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Worksheetsnec fasch
Total questions: 17
Worksheet time: 9mins
Q1. What best defines necrotising fasciitis?
A. A deep dermal infection characterised by neutrophilic infiltration and epidermal necrosis
B. A rapidly progressive infection of the superficial fascia with secondary subcutaneous tissue necrosis
C. An infection limited to muscle tissue with early bacteraemia
D. A chronic granulomatous infection of connective tissue planes
Q2. Which microbial pattern is most classically associated with necrotising fasciitis?
A. Pure anaerobic mono-infection dominated by Clostridium species
B. Polymicrobial synergistic infection or monomicrobial Group A Streptococcus
C. Viral–bacterial co-infection driven by herpesviruses
D. Fungal soft tissue invasion in immunocompetent hosts
Q3. Which patient profile carries the highest pre-test probability of necrotising fasciitis?
A. Healthy young adult with exercise-related myalgia
B. Poorly controlled diabetic with rapidly progressive limb pain after minor trauma
C. Elderly patient with chronic venous eczema and itch
D. Isolated angioedema after penicillin exposure
Q4. Which early clinical feature best distinguishes necrotising fasciitis from uncomplicated cellulitis?
A. Poorly demarcated erythema with subfebrile temperature
B. Lymphangitis with tender regional nodes
C. Severe pain out of proportion to visible skin changes
D. Warmth and oedema that improves with limb elevation
Q5. Which cutaneous finding most strongly suggests established necrotising soft tissue infection?
A. Sharply marginated erythema with scaling edges
B. Violaceous skin discolouration with haemorrhagic bullae and patchy anaesthesia
C. Uniform hyperpigmentation following inflammation
D. Localised desquamation without blistering
Q6. In a haemodynamically stable but clinically suspicious case, what is the most appropriate immediate management?
A. arrange urgent CT scan
B. Start oral antibiotics and observe for 12–24 hours
C. Initiate broad-spectrum IV antibiotics and obtain immediate surgical input
D. Await inflammatory markers and blood culture results before escalation
Q7. Which initial antimicrobial strategy is most appropriate in suspected necrotising fasciitis?
A:beta-lactam monotherapy
B. Broad-spectrum IV combination therapy including toxin-suppressing agents
C. Stepwise escalation only once culture results return
D. Give Clindamycin only in suspected MSRA
Q8. Which intervention most directly reduces mortality in necrotising fasciitis?
A. Early corticosteroid administration
B. Hyperbaric oxygen as definitive therapy
C. Urgent and repeated aggressive surgical debridement
D. High-dose intravenous immunoglobulin alone
Q9. In suspected necrotising fasciitis, which factor should NOT delay surgical referral?
A. Waiting for CT/MRI
B. Waiting for blood results
C. Waiting to see response to IV antibiotics
D. All of the above
Q10. Why is clindamycin specifically recommended in necrotising fasciitis?
A. It improves renal perfusion
B. It suppresses exotoxin and cytokine production
C. It increases the morbidity rate
D. It improves wound epithelialisation
Q11. Regarding the LRINEC score, which statement is most accurate in ED practice?
A. It reliably rules out necrotising fasciitis if low
B. It replaces clinical judgement
C. It may support suspicion but cannot safely exclude the diagnosis
D. It is validated as a screening tool in primary care
Q13. A surgical registrar is unconvinced about your concern for necrotising fasciitis. What is the most effective escalation strategy?
A. Document concerns but take no further action
B: ask him to come to do the finger sweep test
C. Escalate to senior surgical and ED consultants directly
D. Discharge :D
Q13. Which laboratory trend is most concerning for evolving necrotising fasciitis rather than uncomplicated cellulitis?
A. Isolated mild leukocytosis with normal CRP
B. Rising serum lactate with hyponatraemia
C. Normal creatine kinase with stable renal function
D. Mild anaemia with raised platelets
Q14. Which imaging finding is most suggestive of necrotising fasciitis?
A. Diffuse subcutaneous oedema without gas
B. Fascial thickening with fat stranding but no gas
C. Soft tissue gas tracking along fascial planes
D. Isolated skin thickening only
Q15. Which anatomical location is associated with the highest mortality in necrotising fasciitis?
A. Upper limbs
B. Lower limbs
C. Perineum (Fournier’s gangrene)
D. Scalp
Q16. Which of the following best differentiates necrotising fasciitis from gas gangrene clinically?
A. Presence of fever
B. Sweet, foul-smelling “dishwater” exudate
C: Gas gangrene happens only after surgery
D: Gas gangrene is NOT painful
Q17. Which statement regarding pain in necrotising fasciitis is most accurate?
A. Pain is usually mild early on
B. Pain often improves as infection progresses
C. Severe pain may give way to anaesthesia as nerves are destroyed
D. Pain only occurs when palpating the erythematous area
