Septic arthritis — MCCQE Part 1 MCQ

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HardJoint PainSeptic arthritisMCCQE Part 1

4-year-old child presents with fever and refusal to bear weight. The hip is painful with any passive movement and CRP is high. Which of the following is the most appropriate next step?

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Correct answer: A — Urgently aspirate/joint-image and start IV antibiotics with orthopaedic involvement

Urgently aspirate/joint-image and start IV antibiotics with orthopaedic involvement is best because fever, non-weight-bearing and painful passive ROM suggest septic arthritis. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. Transient synovitis is less toxic and usually follows viral illness.

Reference: Canadian Paediatric Society septic arthritis guidance