QuestionSBA
QuestionChoice
Analgesia is a good idea considering this patient has severe pain. However, given its severity, a stronger choice may be more appropriate e.g. morphine or codeine. Also, there is little indication for fluids at this point as we do not know her blood pressure or hydration status.
10000563
c
NSAIDs and supportive IV fluids
QuestionChoice
Whilst this would help with the infection, it would not treat the underlying infection of the deep tissue - removal of the infection tissue via surgical debridement is needed to ensure all infection is treated.
10000562
b
Broad-spectrum IV antibiotics only
QuestionChoice
This is the correct treatment pathway for necrotising fasciitis, which is what this patient is presenting with. Typical symptoms of necrotising fasciitis include pain which is out of proportion to clinical findings, skin discolouration, fever, and local swelling. Urgent surgical debridement is needed to remove the infected tissue to prevent the spread of the infection, and antibiotics are needed to treat the infection.
10000561
a
Broad-spectrum IV antibiotics and urgent surgical debridement
QuestionChoice
This is the treatment for an anaphylactic reaction (severe type 1 hypersensitivity reaction), which is not what this patient is presenting with. In a anaphylactic reaction, we would see airway and/or circulation compromise with a rapid onset of allergic symptoms such as wheeze and urticaria, rather than this patient's fever and severe pain which suggests an infection.
10000565
e
IM adrenaline
QuestionChoice
This may be indicated if this case was a suspected deep vein thrombosis, which would present with pain and swelling of the lower leg. However, the severe pain and fever are more suggestive of a significant infection- necrotising fasciitis. This requires urgent IV antibiotics and surgical debridement.
10000564
d
Oral rivaroxaban
Concept
Chapter
2693
3789
Complications of streptococcus pyogenes
Topic
147
Infectious disease
12659
A 45-year-old woman presents with severe pain in her lower right leg. She ranks the pain a 10/10 when asked. Examination reveals minor swelling and erythema to the area as well as it being warm to the touch. She also has a fever of 39.7C.

What is the most appropriate management of this patient?
a