American Board of Internal Medicine (ABIM) Certification Practice Exam

What symptoms are typical of Polyarteritis Nodosa?

1. Perforation of the nasal septum

2. Arthralgia and skin rashes

3. Hemoptysis and cough

4. Fever and abdominal pain

The correct answer is: Fever and abdominal pain

Polyarteritis nodosa (PAN) is a systemic vasculitis that primarily affects medium-sized muscular arteries. It is characterized by the presence of systemic symptoms and organ-specific manifestations due to ischemia. Fever is a common systemic symptom seen in many forms of vasculitis, including PAN, reflecting an inflammatory process in the body. Abdominal pain is also a significant symptom in PAN, often resulting from mesenteric ischemia due to involvement of the renal and gastrointestinal arteries. Abdominal pain may present as cramping or discomfort, and patients may report exacerbation of pain following meals due to inadequate blood flow to the intestines. While perforation of the nasal septum (often associated with granulomatosis with polyangiitis) and hemoptysis (more characteristic of conditions like Goodpasture syndrome or granulomatosis with polyangiitis) can occur in other forms of vasculitis, these are not typical symptoms of polyarteritis nodosa. Similarly, skin rashes and arthralgia can occur, but abdominal pain and fever are more specifically associated with the systemic nature of PAN and its complications, making fever and abdominal pain a hallmark presentation of the disease.