American Board of Internal Medicine (ABIM) Certification Practice Exam

What distinguishes adult-onset Still disease from other conditions?

1. High uric acid levels

2. High spiking fevers

3. Low platelet counts

4. Joint hypermobility

The correct answer is: High spiking fevers

Adult-onset Still disease is notable for its characteristic high spiking fevers, which can be a key distinguishing feature when diagnosing this condition. These fevers are typically intermittent and can reach significant heights, often occurring once or twice daily, and they may be accompanied by other systemic symptoms such as rash, arthritis, and leukocytosis. The presence of these high fevers can help differentiate adult-onset Still disease from other rheumatological disorders that may feature joint symptoms or other systemic manifestations. For example, while fever may occur in rheumatoid arthritis or other inflammatory conditions, it does not usually present with the striking high daily spikes that characterize adult-onset Still disease. In contrast, the other choices do not provide a distinguishing feature. High uric acid levels are more relevant to conditions like gout, low platelet counts are not specific to Still's disease and can occur in a variety of other conditions, and joint hypermobility is more associated with connective tissue disorders rather than inflammatory diseases like adult-onset Still disease. Thus, the high spiking fevers represent a unique and defining symptom of adult-onset Still disease.