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Celiac disease — USMLE Step 2 CK MCQ

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EasyInternal MedicineCeliac diseaseUSMLE Step 2 CK

A 38-year-old Native American woman comes to the clinic because of abdominal pain or gastrointestinal symptoms. History and focused examination are notable for chronic diarrhea, weight loss, iron deficiency anemia, and dermatitis herpetiformis. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate initial diagnostic study?

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Correct answer: A — Tissue transglutaminase IgA antibody with total IgA level

The vignette describes Celiac disease, supported by chronic diarrhea, weight loss, iron deficiency anemia, and dermatitis herpetiformis. Tissue transglutaminase IgA antibody with total IgA level is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: American College of Gastroenterology 2023 Celiac Disease Guideline