American Board of Internal Medicine (ABIM) Certification Practice Exam

Familial Mediterranean fever is characterized by which of the following symptoms?

1. Chronic joint pain and morning stiffness

2. Episodes of fever and elevated acute phase reactants

3. Joint hypermobility and muscle cramps

4. Rash and systemic lupus erythematosus

The correct answer is: Episodes of fever and elevated acute phase reactants

Familial Mediterranean fever (FMF) is predominantly characterized by recurrent episodes of fever and elevated acute phase reactants, which are indicative of systemic inflammation. Patients typically experience these episodes suddenly, often accompanied by abdominal pain, chest pain, or joint pain. The fever usually lasts for a few days, and during the episodes, markers such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) are elevated, reflecting the inflammatory process occurring in the body. The recurrent nature of the fever and the associated acute phase response distinguishes FMF from other conditions. It is important to note that while familial Mediterranean fever can have joint manifestations, such as arthralgia, the key symptomatic feature that makes option B the correct choice is the combination of fever and inflammation indicated by elevated acute phase reactants. This is a hallmark of FMF, correlating with the underlying genetic defect that affects the body's inflammatory response.