Episode 25 – Stages of Wound Healing

Watch the video version of this Q&A episode on YouTube - https://youtu.be/_WGm354Hlwg

A physical therapist inspects the progress of a partial-thickness wound on a patient’s anterior forearm. The therapist notes evidence of resurfacing of the wound with notable changes in the edges of the wound. This observation is MOST consistent with which of the following conditions? 

1. Maceration
2. Granulation
3. Epithelialization
4. Infection

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist inspects the progress of a partial-thickness wound on a patient’s anterior forearm. The therapist notes evidence of resurfacing of the wound with notable changes in the edges of the wound. This observation is MOST consistent with which of the following conditions? 

1. Maceration
2. Granulation
3. Epithelialization
4. Infection

It’s beneficial for students to simplify questions whenever possible since often only a portion of the presented information is required to successfully answer a given question. 

In this particular case, let’s take a look at each of the pieces individually and determine how essential it is when attempting to select the correct response. Remember the relative value of each piece of information has to be evaluated based solely on the specific question that is being asked.

Presented Information
Type of wound: partial-thickness wound
This is primarily a definition question and therefore the type of wound is not essential.

Location of wound: patient’s anterior forearm
Ditto! Regardless of the location of the wound, this question comes down to the definition of each of the presented options.

Observation: evidence of resurfacing of the wound with notable changes in the edges of the wound
Bingo! In this question we simply have to determine which term is most consistent with the supplied description.

Simplification is a beautiful thing! 

Since we are using these questions as a review tool, let’s take a moment to review partial-thickness wounds prior to defining each of the presented options. 

Partial-thickness Wounds
A partial-thickness wound extends through the epidermis and possibly into, but not through, the dermis. Examples include abrasions, blisters, and skin tears. A partial-thickness wound will typically heal by re-epithelialization or epidermal resurfacing depending on the depth of injury.

Now let’s explore each of the options:

Option 1 - Maceration
Maceration refers to a softening of connective tissue fibers due to excessive moisture. The result is a loss of pigmentation and a wound that is highly susceptible to breakdown or enlargement.

Option 2 - Granulation
Granulation refers to perfused, fibrous connective tissue that replaces a fibrin clot in a healing wound. The tissue is highly vascular and fills the defects of full-thickness wounds.

Option 3 - Epithelialization
Epithelialization refers to the process of epidermal resurfacing and appears as pink or red skin. This process involves the migration of keratinocytes from the wound edges. Keratinocytes make up the layers of the dermis and epidermis as well as the linings of various body organs.

Option 4 - Infection
Signs and symptoms of infection include the production of pus, redness, pain, and swelling. More generalized symptoms of infection may include fever, chills, and an increased pulse rate. Laboratory values associated with infection include an increased erythrocyte sedimentation rate and white blood cell count.

The correct answer is Option 3

Let’s explore the all student data:
11% of students selected Option 1, Maceration
31% of students selected Option 2, Granulation
52% of students selected Option 3, Epithelialization, the correct response
6% of students selected Option 4, Infection

System Classification
This question is an Other Systems question which represents approximately 21% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content? Check out pages 524-525 in PTEXAM: The Complete Study Guide.

Bonus Thought
Little Things – Turn into Big Things

Never underestimate the value of answering multiple-choice questions when preparing for a licensing examination. Let me provide you with an example that shows just how powerful an academic tool they can be.

Each multiple choice question has 4 possible options. When a student reviews a question, they should not only explore the correct option but also take time to explore each incorrect option. In this particular question, we reviewed the correct option epithelialization, and also reviewed each of the incorrect options - maceration, granulation, and infection.

This pattern of review may not wow you at the individual question level, but think about the power of this process over multiple full-length exams.

The typical PT student takes 5-9 sample exams prior to the big day. For calculation purposes, let’s assume that number is 7 exams. Each examination has 180 scored items and there are 4 options for each question. This means that there are 720 options in each exam. 720 options per exam X 7 exams equals 5,040 options. Amazing! Think about how much academic ground is being covered during this review process.

Want to get even crazier? Maybe you are a Basecamp fanatic and have answered all 6,000 of the Climb questions and all 2,000 of the King of the Mountain questions. As a reminder each Climb question has 2 options and each King of the Mountain question has 4 options. 

That would result in 12,000 Climb options and 8,000 King of the Mountain options. Collectively, that is a cool 20,000 additional options. 

Obviously, the exact number of options that you explore is not necessary to determine, but it is critical to understand the value of thoroughly reviewing each option. 

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!