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Necrotising Fasciitis — SCE Dermatology MCQ

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HardCutaneous InfectionNecrotising FasciitisSCE Dermatology

A patient with diabetes has rapidly progressive leg pain out of proportion to the skin findings, hypotension, bullae and anaesthesia beyond the erythematous margin. Necrotising fasciitis is strongly suspected, but CT cannot be performed for 90 minutes. What is the immediate priority?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Begin resuscitation and intravenous antibiotics while arranging immediate surgical exploration and debridement

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

C is correct. Necrotising fasciitis is a time-critical surgical and medical emergency. Resuscitation, broad intravenous antimicrobial cover and microbiology input should occur immediately, but definitive source control is urgent surgical exploration and debridement. Imaging may help when the diagnosis is genuinely uncertain in a stable patient; it must not delay surgical review or operation when clinical suspicion is high. A treats antibiotics as definitive therapy. B requires a radiological sign that may be absent. D introduces a dangerous delay. E makes culture confirmation a prerequisite even though microbiology cannot safely exclude the diagnosis at the bedside.

Reference: NHS Lothian severe soft-tissue infection guidance: https://www.rightdecisions.scot.nhs.uk/antimicrobial-prescribing-nhs-lothian/body-systems/skin-and-soft-tissue-infections/severe-soft-tissue-infection-including-suspected-necrotising-fasciitis-and-fourniers-gangrene/