradient. The patient also has a history of contralateral amputation. Which action is most critical before initiating local wound care?

The cast is contraindicated because fluctuating edema causes pistoning and shear

A clinician is deciding between a total contact cast and a posterior walking splint for a patient with a Wagner grade II plantar ulcer and fluctuating lower-leg edema. Which reasoning supports choosing the splint instead of the cast?

- The cast cannot be used for any plantar ulcer regardless of grade

- The splint provides superior total contact pressure distribution

- The cast is contraindicated because fluctuating edema causes pistoning and shear

- The splint prevents all shear forces during gait

A tourniquet effect proximally causing fluid accumulation below the wrap

A clinician wraps a patient's lower leg using a long-stretch bandage but unintentionally adds extra layers around the mid-calf due to leftover material. According to Laplace's Law, what is the most likely clinical consequence?

Transition the patient to a custom-fit compression garment

A patient using intermittent pneumatic compression shows no further reduction in limb girth after several weeks. What is the most appropriate next step?

Mist therapy avoids painful pressure and maintains moisture on fragile ischemic tissue

A patient with advanced arterial disease demonstrates necrotic tissue over exposed tendons on the dorsum of the foot. The clinician is considering pulsatile lavage. Why is choosing ultrasonic mist therapy instead beneficial?

Debridement exposes ischemic tissue that cannot heal without restored perfusion

A patient with arterial insufficiency and a dry necrotic ulcer is being considered for debridement. Why is delaying aggressive debridement until after revascularization more beneficial?

Set pressure below the measured diastolic and monitor for cardiac symptoms

A patient with congestive heart failure, chronic venous insufficiency, and treated cellulitis is scheduled for intermittent pneumatic compression. Which adjustment is most important to ensure safe and effective treatment?

Increased distal pressure due to limited great-toe extension

A patient with diabetic neuropathy presents with a large plantar ulcer under the first metatarsal head surrounded by thick callus. They report no pain and have significant hallux rigidus. What directly explains the ulcer's location and severity?

Electronic attraction of healing cells and improved local circulation

A patient with severe arterial disease begins electrical stimulation therapy. What is the primary therapeutic benefit in this population?

Dry, fissured skin that cracks easily

Autonomic neuropathy contributes to ulcer formation primarily by causing...

Arterial supply (ABI)

Before applying compression, which factor must be assessed to avoid compromising arterial supply?

Autonomic neuropathy causing vasodilation and bone demineralization

Charcot foot is most strongly associated with:

Patients cannot detect harmful pressure or objects in their shoes

Loss of protective sensation (LOPS) primarily increases the risk of foot ulceration because:

They are highly hydrophilic and will pull moisture out of an already dry wound

Why must alginate dressings be pre-moistened before use on an arterial ulcer?

High working pressure with low resting pressure

What is the main advantage of short-stretch bandages in venous ulcer management?

They have high resting pressure that may compromise arterial flow

What is the primary concern with long-stretch bandages such as ACE wraps?

Ultrasonic mist therapy

Which biophysical technology is described as providing painless, low-frequency mechanical stimulation to promote healing in arterial ulcers?

- Pulsatile lavage with suction

- High-frequency therapeutic ultrasound

- Electrical stimulation with strong muscle contraction

- Ultrasonic mist therapy

Cleansing with mild soap and water

Which debridement method is most appropriate for a venous ulcer according to the content?

Callus acts like a foreign object, increasing focal pressure on underlying tissue

Why does callus formation increase ulcer risk in patients with diabetic neuropathy?

A serum‑filled blister

A Stage 2 pressure injury may present as:

a. A serum‑filled blister

b. A dry, stable eschar on the heel

c. A deep maroon discoloration of intact skin

d. Exposed muscle or tendon