American Board of Internal Medicine (ABIM) Certification Practice Exam

In the case of suspected infection with acute inflammatory monoarthritis, what should be done immediately?

1. Start immunotherapy

2. Initiate antibiotics

3. Perform joint aspiration

4. Order a CT scan

The correct answer is: Initiate antibiotics

When dealing with suspected infection in acute inflammatory monoarthritis, the immediate course of action should involve initiating antibiotics. This is crucial because infections can lead to significant morbidity if not treated promptly and effectively. The risk of joint damage, systemic spread of the infection, and the overall deterioration of the patient's condition emphasize the urgency of antibiotic therapy. Infections such as septic arthritis can have serious consequences, and initiating antibiotics as soon as possible helps to manage the infection and reduce the risk of complications. Delaying treatment can lead to irreversible joint damage and systemic illness. While performing joint aspiration can be important for both diagnostic and therapeutic purposes, it typically occurs after antibiotics are initiated, especially in cases where the patient appears to be clinically unstable or where there is a high suspicion of an aggressive infection. Imaging studies, such as a CT scan, are not the first step in acute management and would be considered later if there is a need for further evaluation of joint structures or if diagnosis remains uncertain after initial management. Immunotherapy is not indicated in this context, as it would not address the immediate and potentially life-threatening infection.