REGARDING NECROTIZING FASCIITIS

1) Group A Streptococcus (GAS) is a common cause of Type I necrotizing fasciitis.

• TRUE

• FALSE

Answer explanation

Answer: False

Explanation: GAS is typically the cause of Type II necrotizing fasciitis. Type I is usually polymicrobial involving mixed aerobic and anaerobic organisms.

2) Pain out of proportion to clinical findings is a hallmark of necrotizing fasciitis.

• TRUE

• FALSE

Answer explanation

Answer: True

Explanation: Severe pain, often exceeding the physical appearance, is one of the earliest and most reliable signs of necrotizing fasciitis.

 

3) Crepitus and skin bullae are late findings in necrotizing fasciitis.

• TRUE

• FALSE

Answer explanation

Answer: True

Explanation: These findings generally appear after significant tissue damage has occurred.

4) Polymicrobial (Type I) necrotizing fasciitis is more commonly associated with diabetic patients.

• TRUE

• FALSE

Answer explanation

Answer: True

Explanation: Diabetic patients, especially those with peripheral vascular disease, are more prone to polymicrobial infections like Type I NF.

5) Necrotizing fasciitis most commonly affects the perineum in all age groups.

• TRUE

• FALSE

Answer explanation

Answer: False

Explanation: The extremities are the most commonly involved sites. Fournier gangrene, which affects the perineum, is more specific to certain populations.

6) Initial skin changes in necrotizing fasciitis are typically severe and obvious.

• TRUE

• FALSE

Answer explanation

Answer: False

Explanation: Due to deep fascial involvement and poor perfusion, early skin changes may be normal or mild despite extensive underlying necrosis.

7) Blood cultures are usually positive in monomicrobial necrotizing fasciitis.

• TRUE

• FALSE

Answer explanation

Answer: True

Explanation: Monomicrobial (Type II) NF, especially those caused by GAS, has higher rates of bacteremia than polymicrobial cases.

8) A LRINEC score ≥6 reliably excludes necrotizing fasciitis.

• TRUE

• FALSE

Answer explanation

Answer: False

Explanation: Although a score ≥6 indicates risk, the LRINEC tool lacks sensitivity and cannot be used to rule out necrotizing fasciitis.

 

9) Elevated creatine kinase (CK) and AST levels can suggest muscle involvement in necrotizing infections.

• TRUE

• FALSE

Answer explanation

Answer: True

Explanation: High CK and AST are markers of myonecrosis and are often elevated in necrotizing myositis or fasciitis involving muscle.

10) MRI is the gold standard for diagnosis of necrotizing fasciitis.

• TRUE

• FALSE

Answer explanation

Answer: False

Explanation:
MRI is the most sensitive imaging modality for detecting early necrotizing fasciitis.

MRI offers excellent soft tissue detail and can detect early fascial edema and non-enhancement

MRI is sensitive but not specific and may delay treatment; SURGICAL exploration is the diagnostic gold standard.