Adult-onset Still's disease — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateConnective Tissue DiseasesAdult-onset Still's diseaseSCE Rheumatology

A 28-year-old woman has quotidian fever, evanescent salmon rash, inflammatory arthritis, neutrophilia, ferritin 18000 micrograms/L and negative ANA/RF after infection exclusion. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Infection and malignancy exclusion with ferritin and inflammatory markers

Infection and malignancy exclusion with ferritin and inflammatory markers is the single best answer because spiking fever, evanescent rash, arthritis and very high ferritin suggest adult-onset Still's disease. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Mixed connective tissue disease is less suitable because it fits a different clinical pattern or a different treatment threshold; Primary Sjögren's disease, Repeat ANA titre alone and Adalimumab do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: BSR/EULAR connective tissue disease recommendations; BNF