182.A 42-year-old diabetic man presents to the ED with 3 days of rapidly
worsening scrotal and perineal pain. His HR is 115 beats per minute, BP is
135/90 mm Hg, RR is 18 breaths per minute, and temperature is 102.9°F.
Laboratory results are notable for a WBC of 18,000/μL. Physical examina-
tion demonstrates a necrotizing infection of the scrotum and perineal sub-
cutaneous fascia. Which of the following is the most appropriate next step
in management?
a. 14-Day course of levofloxacin and early urology follow-up.
b. Oral metronidazole and cephalexin with early urology follow-up.
c. Pain medications, daily warm soaks, and follow-up with an urologist.
d. Aggressive fluid resuscitation, bedside incision and drainage, and urology consult.
e. Surgical debridement, broad-spectrum IV antibiotics, and hospital admission.
183.A 45-year-old woman presents to the ED complaining of 3 days of
fever and worsening throat pain and painful odynophagia without cough
or coryza. She sits on a chair, leaning forward with her mouth slightly
open. She has a cup of saliva and a box of facial tissues at her side. Vitals
are HR of 120 beats per minute, BP of 110/70 mm Hg, RR of 22 breaths per
minute, oxygen saturation of 99% on room air, and temperature of 102°F.
Her voice is hoarse, but she is able to open her mouth fully. Her posterior
oropharynx is moderately hyperemic, without exudates or tonsillar
enlargement. A soft tissue lateral cervical radiograph shows marked edema
of the prevertebral soft tissues and absence of the vallecular space. Which
of the following is the most likely diagnosis?
a. Retropharyngeal abscess
b. Peritonsillar abscess
c. Epiglottitis
d. Pharyngitis
e. Laryngotracheitis
Fever 185