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Exam MCCQE Topic 1 Question 271 Discussion

Actual exam question for Medical Council of Canada's MCCQE exam
Question #: 271
Topic #: 1
A 24-year-old woman presents with rapidly increasing lower leg pain. Less than 24 hours ago, she fell off her bicycle and had some minor abrasions. On examination, she is in severe pain and appears anxious. Local examination of her leg reveals mild discoloration with marked tenderness but no swelling in her calf. Which one of the following is the most likely diagnosis?

Suggested Answer: E Vote an answer

Comprehensive and Detailed Explanation:
Rapid progression of pain out of proportion to exam, systemic symptoms (anxiety), and skinchanges without major swelling are classic for necrotizing fasciitis-a surgical emergency. Discoloration and extreme tenderness should raise immediate concern.
Toronto Notes 2023 - Emergency Medicine / Surgery:
"Necrotizing fasciitis presents with severe pain, systemic toxicity, rapid progression, and early skin changes (discoloration). Pain out of proportion is a key clue." MCCQE1 Objectives (Emergency Medicine > 51-1: Soft Tissue Infections):
"Candidates must recognize necrotizing fasciitis and initiate urgent surgical consultation." Plantaris rupture (A) is benign and localized. DVT (B) is more gradual and often with swelling. Cellulitis (C) progresses more slowly and is less painful. Baker's cyst (D) causes posterior knee pain, not severe systemic illness.

by Wythe at Mar 26, 2026, 08:06 PM

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