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Septic arthritis — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesSeptic arthritisSCE Acute Medicine

A 69-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show purulent synovial fluid with organisms and fever. What is the most appropriate next step in management?

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Correct answer: A — Arrange urgent joint washout and intravenous antibiotics after cultures

The key discriminator is that purulent synovial fluid with organisms and fever, which makes Arrange urgent joint washout and intravenous antibiotics after cultures the single best answer. Give analgesia and antiemetic therapy is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Provide supportive care and close monitoring 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: BSR hot swollen joint guidance