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Difficulty: EasySurgical and Procedural Interventions

A 24-year-old man presents to the ambulatory care clinic with a painful swelling on his left thigh that has been enlarging over the past 4 days. He has no significant past medical history and takes no medications. His temperature is 37.1∘C37.1^\circ\text{C} (98.8∘F98.8^\circ\text{F}), blood pressure is 118/76 mm Hg118/76 \text{ mm Hg}, pulse is 74/min74/\text{min}, and respiratory rate is 14/min14/\text{min}. Physical examination reveals a 3-cm, markedly tender, erythematous, and fluctuant nodule on the anterior left thigh. There is no surrounding induration or purulent drainage, and the patient reports no systemic symptoms such as chills or body aches. Which of the following is the most appropriate next step in management?

  1. Incision and drainageAnswer
  2. B
    Magnetic resonance imaging of the thigh
  3. C
    Inpatient admission and intravenous vancomycin
  4. D
    Administration of oral trimethoprim-sulfamethoxazole
  5. E
    Measurement of prothrombin time and partial thromboplastin time

Answer

Incision and drainage
The correct answer is incision and drainage. The patient presents with an uncomplicated cutaneous abscess, characterized by a localized, fluctuant, and tender nodule without systemic signs of infection or extensive surrounding cellulitis. The primary and definitive treatment for a simple abscess is incision and drainage to achieve source control. In healthy individuals, thorough drainage alone is typically sufficient and systemic antibiotics are generally not required.

Step-by-Step Solution

1
Evaluate the patient's clinical presentation and vital signs.
The patient presents with a localized, fluctuant, 3-cm nodule on the thigh with normal vital signs and an absence of systemic toxicity.
To distinguish between a simple, uncomplicated local abscess and a severe infection requiring systemic therapy or admission.
2
Determine the definitive therapeutic intervention for an uncomplicated cutaneous abscess.
Select incision and drainage as the primary management.
Definitive management of a simple abscess relies on mechanical source control rather than pharmacologic therapy alone.

Key Concept

Primary treatment of an uncomplicated cutaneous abscess
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Topics

Surgical and Procedural Interventions

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