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Necrotising fasciitis — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesNecrotising fasciitisSCE Acute Medicine

A 34-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 pain out of proportion, crepitus, shock and rapidly progressive skin change. What is the most appropriate next step in management?

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Correct answer: E — Arrange urgent surgical exploration with broad-spectrum antibiotics

The key discriminator is that pain out of proportion, crepitus, shock and rapidly progressive skin change, which makes Arrange urgent surgical exploration with broad-spectrum antibiotics the single best answer. Call critical care for escalation is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Give targeted antidote or reversal therapy 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: NICE NG141