Approach to non-healing wounds Quiz: Ace Your Exams

A 48-year-old man was brought to the emergency department by EMS for right foot pain. The patient states that he has had right foot pain for “weeks” and that it has progressively worsened. The patient is unsure whether there has been drainage from the wound, and given that it's on the underside of his right foot, he has not been able to visualize it. He has no pain in his legs or feet when walking. He has a history of substance use disorder. He is currently experiencing homelessness. He does not have access to healthcare or medication, but he knows that he should be on medication for one of his health conditions. Temperature is 38.5 °C (101.3 °F), pulse is 110/min, blood pressure is 105/75 mmHg, and SpO₂ is 100% on room air. Physical exam of the right foot is notable for a clean-based ulcer on the bony prominence of the first toe of the right foot with surrounding induration - a probe reaches the bone. There is no lower extremity edema and pulses are intact bilaterally. Lab results are shown below. Which of the following is the most appropriate diagnostic test to perform at this time?  

Lab Test	Result	Reference range
WBC	15.1 x 109/L	4.5-11 x 109/L
Hgb	13.2 g/dL	13.5-17.5 g/dL
Hct	37.1%	41-53%
PLT	553,000/µL	150,000-400,000/µL
CRP	135 mg/L	<0.3 mg/L
ESR	95 mm/h	0-15 mm/h
HGB A1c	9.2%	≤ 6%

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