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Invasive group A streptococcal infection — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesInvasive group A streptococcal infectionSCE Acute Medicine

A 76-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show severe limb pain, shock, rash and Gram-positive cocci in chains. What is the most appropriate next step in management?

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

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Correct answer: B — Give high-dose beta-lactam plus clindamycin and seek surgical review

The key discriminator is that severe limb pain, shock, rash and Gram-positive cocci in chains, which makes Give high-dose beta-lactam plus clindamycin and seek surgical review the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Arrange routine outpatient follow-up are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: UKHSA iGAS guidance; BNF