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Necrotizing fasciitis — USMLE Step 2 CK MCQ

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ModerateSurgeryNecrotizing fasciitisUSMLE Step 2 CK

A 46-year-old Middle Eastern man comes to the hospital because of progressive symptoms. History and focused examination are notable for rapidly progressive pain, crepitus, bullae, fever, and shock. Temperature is 101.5°F (38.6°C), blood pressure is 82/48 mmHg, pulse is 132/min, respirations are 28/min, and oxygen saturation is 90% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and imaging support an acute surgical process without suggesting a safer outpatient approach. Which of the following is the most likely diagnosis?

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Correct answer: A — Necrotizing fasciitis

The vignette describes Necrotizing fasciitis, supported by rapidly progressive pain, crepitus, bullae, fever, and shock. Necrotizing fasciitis is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: IDSA 2014 Skin and Soft Tissue Infection Guideline