Bone and joint infections: suspected necrotising fasciitis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Bone and joint infections: suspected necrotising fasciitis

Sample item

A diabetic man has a swollen, tense leg with skin pain out of proportion to the findings, dusky blisters, tachycardia and a falling blood pressure. What is the most appropriate immediate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Urgent surgical exploration and debridement with broad-spectrum antibiotics

Pain out of proportion, rapidly spreading skin changes and systemic toxicity indicate necrotising fasciitis. This is a surgical emergency, and mortality rises with each hour of delay. Treatment is early radical debridement with resuscitation and broad-spectrum antibiotics covering Gram-positive, Gram-negative and anaerobic organisms, with clindamycin to suppress toxin production.

Option by option

  • A. MRI of the leg before deciding on any treatment

    Waiting for MRI delays surgery in an unstable patient and should not hold up treatment.

  • B. Oral antibiotics and review in 48 hours

    Oral antibiotics and delay would let the infection spread along fascial planes in a toxic patient.

  • C. Urgent surgical exploration and debridement with broad-spectrum antibiotics (correct)

    Correct. Suspicion alone justifies urgent debridement together with resuscitation and intravenous antibiotics.

  • D. Elevation and a compression bandage

    Compression and elevation are for venous or lymphatic oedema and would worsen compartment pressures here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Urgent surgical exploration and debridement with broad-spectrum antibiotics. Pain out of proportion, rapidly spreading skin changes and systemic toxicity indicate necrotising fasciitis.

Why is "MRI of the leg before deciding on any treatment" not the answer?

Waiting for MRI delays surgery in an unstable patient and should not hold up treatment.

Why is "Oral antibiotics and review in 48 hours" not the answer?

Oral antibiotics and delay would let the infection spread along fascial planes in a toxic patient.

Why is "Elevation and a compression bandage" not the answer?

Compression and elevation are for venous or lymphatic oedema and would worsen compartment pressures here.

What concept does this question test?

It tests Bone and joint infections: suspected necrotising fasciitis in Orthopaedics. This is a surgical emergency, and mortality rises with each hour of delay. Treatment is early radical debridement with resuscitation and broad-spectrum antibiotics covering Gram-positive, Gram-negative and anaerobic organisms, with clindamycin to suppress toxin production.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Bone and joint infections: suspected necrotising fasciitis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.