Rosh Emergency Medicine Practice Test

Which initial treatment is indicated for a patient presenting with severe knee pain and evidence of inflammation?

1. Colchicine and synovial fluid aspiration

2. Intra-articular glucocorticoid injection

3. Nonsteroidal anti-inflammatory drugs

4. Systemic antibiotics and synovial fluid aspiration

The correct answer is: Systemic antibiotics and synovial fluid aspiration

In cases of severe knee pain accompanied by inflammation, a thorough evaluation is crucial to determine the underlying cause. One potential cause of such symptoms is septic arthritis, which is a medical emergency that requires prompt treatment. Systemic antibiotics and synovial fluid aspiration are appropriate initial treatments for septic arthritis. The aspiration allows for diagnostic evaluation of the synovial fluid to confirm the presence of infection, as well as therapeutic relief of pain and pressure within the joint. Administering antibiotics is also critical in controlling the infection and preventing joint damage. Other treatment options may be appropriate in other contexts, such as intra-articular glucocorticoid injection or nonsteroidal anti-inflammatory drugs for inflammatory conditions like gout or rheumatoid arthritis, but they would not address a septic condition effectively. Colchicine is typically used for gout management and would not be the first-line treatment in the case of suspected infection. Therefore, choosing systemic antibiotics and synovial fluid aspiration is the most appropriate initial intervention for this presentation.