Gastroenterology: coeliac disease diagnosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: coeliac disease diagnosis

Sample item

A patient with chronic diarrhoea, weight loss and iron deficiency is evaluated for coeliac disease. What is the best initial test?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. IgA anti-tissue transglutaminase antibody while on a gluten-containing diet

IgA anti-tTG is the best initial test, performed while the patient eats gluten, with total IgA measured. Small bowel biopsy shows villous atrophy and crypt hyperplasia. HLA-DQ2 and DQ8 have high negative predictive value but poor specificity.

Option by option

  • A. Anti-gliadin IgG only

    Anti-gliadin IgG is less specific.

  • B. Stool fat only

    Stool fat does not diagnose coeliac disease.

  • C. IgA anti-tissue transglutaminase antibody while on a gluten-containing diet (correct)

    Correct. IgA tTG is the first-line screening test.

  • D. HLA typing as first test

    HLA typing cannot diagnose disease by itself.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, IgA anti-tissue transglutaminase antibody while on a gluten-containing diet. IgA anti-tTG is the best initial test, performed while the patient eats gluten, with total IgA measured.

Why is "Anti-gliadin IgG only" not the answer?

Anti-gliadin IgG is less specific.

Why is "Stool fat only" not the answer?

Stool fat does not diagnose coeliac disease.

Why is "HLA typing as first test" not the answer?

HLA typing cannot diagnose disease by itself.

What concept does this question test?

It tests Gastroenterology: coeliac disease diagnosis in General Medicine. Small bowel biopsy shows villous atrophy and crypt hyperplasia. HLA-DQ2 and DQ8 have high negative predictive value but poor specificity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: coeliac disease diagnosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.