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Necrotising fasciitis — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesNecrotising fasciitisSCE Acute Medicine

A 57-year-old man is assessed on the acute medical unit. He has severe leg pain out of proportion to signs, fever and rapidly spreading erythema after a minor wound. Sodium is 126 mmol/L and creatinine is rising. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: B — Request urgent surgical review and broad-spectrum intravenous antibiotics

Request urgent surgical review and broad-spectrum intravenous antibiotics is the best answer because pain out of proportion with systemic toxicity suggests necrotising infection needing urgent surgery and antibiotics. Start therapeutic anticoagulation while awaiting imaging is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Definitive management is surgical debridement, not antibiotics alone.

Reference: NICE NG141; surgical infection guidance