The correct answer is #2, mupirocin. There’s no particular question trick at play here, except the tendency to grab non-specific antibiotics. 🙂
The author of the question (or the learning objectives of the question) want you to focus in on the small number of superficial pustules, the localized non-systemic infection. The question stem suggests a contact sport, raising skin-to-skin infection risk.
Why This Question Is Often Missed
– Learners mistake impetigo for folliculitis and reach for systemic antibiotics.
– Confusion between generic “triple antibiotic” ointments and organism-specific topical therapy.
What the Distractors Indicate
| Option | What It Tests / Implies | Why It’s Wrong Here |
|---|---|---|
| Start amoxicillin. | Assumes a narrow-spectrum penicillin will cover strep/staph. | Fails to cover MRSA and isn’t recommended for localized impetigo; systemic therapy not first-line. |
| Apply triple antibiotic ointment. | Relies on broad-spectrum topical neomycin/polymyxin/bacitracin. | Poor activity against common impetigo pathogens and higher risk of contact dermatitis. |
| Start trimethoprim/sulfamethoxazole. | Targets MRSA systemically. | Systemic therapy is unnecessary for a few localized lesions when topical mupirocin suffices. |
| Apply miconazole ointment. | Tests for fungal etiologies (tinea). | Impetigo is bacterial; antifungal therapy is ineffective. |
High-Yield Pearl
Localized nonbullous impetigo is best treated with topical mupirocin, avoiding systemic antibiotics when feasible.
Core Learning Objectives
- Recognize the characteristic presentation of localized nonbullous impetigo in adolescents.
- Know that topical mupirocin is first-line management for a small number of impetigo lesions.
The “Test Trick” at Play
This item plays on the examinee’s tendency to overuse systemic or non–impetigo-specific therapies. By including plausible but suboptimal topical agents (triple antibiotic, antifungal) and systemic antibiotics, it tests whether you recall that impetigo guidelines favor organism-directed, topical mupirocin for limited disease.
Additional Practice Questions and Remediation
Question 1
A 9-year-old boy presents with three honey-crusted lesions around his nostrils for 2 days. He is well-appearing and afebrile. What is your next step?
A. Apply mupirocin 2% ointment
B. Start oral cephalexin
C. Apply clotrimazole cream
D. Start oral doxycycline
Question 2
A 17-year-old basketball player has two small pustules with erythematous halos on his forearm. Cultures are pending. You start:
A. Oral clindamycin
B. Topical mupirocin
C. Triple antibiotic ointment
D. Topical ketoconazole
Question 3
A 12-year-old girl developed four papulovesicular lesions on her chin with clear fluid. She feels well. Culture is pending. Management:
A. Apply mupirocin 2% ointment
B. Start amoxicillin-clavulanate
C. Apply petroleum jelly only
D. Start oral azithromycin
Mini Case Discussion Prompt
Compare and contrast the management of localized nonbullous impetigo versus extensive or bullous impetigo: when do you transition from topical to systemic therapy, and what agents do you choose?
This question appears in one of our Med-Challenger Pediatric Emergency Medicine Review with CME courses based directly on PEMQBook texts.
No matter your program, no matter the size, Med-Challenger for Groups and Institutions can better prepare your program or group, fulfill industry requirements, and increase test scores.
