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Septic bursitis mimicking gout — SCE Acute Medicine MCQ

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HardAcute Rheumatological and Dermatological EmergenciesSeptic bursitis mimicking goutSCE Acute Medicine

A 73-year-old man presents with rash, allergic features, visual symptoms or systemic inflammation. Relevant history includes recent drug exposure, autoimmune disease or allergen exposure. On assessment, skin, mucosal or vascular findings suggest systemic disease. Investigations show olecranon aspirate shows Gram-positive cocci with preserved joint movement. What is the most appropriate next step in management?

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

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Correct answer: D — Treat with antibiotics and drainage where needed

The key discriminator is that olecranon aspirate shows Gram-positive cocci with preserved joint movement, which makes Treat with antibiotics and drainage where needed the single best answer. Provide supportive care and close monitoring is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Give targeted antidote or reversal therapy and Arrange routine outpatient follow-up are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE antimicrobial prescribing; BSR gout guidance