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Acute monoarthritis — RCPSC IM MCQ

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HardRheumatologyAcute monoarthritisRCPSC IM

A patient with known gout has fever and a much more severe hot swollen knee than prior attacks. What is the best investigation before intra-articular treatment?

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Correct answer: E — Aspirate synovial fluid for crystals and culture

The best answer is “Aspirate synovial fluid for crystals and culture”. Gout and septic arthritis can coexist, and fever plus an atypical severe flare requires aspiration. Crystal identification does not eliminate the need for culture when infection is possible. Antibiotics and drainage should begin rapidly if infection remains likely after sampling, rather than awaiting every final culture result.

Reference: Canadian Rheumatology Association, clinical guidelines: https://rheum.ca/resources/publications/