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Anorexia nervosa medical instability — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Anorexia nervosa medical instabilityUSMLE Step 3

A 56-year-old man with diabetes has rapidly progressive calf pain, edema, violaceous bullae, fever, hypotension, and pain extending beyond the visible erythema. Sodium is 128 mEq/L, lactate is 5.1 mmol/L, and radiography shows no gas. Broad cultures are obtained. Which management is most appropriate?

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Correct answer: C — Arrange immediate operative exploration and debridement while starting broad intravenous antibiotics

The best answer is “Arrange immediate operative exploration and debridement while starting broad intravenous antibiotics”. The rapid progression, shock, bullae, and pain out of proportion make necrotizing soft-tissue infection likely even without radiographic gas. Immediate surgical exploration and repeated debridement are decisive, while broad therapy covers streptococci, clostridia, gram-negative organisms, anaerobes, and MRSA. Imaging, narrow monotherapy, superficial drainage, or anticoagulation must not delay operative source control.

Reference: IDSA Guideline: Skin and Soft Tissue Infections: https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/