Integumentary and Other System Conditions
This domain spans wound care, burns, lymphoedema, amputation and prosthetics, rheumatology, oncology, diabetes and pelvic health. The unifying skill is assessment before intervention: for any wound, describe location, size, depth, tissue type, exudate, odour, periwound skin, and signs of infection, and record it reproducibly. Know the healing phases and how moisture balance, pressure, shear and perfusion drive or delay closure.
Concepts to own
- Pressure injury classification: stages 1–4, unstageable (obscured by slough or eschar) and deep tissue injury; risk assessment tools such as the Braden scale, where lower scores mean higher risk.
- Debridement methods and dressing selection by tissue type and exudate level - the aim is a moist, not wet, wound bed.
- Venous versus arterial leg ulcers: venous ulcers favour the gaiter region with oedema and haemosiderin; arterial ulcers are often distal, punched-out and painful at rest. Check ankle-brachial index before compression.
- Burns: depth, the rule of nines for adults, and scar management with pressure and positioning.
- Lymphoedema: complex decongestive therapy components, and contraindications to compression.
- Oncology and bone health: caution with high-load manual therapy and exercise in the presence of bone metastases or significant osteoporosis.
Traps
Staging errors are frequent - you cannot stage a wound covered by eschar, and a blistering intact deep tissue injury is not stage 1. Applying compression without vascular assessment is a classic unsafe answer. Also watch for questions that treat all leg ulcers as venous, or that ignore sensory loss and skin fragility in diabetes.
Rule of thumb
Measure ankle-brachial index before applying compression to a leg. Values around 1.0–1.4 are normal; below roughly 0.8–0.9 suggests arterial compromise, and compression should be modified, deferred, or done only under specialist supervision. When the stem gives you an ABI, it is there to be used.