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Coeliac disease — MCCQE Part 1 MCQ

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ModerateFatigueCoeliac diseaseMCCQE Part 1

A 36-year-old woman has fatigue, bloating, iron deficiency anaemia, an itchy vesicular rash on the elbows and positive tissue transglutaminase IgA. Which of the following is the most appropriate next step?

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

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Correct answer: D — Confirm with small-bowel biopsy or specialist pathway while advising not to start a gluten-free diet before confirmation

Confirm with small-bowel biopsy or specialist pathway while advising not to start a gluten-free diet before confirmation is the single best answer because the age, timing, examination findings and investigations in the vignette fit Coeliac disease better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Celiac Association guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Celiac Association guidance