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Musculoskeletal Medicine & Rheumatology — UKMLA MCQ

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HardMusculoskeletal Medicine & RheumatologyUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1

An immunosuppressed adult has a rapidly developing hot, swollen knee, fever and inability to weight-bear. There is no trauma, and gout has not previously been diagnosed. What is the safest next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Refer immediately through the local septic-arthritis pathway

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · A = shown as D · B = shown as E

D is correct. Acute monoarthritis with systemic illness and immunosuppression must be treated as possible septic arthritis and referred immediately for joint aspiration, cultures and urgent antimicrobial and orthopaedic management. A and E may reduce symptoms while an invasive infection destroys cartilage. B cannot exclude sepsis and serum urate neither confirms nor rules out gout during a flare. C delays time-critical assessment and separates aspiration from the acute treatment pathway.

Reference: NICE NG219: gout recommendations: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map