Rapidly Spreading Leg Cellulitis or Necrotising Fasciitis?
A branching clinical case simulation for a patient presenting with rapidly spreading right leg swelling with severe pain. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5hard20 min6 stages
- Patient
- 58 years, male
- Presenting complaint
- Rapidly spreading right leg swelling with severe pain
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
Mr. Alan Turner, a 58-year-old man with type 2 diabetes on metformin, presents to the ED with a 12-hour history of right leg pain and swelling. He states the pain is out of proportion to the appearance of the leg. On triage, he is febrile (38.9°C), tachycardic (HR 118), and has crepitus on palpation. His lactate is 5.0 mmol/L. You are the Year 5 medical student in the ED. Senior help is available but you must decide on initial management.
What this case teaches
Distinguish necrotising fasciitis from cellulitis; start broad-spectrum antibiotics including clindamycin; resuscitate for sepsis; refer for immediate surgical debridement.
How the case unfolds
- 1Focused HistoryHistory
- 2Examination of the Leg and Systemic AssessmentExamination
- 3Investigations in the EDInvestigations
- 4Formulating a Working DiagnosisDiagnosis
- 5Immediate ManagementTreatment
- 6Post-intervention MonitoringMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.