May Practice Questions

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All answers with explanations can be found at the end of the page!

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Questions will be testing on Cellulitis, Impetigo, NF and SSSS. 

1.A 21-year-old male presents to accident and emergency with severe pain in his left eye. The pain is exacerbated by eye movement and he complains of reduced vision in the left eye. He recently completed a course of antibiotics for tonsillitis.

On examination, his left eye is noticeably more red and oedematous than his right eye. His temperature is recorded at 38.5°C.

Given the most likely diagnosis, what is the best immediate management?

A. Admit the patient for 24 hours for observation

B. Refer for a contrast CT scan of the head

C. Admit the patient for immediate intravenous antibiotic treatment

D. Admit the patient for oral antibiotic treatment

E. Discharge the patient with advice to use hot compresses over the eye

2. An elderly diabetic man with a background of peripheral vascular disease presents with severe sepsis and multi-organ failure. Examination reveals an area of cellulitis on his right leg with blood filled bullae and surgical emphysema. A diagnosis of necrotising fasciitis is suspected.

What is the most appropriate action?

A. Surgical debridement if no response to IV antibiotics

B. MRI to evaluate the extent of soft tissue and bone involvement prior to debridement

C. IV antibiotics and immediate surgical debridement

D. Hyperbaric oxygen therapy

E. IV antibiotics and surgical debridement once patient stabilised

3. A 32-year-old woman presents to her GP due to a swollen leg. On examination her right leg is swollen, tender and warm to touch, her calves are soft and non-tender. She is clinically stable.

Her GP diagnoses her with cellulitis. She is 13 weeks pregnant, has no other medical conditions and takes no regular medications, but is allergic to penicillin.

What is the most appropriate treatment for this patient?

A. Amoxicillin

B. Clarithromycin

C. Ceftriaxone

D. Erythromycin

E. Flucloxacillin

4. A 9 month old baby boy is brought into the Emergency Department by his parents. He has had a fever and been irritable since yesterday. The skin on his body and arms appeared red yesterday, with large blisters forming but these have disappeared. On examination, the image shows how the infant's skin appears today. There is no involvement of the mucous membranes. Considering the likely diagnosis, which of the following is the most appropriate initial management?

A. Intravenous Vancomycin

B. Topical Fusidic acid

C. High-dose Aspirin

D. Intravenous Aciclovir

E. Topical corticosteroids

5. A 10-year-old boy is seen in the GP clinic with his father for a facial rash, predominantly around his mouth. It started as three small blisters four days ago on his upper lip and has rapidly spread all over his face. On examination, there is an evident facial rash with a golden crust-like appearance. Regional lymphadenopathy is noted. A diagnosis of impetigo is confirmed.

What is the recommended timeframe for this child to be kept off school?

A. O2 weeks after commencing antibiotic therapy

B. 48 h after commencing antibiotic therapy

C. Exclusion from school is not necessary

D. 24 h after commencing antibiotic therapy

E. 1 week after commencing antibiotic therapy

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We hope you found these questions useful. For the answers, please refer below

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Q1: C

Explanation: This patient has orbital cellulitis, so it is crucial to admit the patient immediately and give IV antibiotics. Orbital cellulitis occurs when an infection spreads to fat and muscles behind the orbital septum, often caused by an upper respiratory tract infection that has spread through the sinuses. This is a medical emergency that can lead to blindness if left untreated.

Q2: C

Explanation: Swift surgical debridement of all infected and devitalised tissue is the mainstay of management of necrotising fasciitis. IV antibiotics should also be given according to local policy, but will not be sufficient in isolation. Surgical debridement should not be delayed to wait for the patient to stabilise as they may not do so and any delay in debridement will worsen the prognosis. The use of hyperbaric oxygen is controversial and not well established.

Q3: D

Explanation: Erythromycin is the most appropriate antibiotic in this scenario as it not known to be harmful during pregnancy. Amoxicillin contains penicillin. Clarithromycin should be avoided in pregnancy, particularly in the first trimester. Ceftriaxone should be avoided as its effects in pregnancy are not fully known. Supportive treatment alone would be inadequate in this patient, antibiotic therapy is needed. Flucloxacillin is usually used to treat patients with cellulitis, however it contains penicillin so it would be inappropriate in this case.

Q4: A

Explanation: This case describes Staphylococcal Scaled Skin Syndrome (SSSS). SSSS is caused by epidermolytic toxins released from Staphylococcus aureus. It causes intra-epidermal blistering which presents initially as a tender, red, scald-like rash. This progresses to form large thin blisters which burst leaving the skin to peel, as seen in the image. It is a dermatological emergency most commonly affecting infants and young children, partly due to their immature renal system slowing down the removal of toxins.

Intravenous antibiotics are used to treat SSSS. Vancomycin is an example which is used especially if methicillin-resistant Staphylococcus aureus is suspected. Other steps in management include adequate rehydration with fluids, emollients and dressings to the skin.

Q5: B

Explanation: Impetigo is a superficial bacterial skin infection, usually caused by the Staphylococcus aureus bacteria. It occurs when bacteria enter via a break in the skin, eczema, trauma, scabies and chickenpox. A 'golden crust' is characteristic of a staphylococcus skin infection. Patients with impetigo may return to school or daycare following 48h of antibiotic treatment, or when all lesions have crusted over meaning the patient is no longer contagious. 

References:

1. Passmedicine [Internet]. Available from: https://www.passmedicine.com/

2. Quesmed [Internet]. Available from: https://quesmed.com/