[MCQ] Disorders of Absorption- Part 5

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Disorders of Absorption- Part 5

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Question 1

Serum antibodies found in celiac sprue include all except ?

A	IgA antigliadin
B	IgA antiendomysial antibodies
C	IgA anti-tissue transglutaminase
D	IgA anti-tissue transpeptidase

Question 1 Explanation:

“Celiac serologies” in celiac sprue include serum antibodies like IgA antigliadin, IgA antiendomysial and IgA anti-tTG antibodies are present suggesting an immunologic component to etiology

Question 2

Antiendomysial antibodies are directed against ?

A	Epithelial tissue
B	Enzyme
C	Connective-tissue
D	All of the above

Question 2 Explanation:

Serological tests in celiac disease include antigliadin antibodies, connective-tissue antibodies (antireticulin & antiendomysial antibodies), & antibodies against tissue transglutaminase, enzyme responsible for deamidation of gliadin in lamina propria.

Question 3

Antigen recognized by the antiendomysial antibody test is ?

A	Tissue transaminase
B	Tissue transmurase
C	Tissue transglutaminase
D	Tissue transpeptidase

Question 3 Explanation:

In celiac sprue, antigen recognized by antiendomysial antibody test is tissue transglutaminase (tTG).

Question 4

Negative predictive value of which of the following HLA allele is almost 100% in celiac sprue ?

A	HLA-DQ2
B	HLA-DQ3
C	HLA-DQ4
D	HLA-DQ5

Question 4 Explanation:

In patients with doubtful celiac sprue, HLA-DQ2 or HLA-DQ8 typing is useful, since negative predictive value of this test is almost 100%. Almost all patients with celiac sprue express HLA-DQ2 allele. Absence of DQ2 excludes the diagnosis of celiac sprue. All patients with celiac disease express the HLA-DQ2 or HLA-DQ8 allele

Question 5

The HLA-DQ2 haplotype (DQA1*0501/DQB1*0201) is expressed in what proportion of the general population ?

A	One third
B	One half
C	Three fourth
D	None

Question 5 Explanation:

The HLA-DQ2 haplotype (DQA1*0501/DQB1*0201) is expressed in the majority of patients with celiac disease (90%), whereas it is expressed in one third of the general population. In another 5% of patients with celiac disease, the HLA-DQ8 haplotype (DQA1*0301/DQB1*0302) is expressed, whereas almost all the remaining 5% of patients have at least one of the two genes encoding DQ2 (DQB1*0201 or DQA1*0501). DQ2 & DQ8 haplotypes are necessary but not sufficient for the development of celiac disease. At least 39 non-HLA genes that predispose to celiac disease have been identified, mostly involved in inflammatory and immune responses.

Question 6

Which of the following tests have a high negative predictive value in the diagnosis of celiac disease ?

A	IgA anti-tTG antibodies
B	IgG anti-tTG antibodies
C	IgA antiendomysial antibodies
D	HLA-DQ2 or HLA-DQ8

Question 6 Explanation:

Testing for HLA-DQ2 and HLA-DQ8 may be useful in at-risk persons (e.g., family members of patients with celiac disease). Such testing has a high negative predictive value, which means that the disease is very unlikely to develop in persons who are negative for both HLA-DQ2 and HLA-DQ8. Absence of HLA DQ2/DQ8 excludes the diagnosis of celiac disease

Question 7

Which of the following tests have usefulness in patients with IgA deficiency ?

A	IgA anti-tTG antibodies
B	IgG anti-tTG antibodies
C	IgA antiendomysial antibodies
D	HLA-DQ2 or HLA-DQ8

Question 8

Which of the following tests have usefulness in patients with an uncertain diagnosis ?

A	IgA anti-tTG antibodies
B	IgG anti-tTG antibodies
C	IgA antiendomysial antibodies
D	HLA-DQ2 or HLA-DQ8

Question 9

Which of the following is false about duodenal/jejunal biopsy histopathology in celiac sprue ?

A	Reduced height of villi
B	Crypt hyperplasia
C	Increased lymphocytes & plasma cells in lamina propria
D	None of the above

Question 9 Explanation:

A small-intestinal biopsy is required to establish a diagnosis of celiac disease. In celiac sprue, changes seen on duodenal/jejunal biopsy are restricted to mucosa and include absence or reduced height of villi (flat appearance), crypt hyperplasia and villus atrophy and increased lymphocytes and plasma cells in the lamina propria

Question 10

Histopathologic features characteristic of celiac sprue can also be seen in all except ?

A	Tropical sprue
B	Ulcerative colitis
C	Milk-protein intolerance in children
D	Eosinophilic enteritis

Question 11

Histopathologic features characteristic of celiac sprue can also be seen in all except ?

A	Lymphoma
B	Intestinal lymphangiectasis
C	Crohn’s disease
D	Gastrinoma with acid hypersecretion

Question 11 Explanation:

Histopathologic features of celiac sprue is seen in tropical sprue, eosinophilic enteritis & milk-protein intolerance in children, lymphoma, bacterial overgrowth, Crohn’s disease & gastrinoma with acid hypersecretion

Question 12

Which of the following about “Celiac crisis” is false ?

A	Mostly observed in adults
B	Severe diarrhea
C	Hypoproteinemia
D	Metabolic and electrolyte imbalances

Question 12 Explanation:

Metabolic and electrolyte imbalances

Question 13

After how many months of a strict gluten free diet, celiac disease is termed refractory ?

A	3 months
B	6 months
C	9 months
D	12 months

Question 13 Explanation:

Refractory celiac disease is diagnosed when there are persistent or recurrent malabsorptive symptoms and signs with villous atrophy detected on biopsy despite maintenance of a strict gluten free diet for more than 12 months.

Question 14

Which of the following is true for refractory celiac disease type 2 ?

A	Abnormal intraepithelial lymphocytes
B	Clonal intraepithelial lymphocytes without CD3
C	Clonal intraepithelial lymphocytes without CD8
D	All of the above

Question 14 Explanation:

Refractory celiac disease can be classified as type 1 (normal intraepithelial lymphocytes) or type 2 (abnormal intraepithelial lymphocytes; clonal intraepithelial lymphocytes lacking surface markers CD3, CD8, and T-cell receptors; or both). Type 2 is associated with a higher risk of ulcerative jejunoileitis and lymphoma than type 1.

Question 15

In celiac disease, the lowest amount of daily gluten that causes damage to celiac intestinal mucosa over time (gluten threshold) is ?

A	1 to 5 mg per day
B	10 to 50 mg per day
C	100 to 500 mg per day
D	1000 to 2500 mg per day

Question 15 Explanation:

In celiac disease, the lowest amount of daily gluten that causes damage to celiac intestinal mucosa over time (gluten threshold) is 10 to 50 mg per day (a 25 gram slice of bread contains ~1.6 grams of gluten). New Codex Alimentarius regulation permits a maximum gluten contamination of 20 ppm in glutenfree products.

Question 16

Interval between exposure to gluten and onset of symptoms in Celiac disease is ?

A	Minutes to hours
B	Hours to days
C	Weeks to years
D	Any of the above

Question 17

Interval between exposure to gluten and onset of symptoms in Wheat allergy is ?

A	Minutes to hours
B	Hours to days
C	Weeks to years
D	Any of the above

Question 18

Interval between exposure to gluten and onset of symptoms in Gluten sensitivity is ?

A	Minutes to hours
B	Hours to days
C	Weeks to years
D	Any of the above

Question 19

Mechanism of diarrhea in celiac disease is ?

A	Steatorrhea
B	Secondary lactase deficiency
C	Bile acid malabsorption
D	All of the above

Question 19 Explanation:

The diarrhea in celiac disease may be secondary to steatorrhea (due to changes in jejunal mucosal function), secondary lactase deficiency (due to changes in jejunal brush border enzymatic function), bile acid malabsorption (due to bile acid–induced fluid secretion in the colon, and endogenous fluid secretion resulting from crypt hyperplasia

Question 20

The diarrhea in celiac sprue is due to all except ?

A	Steatorrhea
B	Lipase deficiency
C	Bile acid malabsorption
D	Endogenous fluid secretion

Question 20 Explanation:

Diarrhea in celiac sprue may be secondary to steatorrhea, secondary lactase deficiency, bile acid malabsorption and endogenous fluid secretion.

Question 21

Celiac sprue may be associated with following diseases except ?

A	Celiac sprue may be associated with following diseases except ?
B	Type 1 diabetes mellitus
C	IgA deficiency
D	Chronic pancreatitis

Question 21 Explanation:

Celiac disease is associated with dermatitis herpetiformis (DH), diabetes mellitus type 1, IgA deficiency, Down syndrome, Turner’s syndrome, Autoimmune thyroid disease, Sjögren’s syndrome, Microscopic colitis, Rheumatoid arthritis.

Question 22

Prevalence of celiac disease is increased in which of the following conditions ?

A	Hashimoto’s thyroiditis
B	Turner’s syndrome
C	IgA deficiency
D	All of the above

Question 22 Explanation:

Prevalence of celiac disease is 1.5 to 2 times as high among women as among men and is increased among persons who have an affected first-degree relative (10 to 15%), type 1 diabetes (3 to 16%), Hashimoto’s thyroiditis (5%) or other autoimmune diseases (including autoimmune liver diseases, Sjögren’s syndrome, and IgA nephropathy), Down’s syndrome (5%), Turner’s syndrome (3%), and IgA deficiency (9%).

Question 23

Complications of Celiac sprue include all except ?

A	Malignancy
B	Intestinal ulceration
C	Collagenous sprue
D	Fistulas

Question 23 Explanation:

Complications of celiac sprue include gastrointestinal and nongastrointestinal neoplasms, intestinal ulceration and collagenous sprue.

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See all quizzes of Peptic Ulcer Disease at here:

1. Serum antibodies found in celiac sprue include all except ?
A. IgA antigliadin

B. IgA antiendomysial antibodies
C. IgA anti-tissue transglutaminase
D. IgA anti-tissue transpeptidase

2. Antiendomysial antibodies are directed against ?
A. Epithelial tissue
B. Enzyme
C. Connective-tissue
D. All of the above

3. Antigen recognized by the antiendomysial antibody test is ?
A. Tissue transaminase
B. Tissue transmurase
C. Tissue transglutaminase
D. Tissue transpeptidase

4. Negative predictive value of which of the following HLA allele
is almost 100% in celiac sprue ?
A. HLA-DQ2
B. HLA-DQ3
C. HLA-DQ4
D. HLA-DQ5

5. The HLA-DQ2 haplotype (DQA1*0501/DQB1*0201) is expressed
in what proportion of the general population ?
A. One third
B. One half
C. Three fourth
D. None

6. Which of the following tests have a high negative predictive
value in the diagnosis of celiac disease ?
A. IgA anti-tTG antibodies
B. IgG anti-tTG antibodies
C. IgA antiendomysial antibodies

D. HLA-DQ2 or HLA-DQ8

7. Which of the following tests have usefulness in patients with
IgA deficiency ?
A. IgA anti-tTG antibodies
B. IgG anti-tTG antibodies
C. IgA antiendomysial antibodies
D. HLA-DQ2 or HLA-DQ8
8.Which of the following tests have usefulness in patients with
an uncertain diagnosis ?
A. IgA anti-tTG antibodies
B. IgG anti-tTG antibodies
C. IgA antiendomysial antibodies
D. HLA-DQ2 or HLA-DQ8
9. Which of the following is false about duodenal/jejunal biopsy
histopathology in celiac sprue ?
A. Reduced height of villi
B. Crypt hyperplasia
C. Increased lymphocytes & plasma cells in lamina propria
D. None of the above

10. Histopathologic features characteristic of celiac sprue can also
be seen in all except ?
A. Tropical sprue
B. Ulcerative colitis
C. Milk-protein intolerance in children
D. Eosinophilic enteritis
11. Histopathologic features characteristic of celiac sprue can also
be seen in all except ?
A. Lymphoma
B. Intestinal lymphangiectasis
C. Crohn’s disease
D. Gastrinoma with acid hypersecretion

12. Which of the following about “Celiac crisis” is false ?
A. Mostly observed in adults
B. Severe diarrhea
C. Hypoproteinemia

D. Metabolic and electrolyte imbalances

13. After how many months of a strict gluten free diet, celiac disease
is termed refractory ?
A. 3 months
B. 6 months
C. 9 months
D. 12 months

14. Which of the following is true for refractory celiac disease type 2 ?
A. Abnormal intraepithelial lymphocytes
B. Clonal intraepithelial lymphocytes without CD3
C. Clonal intraepithelial lymphocytes without CD8
D. All of the above

15. In celiac disease, the lowest amount of daily gluten that causes
damage to celiac intestinal mucosa over time (gluten threshold)
is ?
A. 1 to 5 mg per day
B. 10 to 50 mg per day
C. 100 to 500 mg per day
D. 1000 to 2500 mg per day

16. Interval between exposure to gluten and onset of symptoms in
Celiac disease is ?
A. Minutes to hours
B. Hours to days
C. Weeks to years
D. Any of the above
17. Interval between exposure to gluten and onset of symptoms in
Wheat allergy is ?
N Engl J Med 2012;367:2419-26
A. Minutes to hours
B. Hours to days
C. Weeks to years
D. Any of the above
18. Interval between exposure to gluten and onset of symptoms in
Gluten sensitivity is ?
A. Minutes to hours

B. Hours to days
C. Weeks to years
D. Any of the above
19. Mechanism of diarrhea in celiac disease is ?
A. Steatorrhea
B. Secondary lactase deficiency
C. Bile acid malabsorption
D. All of the above

20. The diarrhea in celiac sprue is due to all except ?
A. Steatorrhea
B. Lipase deficiency
C. Bile acid malabsorption
D. Endogenous fluid secretion

21. Celiac sprue may be associated with following diseases except ?
A. Dermatitis herpetiformis (DH)
B. Type 1 diabetes mellitus
C. IgA deficiency
D. Chronic pancreatitis

22. Prevalence of celiac disease is increased in which of the
following conditions ?
A. Hashimoto’s thyroiditis
B. Turner’s syndrome
C. IgA deficiency
D. All of the above

23. Complications of Celiac sprue include all except ?
A. Malignancy
B. Intestinal ulceration
C. Collagenous sprue
D. Fistulas

[MCQ] Disorders of Absorption- Part 5

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Disorders of Absorption- Part 5

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