American Board of Internal Medicine (ABIM) Certification Practice Exam

Patients with which condition typically present with symptoms including fever, arthralgia, myalgia, and abdominal pain?

1. Rheumatoid arthritis

2. Systemic lupus erythematosus

3. Polyarteritis nodosa

4. Fibromyalgia

The correct answer is: Polyarteritis nodosa

Patients with polyarteritis nodosa typically present with a range of systemic symptoms, including fever, arthralgia (joint pain), myalgia (muscle pain), and abdominal pain. This condition is a type of vasculitis that primarily affects medium-sized muscular arteries, leading to inflammation and ischemia of various organ systems. The systemic symptoms arise due to the inflammatory process and can manifest in multiple ways, including systemic fever and pain, reflecting the widespread involvement of the vascular system and its impact on different tissues and organs. In polyarteritis nodosa, the abdominal pain can result from compromised blood flow to the gastrointestinal tract due to vascular involvement. The combination of fever and generalized malaise paired with muscular and joint pain is characteristic of inflammatory conditions like this one, showcasing the body’s immune response. Other options present conditions with different symptom profiles. For example, rheumatoid arthritis is more distinctly characterized by chronic joint symptoms, while systemic lupus erythematosus involves a wider array of additional symptoms, including skin manifestations and renal involvement. Fibromyalgia is associated primarily with chronic widespread pain and fatigue, lacking the acute fever and systemic inflammatory signs typical of polyarteritis nodosa. Thus, the clinical picture described aligns most closely with polyarteritis nodosa.