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This quiz tests your diagnostic skills for leg ulceration.
For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.
Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.
When you finish the quiz, you can download a certificate.
What is the diagnosis?
Severe cellulitis or early necrotising fasciitis.
What are the clinical features of this condition?
A hot red swollen limb in a sick patient is characteristic of cellulitis, which is most often streptococcal in origin, or less often, staphylococcal. In this case the edges of the affected area show angulated purple patches, and surface skin is peeling off to reveal the underlying tissues, suggesting the patient may have necrotising fasciitis. Anaesthesia of the affected area indicates deep injury to fascia, not yet present in this case. Necrotising fasciitis may be due to haemolytic streptococcus or mixed organisms, depending on the clinical scenario.
How would you manage this condition?
This is a medical and surgical emergency. The patient should be admitted to hospital. The necrotic tissue should be widely debrided. Intravenous antistreptococcal and broad-spectrum antibiotics should be given while carefully observing whether the inflamed area is continuing to extend.
Finished!
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