Septic arthritis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Septic arthritis

Sample item

A 4-year-old has a three-day fever, refuses to bear weight and holds her right hip flexed, abducted and externally rotated, crying on any movement. Temperature is 39 C, ESR and CRP are very high and she cannot walk. Radiographs are normal. What is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Urgent ultrasound-guided hip aspiration, followed by surgical drainage and antibiotics if pus is present

Fever, inability to bear weight, a high ESR and CRP in a child point to septic arthritis of the hip, an orthopaedic emergency because pus raises intracapsular pressure, compromises the femoral head blood supply and destroys cartilage. Aspiration confirms the diagnosis, and arthrotomy or arthroscopic washout with intravenous antibiotics follows.

Option by option

  • A. Discharge with oral analgesics for presumed transient synovitis

    Transient synovitis does not cause marked fever and raised inflammatory markers, and this assumption would delay treatment.

  • B. Plaster spica for six weeks

    A spica cast is used for fractures and dysplasia, not an infected joint.

  • C. Wait for the blood culture result before doing anything

    Delay for culture risks irreversible joint destruction.

  • D. Urgent ultrasound-guided hip aspiration, followed by surgical drainage and antibiotics if pus is present (correct)

    Correct. Early drainage is essential to protect the femoral head.

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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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Urgent ultrasound-guided hip aspiration, followed by surgical drainage and antibiotics if pus is present. Fever, inability to bear weight, a high ESR and CRP in a child point to septic arthritis of the hip, an orthopaedic emergency because pus raises intracapsular pressure, compromises the femoral head blood supply and destroys cartilage.

Why is "Discharge with oral analgesics for presumed transient synovitis" not the answer?

Transient synovitis does not cause marked fever and raised inflammatory markers, and this assumption would delay treatment.

Why is "Plaster spica for six weeks" not the answer?

A spica cast is used for fractures and dysplasia, not an infected joint.

Why is "Wait for the blood culture result before doing anything" not the answer?

Delay for culture risks irreversible joint destruction.

What concept does this question test?

It tests Septic arthritis in Orthopaedics. Aspiration confirms the diagnosis, and arthrotomy or arthroscopic washout with intravenous antibiotics follows.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Septic arthritis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.