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Radiograph
9%
3/32
MRI
0%
0/32
Ultrasound
3%
1/32
Broad spectrum antibiotics
6%
2/32
Synovial fluid analysis
78%
25/32
Select Answer to see Preferred Response
This child is presenting with pain, erythema, and calor of the knee, concerning for infectious arthritis. The best initial step in management is synovial fluid analysis and culture. Infectious arthritis can present in a normal joint or more commonly in a joint with previous damage/trauma (gout, osteoarthritis, and rheumatoid arthritis). Patients can present with fever, erythema, edema, and calor of the affected joint. Physical exam typically includes decreased range of motion with antalgic gait or severe pain with weight bearing. Laboratory tests will reveal an increased ESR and CRP. ESR and CRP can be used to track response to therapy. The best initial step in management is aspiration and synovial fluid analysis and culture. Typically, there will be > 50,000 cells/mm^3. Once cultures are sent, then broad spectrum antibiotics can be started. Incorrect Answers: Answer 1: Radiography is best for detecting bony abnormalities and trauma. Infectious arthritis is a more likely diagnosis given the history of skin infection, fever, and pain in the joint which could be better characterized by tapping the joint. Answer 2: MRI may reveal greater detail regarding the extent of the damage; however, it will not offer any information with regards to the type of pathology, or the organism present. Answer 3: Ultrasound is used to assess conditions such as congenital hip dysplasia. Though it could assess tissue damage to some extent, it would not be useful in identifying the organism causing this patient’s presentation. Answer 4: Broad spectrum antibiotics would not be administered prior to aspiration and synovial fluid analysis. Antibiotics could affect the culture results, thus they would be delayed until just after aspiration. Once synovial fluid has been sent off for culture, broad spectrum antibiotics should be administered. Bullet Summary: The best initial step in management of infectious arthritis is synovial fluid analysis to confirm the diagnosis and send cultures, followed by antibiotic administration.
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