American Board of Internal Medicine (ABIM) Certification Practice Exam

In which condition is mononeuritis multiplex highly specific?

1. Systemic lupus erythematosus

2. Rheumatoid arthritis

3. Vasculitis disorders

4. Osteoarthritis

The correct answer is: Vasculitis disorders

Mononeuritis multiplex is highly specific to vasculitis disorders due to its characteristic presentation and underlying pathology. This condition involves the simultaneous or sequential inflammation of individual peripheral nerves, which is often due to multiple small-vessel vasculitis affecting the vasa nervorum (small blood vessels supplying nerves). In the context of vasculitis, conditions such as polyarteritis nodosa, granulomatosis with polyangiitis, and other systemic vasculitides frequently present with mononeuritis multiplex as a significant clinical feature. The inflammation disrupts blood flow to the nerves, resulting in ischemia and subsequent neurological symptoms. While systemic lupus erythematosus and rheumatoid arthritis can indeed cause neurological complications and may involve peripheral nerves, these conditions do not specifically lead to mononeuritis multiplex. They are associated with a broader range of complications and varied types of neuropathies. Osteoarthritis, primarily a degenerative joint disease, is not associated with mononeuritis multiplex at all. Thus, the unique association of mononeuritis multiplex with vascular inflammation makes vasculitis disorders the condition in which it is highly specific.