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Cellulitis — MCCQE Part 1 MCQ

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HardSkin LesionsCellulitisMCCQE Part 1

A stable adult has unilateral nonpurulent lower-leg cellulitis after a fissure between the toes. There is no fluctuance, systemic toxicity or MRSA history. Which initial plan is best?

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Correct answer: B — Oral streptococcal/MSSA coverage, elevation and reassessment

This is uncomplicated nonpurulent cellulitis in a stable patient. Initial outpatient therapy should cover streptococci and methicillin-susceptible Staphylococcus aureus, with limb elevation, treatment of the toe-web portal and planned reassessment. Incision and drainage is for a drainable purulent collection. Routine broad MRSA or intravenous therapy is unnecessary without risk factors or systemic illness. DVT should be assessed when clinical probability supports it, but empiric full-dose anticoagulation is not a substitute for evaluation.

Reference: Alberta Health Services, Adult Cellulitis Clinical Pathway, https://publicshare.albertahealthservices.ca/teams/policydocuments/1/klink/et-klink-ckv-cellulitis-adult.pdf