CWS Practice Questions (2026) — Free Sample Questions with Answers

Answer: A

Senescent fibroblasts and excess proteases blunt growth-factor response.: Correct. Cells in long-standing wounds become senescent and respond poorly to growth factors, while excess proteases break down growth factors and receptors. This is why the edge and bed often need more debridement or advanced therapy to restart healing.

Too few inflammatory cells reach the wound bed.: Chronic wounds usually have too much, not too little, persistent inflammation.

Type III collagen converts too early to type I.: The collagen switch belongs to normal maturation and does not cause a stalled bed.

Myofibroblast overactivity causes excess contraction.: Overactive contraction would reduce area; this wound is not changing at all.

Chronic wounds stall through senescent cells, protease excess and persistent inflammation; correct etiology first, then refresh the bed and consider advanced therapies.

Answer: A

Long venous overload has exceeded and then damaged lymphatic transport: Correct. Long-standing venous hypertension raises lymphatic load until the overworked lymphatics fail (combined insufficiency). Firm, poorly pitting edema that reaches the foot and toes, a positive Stemmer sign and papillomatosis show a lymphatic component: phlebolymphedema.

Venous hypertension alone, since venous edema usually includes the toes: Pure venous edema usually spares the toes and pits easily; toe involvement and a positive Stemmer sign point to lymphatic failure.

Primary lymphedema unrelated to his long venous history: Onset after decades of venous disease points to a secondary process, not a separate primary lymphedema.

Low plasma oncotic pressure from protein deficiency: Albumin is normal, and hypoalbuminemic edema is bilateral, soft and easily pitting.

Toe involvement, a positive Stemmer sign and fibrotic, poorly pitting edema in a venous limb signal phlebolymphedema; management adds lymphedema care to compression.

Answer: D

A healing ridge is not expected until maturation begins at about 3 weeks.: The ridge reflects collagen laid down in the proliferative phase and should be palpable by about days 5–9, well before maturation.

The rising serous drainage confirms a surgical site infection.: Serous drainage alone does not confirm infection; the decisive cue is the missing ridge, which predicts separation whether or not infection develops.

Approximation has replaced the need for proliferative collagen deposition.: Sutures hold the edges only until collagen bridges them; approximation does not replace proliferative healing.

The absent ridge shows impaired proliferation and a higher risk of dehiscence.: Correct. A healing ridge (induration from new collagen under the incision) should be palpable by about days 5–9. Its absence, with corticosteroid use, obesity and increasing drainage, signals impaired proliferation and risk of dehiscence, so the incision needs closer monitoring and the surgeon should be informed.

Palpate closed incisions: a healing ridge by days 5–9 is a sign of normal proliferation; its absence is an early warning of dehiscence.

Answer: D

Accept the normal WBC as excluding osteomyelitis and continue care.: A normal white count is common in diabetic foot osteomyelitis and does not exclude it.

Order a three-phase bone scan to confirm bone infection.: A bone scan is sensitive but not specific; neuropathic and post-surgical bone change also light it up.

Send a swab culture of the ulcer surface to identify the organism.: A surface swab does not diagnose osteomyelitis and often grows colonizers rather than the bone pathogen.

Obtain an MRI of the foot to evaluate for osteomyelitis.: Correct. A positive probe-to-bone test with ESR 88 mm/h and a raised CRP makes osteomyelitis likely. Radiographs are often normal for the first 2–4 weeks of bone infection, so MRI is the advanced imaging of choice; bone biopsy remains the reference standard.

Probe-to-bone plus raised ESR/CRP suggests osteomyelitis even when the WBC and radiographs are normal; MRI is the next imaging test, and bone biopsy is the reference standard.

Answer: C

1. Formula: ABI = higher ankle pressure (dorsalis pedis or posterior tibial) of that leg ÷ higher brachial pressure of either arm.
2. Substitute: right ankle = 96 (posterior tibial); higher brachial = 146 (left).
3. Result: 96 ÷ 146 = 0.657, which rounds to 0.66.
4. Interpretation: 0.66 = moderate PAD (about 0.5–0.8): reduced compression only, with specialist oversight and vascular referral.

0.58: Uses the lower right ankle pressure (84 ÷ 146); the ABI uses the higher of the dorsalis pedis and posterior tibial pressures.

0.64: Uses both the lower ankle pressure and the same-side brachial pressure (84 ÷ 132).

0.66: Correct. ABI = higher right ankle pressure ÷ higher brachial pressure = 96 ÷ 146 = 0.66. This is moderate PAD: full compression is unsafe, so use reduced compression under specialist oversight and refer for vascular assessment.

0.73: Uses the same-side (right) brachial pressure (96 ÷ 132); the denominator is the higher brachial pressure from either arm.

Right ABI = the higher right ankle pressure ÷ the higher brachial pressure from either arm; small method errors can move a patient across a compression band.

Answer: B

Stage 2: Stage 2 is partial thickness and has no granulation, slough or visible fat.

Stage 3: Correct. Full-thickness loss with visible fat, granulation, some slough and epibole, but no exposed or palpable fascia, muscle, tendon or bone, is Stage 3. Slough covers only 30%, so the depth can be seen and the wound can be staged.

Stage 4: Stage 4 needs exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone.

Unstageable: Unstageable applies only when slough or eschar hides the base so the depth cannot be confirmed; here most of the base is visible.

Stage from the deepest tissue you can see or feel; "unstageable" is only for a base hidden by slough or eschar.

Answer: A

Pouch it with a high-output wound manager, protect the skin, and measure output.: Correct. Containment protects the skin from enzymatic effluent and allows accurate output measurement for fluid and nutrition management; it is the standard first step for a high-output fistula.

Pack the wound with saline-moistened gauze and change it every 4 hours.: Gauze cannot contain 700 mL a day; the skin stays soaked and output cannot be measured.

Apply NPWT at −125 mm Hg over the entire wound bed.: NPWT is contraindicated over an unexplored fistula; specialized fistula isolation is used only after surgical evaluation.

Fill the wound with calcium alginate under a foam cover.: Absorbent dressings saturate quickly with high-output effluent and do not protect the skin from it.

High-output fistula: contain (pouch or wound manager), protect the skin, measure output, and involve the surgical team before considering NPWT.

Answer: B

1. ABI = highest ankle pressure on the limb (DP or PT) ÷ highest brachial pressure of either arm.
2. Highest right ankle pressure = 114 mm Hg (posterior tibial); highest brachial = 150 mm Hg (left).
3. 114 ÷ 150 = 0.76.
4. 0.76 lies in the 0.5–0.8 band (moderate arterial disease): use reduced compression with specialist oversight and refer for vascular assessment; do not apply full 40 mm Hg compression.

0.47; avoid sustained compression and refer: Uses the lower ankle pressure (70 ÷ 150); the ABI uses the higher of the dorsalis pedis and posterior tibial pressures.

0.76; reduced compression with specialist oversight: Correct. Highest right ankle pressure 114 ÷ highest brachial pressure 150 = 0.76; an ABI of about 0.5–0.8 calls for reduced compression and vascular referral.

0.89; full multilayer compression: Uses the same-side (right) brachial pressure (114 ÷ 128); the ABI uses the higher brachial pressure of either arm.

1.32; noncompressible vessels, so obtain a TBI: Inverts the ratio (150 ÷ 114); the ABI is ankle ÷ brachial.

Always use the highest ankle and highest brachial pressures. ABI ≥ 0.8: full compression; about 0.5–0.8: reduced compression with oversight; below 0.5: no sustained compression and refer.

Answer: D

Start an oral antibiotic and continue the current dressings.: Systemic antibiotics are for spreading or deep infection (erythema beyond 2 cm, induration, warmth, systemic signs); these are local signs only.

Obtain a swab culture and keep the plan unchanged until results return.: A culture does not treat the local signs; the decision is clinical, and topical treatment should not wait for results.

Start NPWT now to restart contraction of the stalled wound.: NPWT is not a treatment for wound infection; the local infection is addressed first, and NPWT over an untreated infected bed is a precaution.

Add a topical antimicrobial dressing and reassess in 2 weeks.: Correct. Stalled healing with friable, dusky granulation, more debris and more exudate, without deep or spreading signs, indicates local (superficial) infection. Treat with cleansing, debridement as needed and a topical antimicrobial, then reassess.

Separate local infection (NERDS: nonhealing, exudate, red friable granulation, debris, smell) from deep or spreading infection (STONEES). Local infection is treated topically; systemic antibiotics are for deep or spreading infection.

Answer: B

Perform conservative sharp debridement to expose a viable wound base.: Sharp debridement of stable eschar on an ischemic limb creates a larger open wound without the perfusion to heal it.

Keep the eschar dry and intact, float the heel, and refer for vascular evaluation.: Correct. Stable, dry, adherent eschar on an ischemic heel acts as a natural cover. Removing it opens a wound that cannot heal at an ABI of 0.45, so offload the heel, monitor the eschar daily and refer for revascularization assessment.

Apply collagenase daily under a moist dressing to soften the eschar.: Enzymatic debridement removes the protective eschar; it is reserved for unstable eschar or for use after perfusion is restored.

Crosshatch the eschar and apply hydrogel under a film to start autolysis.: Moisture-retentive autolysis turns a dry, stable eschar into a moist, open ischemic wound that invites infection.

Do not debride stable, dry, adherent eschar on an ischemic heel. Keep it dry, offload it and watch for instability (drainage, fluctuance, erythema, odor), which would change the plan.

Answer: C

1. Adult Rule of Nines: head and neck 9%, each upper limb 9%, anterior trunk 18%, posterior trunk 18%, each lower limb 18%, perineum 1%.
2. Count only partial- and full-thickness areas: right upper limb 9%, anterior trunk 18%, perineum 1%.
3. 9 + 18 + 1 = 28% TBSA.
4. Full-thickness burns, burns over 10% TBSA and perineal burns all meet burn-center referral criteria.

19%: Gives the anterior trunk 9% instead of 18%.

27%: Leaves out the perineum (1%), which has a partial-thickness burn.

28%: Correct. Right upper limb 9% + anterior trunk 18% + perineum 1% = 28%; the superficial head and neck burn is excluded.

37%: Adds the superficial head and neck burn (9%); superficial burns are not counted in TBSA.

TBSA counts partial- and full-thickness burns only; the adult Rule of Nines gives 18% to the anterior trunk and 1% to the perineum.

Answer: B

Order an outpatient arterial duplex within the next week: Duplex is a reasonable test, but a week's delay risks limb loss; an acutely threatened limb needs same-hour vascular evaluation.

Arrange emergency vascular evaluation for acute limb ischemia: Correct. Sudden pain, pallor, pulselessness, paresthesia and early motor loss (the 6 Ps) in a patient with atrial fibrillation suggest an embolic acute limb ischemia. Sensory and motor loss mean the limb is threatened, so emergency anticoagulation and revascularization are needed within hours.

Start compression and elevation for a presumed deep vein thrombosis: DVT causes a warm, swollen limb with palpable pulses; a cold, pale, pulseless foot is arterial, and compression would worsen ischemia.

Treat as chronic ischemia with a routine vascular referral: Sudden onset without prior claudication, with neurologic deficit, is acute, not chronic, ischemia; a routine referral is too slow.

Sudden pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia mean acute limb ischemia: a vascular emergency in which sensory or motor loss shortens the window to save the limb.

Answer: A

Immobilize the foot in a non-removable knee-high device and obtain an MRI.: Correct. A warm, swollen insensate foot with a difference above 2 °C and intact skin is active Charcot neuro-osteoarthropathy until proven otherwise. Offload and immobilize at once; normal radiographs do not exclude it, so MRI confirms early disease (IWGDF 2023).

Start oral antibiotics for cellulitis and recheck the foot in 1 week.: Intact skin with no portal of entry and no fever argues against cellulitis; treating it as infection delays immobilization while the midfoot collapses.

Elevate the foot and repeat radiographs in 4 weeks before offloading.: Waiting for radiographic change lets fractures and deformity progress; offloading must not wait for imaging.

Fit extra-depth therapeutic shoes with a rigid rocker sole.: Footwear belongs to the inactive (consolidated) phase; the active phase needs knee-high immobilization.

Suspect active Charcot in any warm, swollen, insensate foot with intact skin and a temperature difference over 2 °C: immobilize first, then confirm with MRI if radiographs are normal.

Answer: D

Dressing X should replace Dressing Y, because its healing benefit is large.: A 3-point difference in healing and a 2-day difference in time to healing are small; significance is not the same as size.

The results are not significant, because infection rates did not differ.: The primary healing outcomes were significant (p below 0.05); equal infection rates do not change that.

There is a 96% probability that Dressing X is truly better, because p = 0.04.: A p value is the probability of a difference at least this large if there were no true difference; it is not the probability that Dressing X is better. This is a common misreading of p values.

The difference is statistically significant but small in clinical terms.: Correct. With 4,000 patients, small differences reach significance. Healing rose by 3 percentage points (about 33 patients treated for 1 extra healed ulcer) and time to healing fell by 2 days, so cost, patient factors and ease of use should also guide the choice.

A p value shows that a difference is unlikely to be chance, not that it matters; judge clinical significance by the size of the effect.

Answer: A

Control odor, exudate and pain with fewer, more comfortable dressing changes.: Correct. Healing is not a reasonable expectation, and her goal is comfort. The plan becomes palliative: absorbent, odor-controlling dressings changed less often, premedication for pain, and positioning for comfort, with the goals documented.

Start negative pressure wound therapy to speed closure of the wound.: NPWT aims at closure and adds device burden; it does not match a comfort goal in her last weeks.

Sharply debride the wound weekly to promote healthy granulation.: Serial debridement is painful and aims at healing, which is not her goal.

Raise her protein intake to 1.5 g/kg/day to support wound healing.: Reasonable for a healable wound, but pushing intake near the end of life does not fit her goals.

When healing is not a realistic outcome, set palliative wound goals (odor, exudate, pain, bleeding, dignity) that match the patient's wishes.