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Necrotising fasciitis — MCCQE Part 1 MCQ

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HardRashNecrotising fasciitisMCCQE Part 1

46-year-old man presents with rapidly worsening thigh pain after minor trauma. Pain is out of proportion with fever, crepitus and hypotension. Which of the following is the most appropriate next step?

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Correct answer: E — Give broad-spectrum antibiotics and urgent surgical exploration/debridement

Give broad-spectrum antibiotics and urgent surgical exploration/debridement is best because pain out of proportion and systemic toxicity suggest necrotising infection. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Surgery should not wait for imaging if clinical suspicion is high.

Reference: Canadian surgical infectious disease guidance