Celiac Disease Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Celiac Disease. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Celiac Disease Indian Medical PG Question 1: A female engineer works for 12-14 hours a day and reports consuming only fast food, with no vegetables or fruits in her diet. Her hemoglobin (Hb) count is $9 \mathrm{~g} / \mathrm{dL}$, and her mean corpuscular volume (MCV) is 120 fL . Peripheral smear (PS) shows the presence of macrocytes. What is the most likely diagnosis?
- A. Folic acid deficiency (Correct Answer)
- B. Combined Vitamin B12 and Folic acid deficiency
- C. Iron deficiency anemia
- D. Vitamin B12 deficiency
- E. Anemia of chronic disease
Celiac Disease Explanation: ***Folic acid deficiency***
- A **highly restrictive diet** lacking vegetables and fruits, combined with **macrocytic anemia** (Hb 9 g/dL, MCV 120 fL), strongly suggests folic acid deficiency.
- Folic acid is essential for **DNA synthesis**, and its deficiency leads to impaired erythrocyte maturation, resulting in **large, immature red blood cells (macrocytes)**.
- **Folate stores deplete within 3-4 months** of inadequate intake, making dietary deficiency clinically significant.
- The patient's diet explicitly lacks **folate-rich foods** (green vegetables, fruits, legumes).
*Vitamin B12 deficiency*
- Also causes **macrocytic anemia** with identical hematological findings.
- However, **Vitamin B12 is found in animal products** (meat, dairy, eggs), which are commonly present in fast food.
- **B12 stores last 3-5 years**, so dietary deficiency takes much longer to develop unless there is **malabsorption** (pernicious anemia, gastrectomy).
- No evidence of malabsorption or strict veganism in this case.
*Combined Vitamin B12 and Folic acid deficiency*
- While theoretically possible, the dietary history points more specifically to **folate deficiency**.
- Combined deficiencies are more common in **severe malnutrition** or **malabsorption syndromes**.
- Fast food typically contains adequate B12 from animal products.
*Iron deficiency anemia*
- Presents as **microcytic hypochromic anemia** with **low MCV** (<80 fL).
- This patient has **macrocytic anemia** (MCV 120 fL), which directly contradicts iron deficiency.
- Caused by **chronic blood loss** or inadequate iron intake, leading to small, pale RBCs.
*Anemia of chronic disease*
- Usually presents as **normocytic** or **mildly microcytic** anemia, not macrocytic.
- While chronic stress and poor nutrition could contribute, the **high MCV (120 fL)** and **macrocytes** are inconsistent with this diagnosis.
- Anemia of chronic disease typically has **normal to low MCV** and **normal RBC morphology** without macrocytosis.
Celiac Disease Indian Medical PG Question 2: In celiac disease, all are true EXCEPT:
- A. Gliadin is the cause
- B. Increased brush border (Correct Answer)
- C. Decreased villi to crypt ratio
- D. Associated with HLA-DQ2 and HLA-DQ8
Celiac Disease Explanation: ***Increased brush border***
- Celiac disease is characterized by **atrophy of the intestinal villi**, leading to a **decreased surface area** for absorption, not an increased brush border [1], [2]. This leads to malabsorption and its associated symptoms.
- The inflammatory process in celiac disease causes destruction of the enterocytes and their microvilli, which constitute the brush border, thus reducing its integrity and function [2].
*Gliadin is the cause*
- **Gliadin**, a component of gluten found in wheat, barley, and rye, is the primary trigger for the immune response in genetically predisposed individuals with celiac disease [1], [2].
- Digested gliadin peptides are recognized by immune cells, leading to an inflammatory reaction in the small intestine [2].
*Decreased villi to crypt ratio*
- One of the hallmark histological findings in celiac disease is **villous atrophy**, which results in a significant **decrease in the villi to crypt ratio**, indicating loss of the absorptive surface and compensatory crypt hyperplasia [2].
- This architectural change is crucial for the diagnosis of celiac disease and reflects the damage to the small intestine lining.
*Associated with HLA-DQ2 and HLA-DQ8*
- Celiac disease is strongly associated with specific **HLA (Human Leukocyte Antigen) class II alleles**, primarily **HLA-DQ2 and HLA-DQ8**, which are found in over 95% of affected individuals [1].
- These genetic markers are essential for disease susceptibility, with **HLA-DQ2** present in approximately 90-95% of patients and **HLA-DQ8** in the remaining 5-10% [1].
**References:**
[1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 360-361.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 789-790.
Celiac Disease Indian Medical PG Question 3: Gold standard method of diagnosing celiac disease is
- A. Blood picture
- B. Small bowel biopsy (Correct Answer)
- C. Anti-endomysial antibodies
- D. Biochemical test
Celiac Disease Explanation: ***Small bowel biopsy***
- A **small bowel biopsy** is considered the **gold standard** for diagnosing celiac disease as it directly visualizes the characteristic damage to the intestinal lining.
- The biopsy reveals histologic changes like **villous atrophy**, crypt hyperplasia, and increased intraepithelial lymphocytes, which are pathognomonic for celiac disease [1].
*Blood picture*
- A blood picture (complete blood count) might show **anemia** (often iron-deficiency anemia) due to malabsorption, but this is a non-specific finding and not diagnostic for celiac disease [1].
- It does not provide direct evidence of intestinal damage caused by gluten.
*Anti-endomysial antibodies*
- **Anti-endomysial antibodies (EMA)** are highly specific for celiac disease, but they are still a serological test, not the definitive diagnostic method.
- Serological tests like EMA and **tissue transglutaminase (tTG) antibodies** are used for screening and monitoring but require biopsy confirmation.
*Biochemical test*
- Biochemical tests might show abnormalities related to **malabsorption**, such as low iron, calcium, or vitamin D levels, but these are secondary effects and not diagnostic of celiac disease itself [1].
- These tests indicate nutritional deficiencies but do not identify the underlying cause.
Celiac Disease Indian Medical PG Question 4: A 2-year-old presents with chronic diarrhea, failure to thrive, and a distended abdomen. Celiac disease is suspected. What is the most appropriate initial test to confirm the diagnosis?
- A. Positive stool culture
- B. Elevated ESR
- C. Anti-tTG antibodies (Correct Answer)
- D. Serum IgA levels
Celiac Disease Explanation: ***Anti-tTG antibodies***
- **Anti-tissue transglutaminase (anti-tTG) antibodies** are the primary serological test used to screen for **celiac disease** in children and adults.
- A positive result, especially when several fold above the upper limit of normal, is highly suggestive of celiac disease and often followed by a **small bowel biopsy** for definitive diagnosis.
*Positive stool culture*
- A **positive stool culture** identifies bacterial or viral infections of the gastrointestinal tract, which can cause acute diarrhea.
- While it can explain diarrhea, it does not confirm a diagnosis of **celiac disease**, which is an autoimmune condition triggered by gluten.
*Elevated ESR*
- **Elevated erythrocyte sedimentation rate (ESR)** is a general marker of inflammation and can be seen in many conditions, including infections, autoimmune diseases, and malignancies.
- It is not specific to **celiac disease** and does not confirm the diagnosis.
*Serum IgA levels*
- Measuring **total serum IgA levels** is crucial alongside anti-tTG testing to rule out **IgA deficiency**, which can lead to a false-negative anti-tTG result.
- However, IgA levels alone do not diagnose celiac disease; they are a preliminary check before interpreting IgA-based antibody tests.
Celiac Disease Indian Medical PG Question 5: A 12 year old girl has history of recurrent bulky stools and abdominal pain since 3 year of age. She has moderate pallor and her weight and height are below the 3rd percentile. Which of the following is the most appropriate investigation to make a specific diagnosis?
- A. Barium studies
- B. Small intestinal biopsy (Correct Answer)
- C. 24-hour fecal fat estimation
- D. Urinary d-xylose test
Celiac Disease Explanation: ***Small intestinal biopsy***
- This clinical presentation of **chronic bulky stools**, **growth retardation** (weight and height <3rd percentile), **pallor**, and abdominal pain since early childhood strongly suggests **celiac disease**
- Small intestinal biopsy is the **gold standard for definitive diagnosis** of celiac disease, showing characteristic features: **villous atrophy**, **crypt hyperplasia**, and **increased intraepithelial lymphocytes** (Marsh classification)
- While serological testing (anti-tTG IgA) is typically performed first in modern practice, among the given options, **biopsy provides the specific histological diagnosis** required
- Biopsy allows differentiation from other causes of villous atrophy (tropical sprue, Giardia infection, cow's milk protein allergy)
*Barium studies*
- May show **non-specific findings** like dilated bowel loops, flocculation of barium, or jejunization of ileum in malabsorption
- **Not diagnostic** for the specific underlying cause of malabsorption
- Involves **radiation exposure** in a pediatric patient
- Requires follow-up with more specific investigations for definitive diagnosis
*24-hour fecal fat estimation*
- Quantifies **steatorrhea** and confirms fat malabsorption (normal <7g/day in children)
- Useful for **documenting the presence** of malabsorption but **does not identify the etiology**
- Cannot differentiate between celiac disease, chronic pancreatitis, or other causes of malabsorption
- Non-specific screening test rather than a diagnostic investigation
*Urinary d-xylose test*
- Assesses **small intestinal mucosal absorptive function** for carbohydrates
- Abnormal in conditions affecting mucosa (celiac disease, tropical sprue, Crohn's disease)
- **Not specific** for any particular disease entity
- Less commonly used in modern practice due to availability of better diagnostic modalities
Celiac Disease Indian Medical PG Question 6: In a child, which of the following diseases is commonly misdiagnosed as appendicitis?
- A. Intussusception
- B. Lymphadenitis
- C. Gastroenteritis
- D. All of the options (Correct Answer)
Celiac Disease Explanation: ***All of the options***
- **Intussusception**, **lymphadenitis**, and **gastroenteritis** can all present with symptoms mimicking appendicitis in children, leading to potential misdiagnosis.
- The similarities in abdominal pain, fever, and vomiting can make differentiation challenging without further diagnostic imaging or clinical evaluation.
**Intussusception**
- This condition involves the **telescoping of one segment of the intestine** into another, causing abdominal pain, vomiting, and sometimes a palpable mass.
- While it can cause symptoms similar to appendicitis, classic signs like **currant-jelly stools** and an abdominal mass are often differentiating features.
- Can present with colicky abdominal pain and guarding that mimics acute appendicitis.
**Lymphadenitis (Mesenteric)**
- **Mesenteric lymphadenitis** is an inflammation of the abdominal lymph nodes, often following a viral infection, causing generalized or right lower quadrant pain.
- Its presentation can closely mimic appendicitis, and is one of the most common appendicitis mimics in children.
- It typically lacks the progressive periumbilical pain migrating to the right lower quadrant that is typical of appendicitis, though this differentiation can be subtle.
**Gastroenteritis**
- **Gastroenteritis** presents with diffuse abdominal pain, vomiting, and diarrhea, which can sometimes be localized enough to suggest appendicitis, especially if pain is predominantly in the right lower quadrant.
- However, the presence of significant diarrhea and more generalized abdominal discomfort often helps distinguish it from the focused pain of appendicitis.
- In early presentations before diarrhea develops, differentiation can be particularly challenging.
Celiac Disease Indian Medical PG Question 7: A child presents with itchy lesions and diarrhea and has been advised to follow a gluten-free diet. What is the most likely etiology of this condition?
- A. Whipple's disease
- B. Crohn's disease
- C. Dermatitis herpetiformis
- D. Celiac disease (Correct Answer)
Celiac Disease Explanation: ***Celiac disease***
- **Celiac disease** is an autoimmune condition triggered by **gluten ingestion**, leading to small intestine damage and nutrient malabsorption.
- The combination of **itchy lesions** (dermatitis herpetiformis, a skin manifestation of celiac disease), **diarrhea**, and improvement on a **gluten-free diet** are highly characteristic.
- Since the question asks for the **underlying etiology**, celiac disease is the correct answer as it causes both the skin and GI manifestations.
*Whipple's disease*
- This is a rare systemic infection caused by the bacterium **Tropheryma whipplei**, presenting with **arthralgia, fever, malabsorption, and lymphadenopathy**.
- While it can cause diarrhea and malabsorption, it is not associated with itchy skin lesions and does not respond to a gluten-free diet.
*Crohn's disease*
- **Crohn's disease** is a type of inflammatory bowel disease affecting any part of the GI tract, causing **abdominal pain, diarrhea, and weight loss**.
- It is not associated with dermatitis herpetiformis and does not improve with a gluten-free diet (though some patients may have gluten sensitivity).
*Dermatitis herpetiformis*
- **Dermatitis herpetiformis** is the **cutaneous manifestation of celiac disease**, presenting as intensely itchy, vesicular lesions.
- While DH explains the itchy lesions in this case, it is a **symptom/manifestation**, not the underlying **etiology**—the root cause is celiac disease itself, which produces both the intestinal damage (diarrhea) and the skin manifestations (DH).
Celiac Disease Indian Medical PG Question 8: The histological features of celiac disease include all of the following EXCEPT:
- A. Crypt hyperplasia
- B. Increase in intraepithelial lymphocytes
- C. Increase in inflammatory cells in lamina propria
- D. Increase in thickness of the mucosa (Correct Answer)
Celiac Disease Explanation: ***Increase in thickness of the mucosa***
- Celiac disease typically causes **villous atrophy**, leading to a **thinner intestinal mucosa**, not an increase in thickness [1].
- The architectural changes in celiac disease primarily involve blunting or absence of villi [2].
*Crypt hyperplasia*
- This is a characteristic feature of celiac disease, where the **crypts of Lieberkühn** become elongated and hyperplastic to compensate for the damaged villi [1].
- It reflects increased cell turnover in response to mucosal injury.
*Increase in intraepithelial lymphocytes*
- An increase in **intraepithelial lymphocytes (IELs)** is a hallmark histological finding in celiac disease, often seen even before significant villous atrophy [1].
- These lymphocytes are typically CD3+ T-cells that infiltrate the epithelial layer.
*Increase in inflammatory cells in lamina propria*
- The lamina propria in celiac disease shows an increased infiltration of **chronic inflammatory cells**, including plasma cells and lymphocytes [2].
- This reflects the ongoing immune response to gluten peptides in the intestinal wall.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 789-790.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 361-362.
Celiac Disease Indian Medical PG Question 9: Secretory diarrhea is not typically associated with which of the following conditions?
- A. Phenolphthalein
- B. Cholera
- C. Celiac disease (Correct Answer)
- D. VIPoma
Celiac Disease Explanation: ***Celiac disease*** [1]
- Characterized by **malabsorption** due to immune-mediated damage to the intestinal mucosa, leading to **osmotic diarrhea** rather than secretory diarrhea [1].
- Symptoms include **bloating**, **weight loss**, and **steatorrhea**, which are not consistent with secretory processes.
*Cholera*
- Caused by **Vibrio cholerae**, leading to **massive secretory diarrhea** due to the action of cholera toxin on intestinal epithelial cells.
- Presents with **watery diarrhea**, potentially leading to **dehydration** and electrolyte imbalances.
*Addison's Disease*
- This condition may cause **diarrhea** but typically results in **non-secretory diarrhea**, often associated with adrenal insufficiency symptoms.
- Presenting features include **fatigue**, **weight loss**, and **hyperpigmentation**, not primarily secretory processes.
*Phenolphthalein*
- A laxative that can induce **secretory diarrhea** through its stimulant effects on the bowel.
- Its mechanism leads to increased fluid secretion in the intestines, thus contributing to secretory diarrhea.
Celiac Disease Indian Medical PG Question 10: All are true about Hirschsprung disease Except
- A. Absence of ganglion cells within the affected segment
- B. The rectum is never affected (Correct Answer)
- C. Dilation proximal to the affected segment.
- D. Hirschsprung disease typically presents with a failure to pass meconium in the immediate postnatal period.
Celiac Disease Explanation: ***The rectum is never affected***
- Hirschsprung disease always involves the **rectum** and extends proximally for a variable distance.
- The aganglionic segment uniformly includes the **distal rectum**.
*Absence of ganglion cells within the affected segment*
- The primary defect in Hirschsprung disease is the **absence of ganglion cells** (Meissner and Auerbach plexuses) in the affected intestinal segment.
- This **aganglionosis** leads to a functional obstruction.
*Dilation proximal to the affected segment*
- Due to the functional obstruction from the aganglionic segment, the normal bowel **proximal** to it becomes dilated and hypertrophied.
- This dilation occurs as the bowel tries to overcome the obstruction.
*Hirschsprung disease typically presents with a failure to pass meconium in the immediate postnatal period*
- A classic presentation of Hirschsprung disease is the failure to pass **meconium** within the first 24-48 hours of life.
- This symptom is due to the lack of peristalsis in the aganglionic segment.
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