American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following symptoms is NOT associated with the CREST syndrome?

1. Raynaud phenomenon

2. Heartburn

3. Fatigue

4. Telangiectasia

The correct answer is: Fatigue

In the context of CREST syndrome, each of the symptoms has specific relevance to the condition. CREST syndrome, which is a limited form of systemic sclerosis, includes the following key symptoms: Calcinosis, Reynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Raynaud phenomenon is a classic symptom associated with CREST syndrome and involves episodic vasospasm of the small blood vessels in response to cold or stress, leading to color changes in the fingers and toes. Heartburn, also an important symptom, results from esophageal dysmotility caused by fibrosis in the esophagus, which is common in this condition. Telangiectasia, which refers to small dilated blood vessels appearing on the skin, is another hallmark feature of CREST syndrome. Fatigue, while it can certainly be experienced by patients with various conditions, including autoimmune diseases like scleroderma, it is not a defining symptom of CREST syndrome specifically. Therefore, it stands apart from the hallmark symptoms that primarily characterize CREST syndrome. Recognizing the core symptoms of CREST syndrome can help in understanding the condition's clinical presentation and differentiating it from other disorders that may also cause fatigue.