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Pediatrics · Orthopaedics: septic arthritis
Sample itemA 3-year-old with fever refuses to bear weight and holds the hip flexed, abducted and externally rotated. Pain is severe with passive movement and ESR is raised. What is the most important step?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Urgent aspiration or arthrotomy with antibiotics
Septic arthritis is an orthopaedic emergency because cartilage destruction and avascular necrosis of the femoral head occur rapidly. Joint aspiration and drainage along with intravenous antibiotics covering Staphylococcus aureus are required. Kocher criteria help differentiate it from transient synovitis.
Option by option
A. Plaster immobilisation alone
Immobilisation alone does not treat infection.
B. MRI after 2 weeks
Waiting 2 weeks is dangerous.
C. Urgent aspiration or arthrotomy with antibiotics (correct)
Correct. Drainage and antibiotics are urgent.
D. Oral analgesics and review in a week
Delay risks joint destruction.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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