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CWCA (Other exams) practice questions

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Question 1Wound Healing and Tissue Repair

Which process occurs immediately after tissue injury, before the inflammatory phase begins?

  1. Neutrophil phagocytosis of bacteria
  2. Myofibroblast-mediated wound contraction
  3. Platelet aggregation and fibrin clot formation Correct answer.
  4. Fibroblast deposition of collagen

Explanation

Hemostasis is the immediate response to injury: platelets adhere and aggregate, and the coagulation cascade produces a fibrin clot. Inflammation, proliferation, and remodeling follow in sequence.

Question 2Wound Healing and Tissue Repair

Which white blood cell is typically the first to arrive in large numbers at an acute wound?

  1. Macrophage
  2. Fibroblast
  3. Lymphocyte
  4. Neutrophil Correct answer.

Explanation

Neutrophils are the first leukocytes to reach an acute wound, arriving within hours and peaking early. Macrophages arrive afterward and become the predominant inflammatory cell by roughly 48 to 72 hours.

Question 3Wound Healing and Tissue Repair

Which collagen type is most abundant in newly formed granulation tissue?

  1. Type IV
  2. Type II
  3. Type I
  4. Type III Correct answer.

Explanation

Early granulation tissue contains predominantly type III collagen, which is gradually replaced by type I collagen during remodeling. Type IV collagen is found in basement membranes, and type II is characteristic of cartilage.

Question 4Wound Healing and Tissue Repair

Which wound environment best supports epithelial cell migration and wound closure?

  1. A surface covered by dry eschar
  2. A moist, temperature-controlled surface Correct answer.
  3. A dry, desiccated surface
  4. A surface repeatedly exposed to air

Explanation

A moist wound surface allows keratinocytes to migrate and divide, supporting epithelialization. Desiccation and eschar formation create a physical barrier that impedes cell migration.

Question 5Wound Healing and Tissue Repair

Which cell type is primarily responsible for wound contraction?

  1. Keratinocytes
  2. Myofibroblasts Correct answer.
  3. Neutrophils
  4. Endothelial cells

Explanation

Myofibroblasts contain smooth muscle actin and generate contractile forces that pull wound margins together. Keratinocytes resurface the wound, endothelial cells form new vessels, and neutrophils debride the wound.

Question 6Wound Healing and Tissue Repair

Which vitamin is required for hydroxylation of proline and lysine during collagen synthesis?

  1. Vitamin D
  2. Vitamin C Correct answer.
  3. Vitamin K
  4. Vitamin A

Explanation

Vitamin C is a cofactor for prolyl and lysyl hydroxylase, enzymes that stabilize the collagen triple helix. Deficiency impairs collagen cross-linking and wound strength.

Question 7Wound Healing and Tissue Repair

Healing by primary intention is characteristic of which wound?

  1. A full-thickness burn left to heal by contraction
  2. A clean surgical incision with approximated edges Correct answer.
  3. An infected surgical wound packed open
  4. A pressure injury with necrotic tissue

Explanation

Primary intention occurs when a clean wound has approximated edges and minimal tissue loss, allowing rapid epithelialization with a small scar. Wounds with tissue loss or infection that are left open heal by secondary intention.

Question 8Wound Healing and Tissue Repair

Which phase of wound healing lasts the longest?

  1. Proliferation
  2. Inflammation
  3. Hemostasis
  4. Remodeling Correct answer.

Explanation

The remodeling phase can continue for months to years as collagen is reorganized, cross-linked, and strengthened. Hemostasis lasts minutes, inflammation days, and proliferation weeks.

Question 9Wound Healing and Tissue Repair

What is the principal role of macrophages in the inflammatory phase of wound healing?

  1. Contraction of wound margins
  2. Vasodilation and histamine release
  3. Debridement of debris and release of growth factors Correct answer.
  4. Formation of the fibrin plug

Explanation

Macrophages phagocytose debris and apoptotic neutrophils and secrete growth factors such as PDGF and TGF-beta that drive the transition to proliferation. Histamine release is mainly a mast cell function, and clot formation belongs to hemostasis.

Question 10Wound Healing and Tissue Repair

In an uninfected wound, which inflammatory cell predominates after the first 48 to 72 hours?

  1. Eosinophil
  2. Neutrophil
  3. Macrophage Correct answer.
  4. Mast cell

Explanation

Neutrophils dominate the first one to two days, after which macrophages become the predominant inflammatory cell. Macrophages orchestrate debridement and the transition to the proliferative phase.

Question 11Wound Healing and Tissue Repair

Which growth factor is the principal chemoattractant and mitogen for fibroblasts during repair?

  1. Vascular endothelial growth factor
  2. Platelet-derived growth factor Correct answer.
  3. Erythropoietin
  4. Epidermal growth factor

Explanation

Platelet-derived growth factor, released by platelets and macrophages, is chemotactic and mitogenic for fibroblasts and stimulates collagen production. VEGF acts mainly on endothelial cells, and EGF acts mainly on epithelial cells.

Question 12Wound Healing and Tissue Repair

Vascular endothelial growth factor primarily drives which process in wound healing?

  1. Wound contraction
  2. Collagen cross-linking
  3. Angiogenesis Correct answer.
  4. Epithelial migration

Explanation

VEGF stimulates endothelial cell proliferation and migration, leading to formation of new capillaries. This angiogenic response restores oxygen and nutrient delivery to healing tissue.

Question 13Wound Healing and Tissue Repair

During epithelialization, keratinocytes migrate from the wound margins across which substrate?

  1. Exposed subcutaneous fat
  2. Dry eschar
  3. Viable moist granulation tissue Correct answer.
  4. Intact stratum corneum

Explanation

Keratinocytes require a moist, viable bed of granulation tissue over which to migrate and resurface the wound. Dry eschar or nonviable tissue blocks epithelial migration.

Question 14Wound Healing and Tissue Repair

Wound contraction by myofibroblasts typically begins during which phase?

  1. Hemostatic
  2. Proliferative Correct answer.
  3. Inflammatory
  4. Remodeling

Explanation

Myofibroblasts appear during the proliferative phase and begin contracting the wound margins, a process that continues into remodeling. Hemostasis and inflammation occur before contraction begins.

Question 15Wound Healing and Tissue Repair

At the end of the remodeling phase, healed skin tensile strength is approximately what percentage of uninjured skin?

  1. 50%
  2. 20%
  3. 80% Correct answer.
  4. 65%

Explanation

Remodeling increases collagen cross-linking and alignment, but tensile strength plateaus at about 80% of uninjured skin. Healed tissue never regains full original strength.

Question 16Wound Healing and Tissue Repair

Systemic corticosteroid therapy delays wound healing chiefly by doing which?

  1. Enhancing angiogenesis
  2. Stimulating epithelial migration
  3. Increasing collagen cross-linking
  4. Suppressing inflammation and fibroblast proliferation Correct answer.

Explanation

Corticosteroids blunt the inflammatory response, impair macrophage function, and inhibit fibroblast proliferation and collagen synthesis. These effects slow both the inflammatory and proliferative phases of repair.

Question 17Wound Healing and Tissue Repair

Which combination of diabetes-related changes most directly impairs wound healing?

  1. Enhanced collagen synthesis and angiogenesis
  2. Increased neutrophil function and vasodilation
  3. Reduced blood glucose and improved perfusion
  4. Microvascular disease and peripheral neuropathy Correct answer.

Explanation

Diabetes causes microangiopathy that reduces tissue perfusion and neuropathy that reduces protective sensation, both of which impair healing and increase ulcer risk. Hyperglycemia also compromises leukocyte function and collagen synthesis.

Question 18Wound Healing and Tissue Repair

A biofilm in a wound is best described as which of the following?

  1. A single planktonic bacterium suspended in wound exudate
  2. A surface-attached microbial community encased in extracellular matrix Correct answer.
  3. A collection of dead neutrophils forming pus
  4. A sterile fibrinous layer covering granulation tissue

Explanation

A biofilm is a structured, surface-attached community of microorganisms embedded in an extracellular matrix. This organization makes the organisms tolerant to antibiotics and host defenses.

Question 19Wound Healing and Tissue Repair

Chronic wounds often fail to heal because of an excess of which class of enzymes?

  1. Kinases
  2. Lipases
  3. Matrix metalloproteinases Correct answer.
  4. Proteasomes

Explanation

Chronic wounds frequently show elevated matrix metalloproteinases relative to their inhibitors, leading to degradation of growth factors and extracellular matrix. This proteolytic imbalance contributes to a stalled repair process.

Question 20Wound Healing and Tissue Repair

Delayed primary closure is most appropriate for which wound?

  1. A wound with exposed bone and heavy contamination
  2. A contaminated wound observed for several days before closure Correct answer.
  3. A clean facial laceration seen within 6 hours
  4. A chronic venous ulcer with biofilm

Explanation

Delayed primary closure leaves a contaminated wound open for several days of cleaning and debridement, then closes it before granulation tissue fills the defect. Clean, fresh lacerations are typically closed primarily, whereas heavily contaminated or chronic wounds are managed differently.

Question 21Wound Healing and Tissue Repair

Which feature best explains scarless healing of early-gestation fetal wounds?

  1. A vigorous neutrophil response with rapid debridement
  2. Rapid collagen cross-linking and early scar maturation
  3. Blunted inflammation with TGF-beta3 predominance over TGF-beta1 Correct answer.
  4. High TGF-beta1 activity driving dense collagen deposition

Explanation

Early fetal wounds heal with minimal inflammation and a higher ratio of TGF-beta3 to TGF-beta1, favoring regenerative matrix organization rather than fibrosis. A vigorous inflammatory response and TGF-beta1 dominance promote scarring.

Question 22Wound Healing and Tissue Repair

What effect do accumulated senescent fibroblasts have in a chronic wound?

  1. They increase wound tensile strength
  2. They promote angiogenesis
  3. They accelerate keratinocyte migration
  4. They secrete MMPs and inflammatory cytokines Correct answer.

Explanation

Senescent fibroblasts adopt a senescence-associated secretory phenotype, releasing matrix metalloproteinases and inflammatory cytokines that degrade matrix and sustain chronic inflammation. This contributes to the stalled healing seen in chronic wounds.

Question 23Wound Healing and Tissue Repair

Why does local tissue hypoxia impair wound healing?

  1. It limits oxygen-dependent neutrophil killing and collagen synthesis Correct answer.
  2. It accelerates epithelial migration across the wound
  3. It reduces matrix metalloproteinase activity
  4. It increases fibroblast proliferation and collagen cross-linking

Explanation

Oxygen is required for the neutrophil respiratory burst and for prolyl hydroxylase activity during collagen synthesis. Severe or prolonged hypoxia therefore impairs both microbial killing and matrix production.

Question 24Wound Healing and Tissue Repair

Which mechanism best explains impaired healing in previously irradiated tissue?

  1. Increased tensile strength of the dermis
  2. Obliterative endarteritis with progressive hypovascularity Correct answer.
  3. Transient vasodilation with increased perfusion
  4. Enhanced fibroblast proliferation

Explanation

Radiation causes progressive obliterative endarteritis and fibrosis, reducing vascularity and delivery of oxygen and nutrients. This hypovascular, fibrotic bed impairs both inflammation and proliferation during repair.

Question 25Wound Healing and Tissue Repair

Which age-related change most directly slows the proliferative phase of healing?

  1. Thickened dermal collagen bundles
  2. Increased macrophage chemotaxis
  3. Reduced fibroblast proliferation and collagen synthesis Correct answer.
  4. Higher resting blood flow to skin

Explanation

Aging reduces fibroblast proliferation, collagen synthesis, and the angiogenic response, which slows granulation tissue formation and re-epithelialization. These changes prolong the proliferative phase and delay wound closure.

Question 26Wound Healing and Tissue Repair

Which blood component is the first to accumulate at the site of a fresh injury and thereby initiates hemostasis?

  1. Platelets Correct answer.
  2. Circulating fibrocytes
  3. Neutrophils
  4. Tissue macrophages

Explanation

Hemostasis is the opening phase of repair, and platelets are the first formed elements to reach the injured vessel wall. They adhere to exposed subendothelial collagen, aggregate to form the platelet plug, and degranulate to release chemoattractants and growth factors that recruit inflammatory cells. Leukocyte infiltration follows rather than initiates this step.

Question 27Wound Healing and Tissue Repair

The collagen newly deposited in granulation tissue during the proliferative phase is predominantly which type, before it is progressively replaced during remodeling?

  1. Type V
  2. Type III Correct answer.
  3. Type I
  4. Type IV

Explanation

Granulation tissue is rich in type III collagen, which is synthesized rapidly by fibroblasts and is thinner and less organized than mature collagen. During remodeling, metalloproteinases degrade this provisional matrix and type I collagen progressively predominates, restoring tensile strength. Type IV collagen is a basement membrane component rather than a dermal matrix collagen.

Question 28Wound Healing and Tissue Repair

A raised scar that extends well beyond the boundaries of the original wound and recurs after excision is best identified as which entity?

  1. Hypertrophic scar
  2. Wound contracture
  3. Marjolin ulcer
  4. Keloid Correct answer.

Explanation

Keloids are characterized by excessive collagen deposition that spreads past the original wound margins and tends to recur after simple excision. Hypertrophic scars also rise above the skin but remain confined to the wound boundary and often regress over time. Distinguishing these two guides the choice of intralesional or surgical therapy.

Question 29Wound Healing and Tissue Repair

A clean, shallow surgical wound with intact surrounding skin is being dressed. Which dressing strategy best supports epithelialization?

  1. An open dressing that lets the surface dry and form a firm eschar
  2. Gauze soaked in an antiseptic solution left undisturbed for seven days
  3. Wet-to-dry gauze changed twice daily to debride the surface
  4. A semipermeable film that keeps the bed moist Correct answer.

Explanation

A moist wound bed allows keratinocytes to migrate more rapidly across the surface and reduces crust formation that obstructs cell movement. Semipermeable film dressings maintain that moisture while permitting gas exchange and shielding the wound from contamination. Desiccation and cytotoxic agents both slow epithelialization.

Question 30Wound Healing and Tissue Repair

Which structural feature of scar collagen best accounts for the permanently reduced tensile strength of healed skin?

  1. Parallel, thinner fibrils lacking a basket-weave arrangement Correct answer.
  2. Increased elastin content that lowers the stiffness of the dermal matrix
  3. Excess type I collagen laid down in a random basket-weave pattern with dense cross-linking
  4. Persistence of type III collagen as the dominant dermal collagen

Explanation

Uninjured dermis consists of thick collagen fibrils woven in a random basket-weave that distributes load in multiple directions. Scar collagen is deposited in thinner bundles aligned along lines of tension, so it resists force well in one axis but fails at lower loads overall. This architectural difference, not merely collagen quantity, sets the ceiling on recovered strength.

Question 31Patient and Wound Assessment

When measuring a wound with a disposable ruler, how is wound length determined?

  1. Along the axis of the nearest joint
  2. Left to right across the wound bed
  3. Head to toe, regardless of orientation Correct answer.
  4. The longest dimension of the wound in any direction

Explanation

Length is measured along the body's long axis, described as 12 o'clock to 6 o'clock on a clock face, regardless of how the wound lies. Width is measured perpendicular to length, and depth is measured by gently inserting a swab. Keeping the same reference orientation each time allows valid comparison over time.

Question 32Patient and Wound Assessment

Which of these is a subscale of the Braden Scale for predicting pressure injury risk?

  1. Body mass index
  2. Serum albumin level
  3. Moisture Correct answer.
  4. Patient age

Explanation

The Braden Scale has six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Each is scored and summed to give a total risk score. Laboratory values, BMI, and age are not Braden items.

Question 33Patient and Wound Assessment

A pressure injury presents as a shallow open ulcer with a pink or red, moist wound bed and no visible slough. Which stage does this describe?

  1. Stage 1
  2. Deep tissue pressure injury
  3. Stage 3
  4. Stage 2 Correct answer.

Explanation

Stage 2 is partial-thickness loss of skin with exposed dermis; the wound bed is viable, pink or red, and moist, and may also appear as an intact or ruptured serum-filled blister. Adipose tissue and deeper structures are not visible.

Question 34Patient and Wound Assessment

Which term describes red, moist, pebbly tissue that fills a healing wound bed?

  1. Slough
  2. Eschar
  3. Granulation tissue Correct answer.
  4. Epibole

Explanation

Granulation tissue is new connective tissue with a rich capillary network, appearing red, moist, and granular. Its presence signals that the wound bed is progressing toward closure. Eschar and slough are devitalized tissue, and epibole refers to rolled wound edges.

Question 35Patient and Wound Assessment

A wound's edges are thickened, rolled, and turned inward. What does this finding most likely indicate?

  1. A deep tissue pressure injury developing
  2. Normal epithelial advancement across the wound
  3. Maceration of the periwound skin
  4. Epibole, which signals stalled healing Correct answer.

Explanation

Rolled, thickened margins are called epibole and occur when epithelial cells migrate down the wound wall instead of across the bed. The margin usually must be opened or debrided before healing can resume.

Question 36Patient and Wound Assessment

Which exudate description is most consistent with a wound infection?

  1. Absent, with a dry wound bed
  2. Thick, opaque, and yellow-green Correct answer.
  3. Pale pink and watery
  4. Clear, straw-colored, and thin

Explanation

Purulent exudate is thick, opaque, and yellow, green, or gray, and often accompanied by odor and surrounding inflammation. A change in the amount, color, or consistency of drainage from the patient's baseline is an important warning sign of infection.

Question 37Patient and Wound Assessment

Which describes the correct Levine technique for obtaining a wound swab for culture?

  1. Collect drainage from intact periwound skin
  2. Soak the swab in pooled exudate
  3. Swab lightly, including any eschar and slough
  4. Press and rotate swab over 1 cm² of tissue Correct answer.

Explanation

The Levine technique samples viable wound tissue: after cleansing, the swab is pressed and rotated over about 1 cm² with enough force to express fluid from the tissue. This recovers tissue pathogens more reliably than a dry surface swab or a sample of pooled drainage.

Question 38Patient and Wound Assessment

The PUSH Tool scores a pressure injury using which three parameters?

  1. Depth, odor, and pain
  2. Periwound color, edema, and warmth
  3. Surface area, exudate, tissue type Correct answer.
  4. Braden score, age, and location

Explanation

The PUSH Tool uses surface area (length times width), exudate amount, and predominant tissue type, each scored on a 0-to-4 or 0-to-5 scale. The three scores are summed, and serial totals are tracked to show whether the wound is improving.

Question 39Patient and Wound Assessment

A venous leg ulcer has not decreased in size after 8 weeks of appropriate compression. The bed is dull, and a thin film reforms each time it is cleansed. What is the most likely explanation?

  1. Overgranulation of the wound edges
  2. Biofilm formation in the wound bed Correct answer.
  3. Normal wound contraction
  4. Contact dermatitis from the dressing

Explanation

Biofilm is a structured bacterial community embedded in an extracellular matrix that resists host defenses and many topical antimicrobials. It classically produces a dull, slimy film that reforms after cleansing and is associated with stalled healing. Effective management usually combines repeated debridement with appropriate antimicrobial therapy.

Question 40Patient and Wound Assessment

A sacral pressure injury is covered by a firmly adherent black eschar. Which classification is correct at this time?

  1. Unstageable Correct answer.
  2. Stage 4
  3. Deep tissue pressure injury
  4. Stage 2

Explanation

When slough or eschar obscures the wound bed, depth cannot be determined, so the injury is classified as unstageable until enough necrotic tissue is removed to see the base. A stable, dry, intact eschar on a heel is an exception and is left intact.

Question 41Patient and Wound Assessment

How is a 10-g (5.07) monofilament correctly applied during foot sensory testing?

  1. Apply while the patient watches each touch
  2. Drag the filament briskly across the sole of the foot
  3. Test only over areas of thickened callus
  4. Press until the filament buckles, hold 1 second Correct answer.

Explanation

The filament is applied perpendicular to the skin and pushed until it bows, held for about one second, and the patient reports whether it is felt. Testing is performed with the patient's eyes closed at standardized plantar sites, and callused or ulcerated areas are avoided.

Question 42Patient and Wound Assessment

Which periwound finding is most consistent with maceration?

  1. Firm, raised, and warm skin
  2. White, soft, wrinkled skin Correct answer.
  3. Dark purple discoloration that does not blanch
  4. Dry, scaly, and cracked skin

Explanation

Prolonged moisture exposure causes the stratum corneum to absorb water, producing skin that is white, softened, and wrinkled. Macerated skin is weaker, more permeable, and more likely to break down or enlarge the wound.

Question 43Patient and Wound Assessment

How should undermining be assessed and documented?

  1. Measure the longest surface dimension and halve it
  2. Record the number of millimeters of wound contraction per week
  3. Probe under the edge and record depth and clock position Correct answer.
  4. Estimate the percentage of the wound bed that is covered by slough

Explanation

Undermining is destruction of tissue beneath intact wound edges. A cotton-tipped applicator is inserted perpendicular to the edge to the limit of the tract, and the depth plus its clock-face location (12 o'clock at the patient's head) is recorded.

Question 44Patient and Wound Assessment

In a patient with diabetes and a plantar ulcer, a sterile probe passes easily to a hard, gritty surface at the base. What does this finding most suggest?

  1. An abscess within the plantar fascia
  2. Osteomyelitis of the underlying bone Correct answer.
  3. Normal granulation tissue at the base
  4. A superficial partial-thickness ulcer

Explanation

A positive probe-to-bone test in a diabetic foot ulcer is highly specific for osteomyelitis and warrants plain films or MRI plus specialist referral. Palpating bone through the wound indicates that the ulcer extends to the depth of the bone.

Question 45Patient and Wound Assessment

Which description matches slough in a wound bed?

  1. Pale pink and flush with the wound edges
  2. Black, leathery, and firmly adherent
  3. Yellow, tan, soft, and stringy Correct answer.
  4. Bright red, beefy, and granular

Explanation

Slough is devitalized tissue that is moist, soft, and yellow-tan; it may be loosened with surfactants, irrigation, or debridement. Eschar is dry, dark, and leathery, while granulation tissue is red and granular and new epithelium is pale pink.

Question 46Patient and Wound Assessment

Which assessment finding points to arterial insufficiency rather than venous disease as the ulcer's cause?

  1. Punched-out ulcer on the toe with a pale, dry bed Correct answer.
  2. Wound bed with heavy, malodorous drainage
  3. Brown, hardened surrounding skin
  4. Irregular ulcer over the medial malleolus

Explanation

Arterial ulcers are typically pale, dry, and punched out, located on the toes, lateral malleolus, or pressure points, and are often intensely painful. Venous ulcers are usually shallow and weepy near the medial malleolus with surrounding hemosiderin staining and fibrosis.

Question 47Patient and Wound Assessment

Which finding best distinguishes incontinence-associated dermatitis from a pressure injury?

  1. Diffuse perineal redness with no tissue loss Correct answer.
  2. A shallow ulcer with a red, moist wound bed
  3. Skin that does not blanch when pressed firmly
  4. Full-thickness loss with visible subcutaneous fat

Explanation

Incontinence-associated dermatitis is moisture-associated skin damage caused by urine and stool; it presents as diffuse erythema and superficial erosion confined to skin in contact with the irritant. Absence of necrosis or full-thickness loss and a pattern that follows the diaper contact area are the key discriminators.

Question 48Patient and Wound Assessment

A wound measured 5.0 × 3.5 cm at baseline and 4.0 × 3.0 cm four weeks later. What is the approximate reduction in surface area?

  1. About 69%
  2. About 45%
  3. About 15%
  4. About 31% Correct answer.

Explanation

Baseline area is 17.5 cm² and current area is 12.0 cm², a decrease of 5.5 cm². Dividing 5.5 by 17.5 gives roughly 31% reduction, which is a practical marker of healing progress over time.

Question 49Patient and Wound Assessment

A patient with advanced dementia grimaces and guards during dressing changes but cannot describe pain. Which approach is best?

  1. Use a validated observational tool such as PAINAD Correct answer.
  2. Delay analgesia until vital signs become abnormal
  3. Assume the patient is not in pain unless they cry out
  4. Wait for the patient to request pain medication

Explanation

Patients who cannot self-report require a structured behavioral tool such as PAINAD or FLACC, which scores facial expression, body language, and vocalization. Behaviors such as guarding and grimacing during wound care are legitimate indicators of pain and should prompt premedication.

Question 50Patient and Wound Assessment

Which laboratory value best reflects short-term nutritional status in a patient with a healing wound?

  1. C-reactive protein
  2. Hemoglobin A1c
  3. Serum prealbumin Correct answer.
  4. Serum albumin

Explanation

Prealbumin (transthyretin) has a half-life of about two days and responds quickly to changes in protein and energy intake, making it more useful for short-term monitoring than albumin. Because inflammation also lowers prealbumin, results must be interpreted alongside the clinical picture.