skip to main content

Coeliac disease — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardGastroenterologyCoeliac diseaseRACP Paediatrics

A 10-year-old with growth faltering and iron deficiency is eating gluten. Tissue-transglutaminase IgA is negative, but total IgA is profoundly low. Coeliac disease remains clinically plausible. What is the next serological approach?

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

Reveal the answer and explanation

Correct answer: A — Request IgG-based coeliac serology while gluten continues, referring if positive

Explanation lettering: E = shown as A · A = shown as D · D = shown as E

E is correct because profound IgA deficiency can make tTG-IgA falsely negative; an IgG-based coeliac assay is required while gluten remains in the diet, with specialist confirmation when positive or suspicion remains high. A ignores the assay limitation. B compromises subsequent diagnostic accuracy. C uses a common susceptibility genotype as if it proved disease. D evaluates intestinal inflammation but is not a coeliac-specific antibody test.

Reference: Coeliac Australia, Testing and diagnosis of coeliac disease in children: https://coeliac.org.au/article/testing-and-diagnosis-of-coeliac-disease-in-children/