Celiac

Question 1

What characterizes celiac disease?
.

Answer 1

A: Intestinal hypersensitivity to gluten

Question 2

What is gluten?

Answer 2

A: A group of proteins, including gliadins and glutelins, found in wheat, barley, and rye.

Question 3

What is the peak age of onset for celiac disease?

Answer 3

A: 8–12 months, third to fourth decade of life, and 5th decade.

Question 4

Which HLA antigens are associated with celiac disease?

Answer 4

A: HLA-DQ2 (90–95%) and HLA-DQ8 (5–10%).

Question 5

7. Q: What triggers the autoimmune reaction in celiac disease?

Answer 5

A: Gliadin from gluten-containing grains like wheat, rye, and barley.

Question 6

What happens to the intestinal lining in celiac disease?

Answer 6

A: Chronic inflammation causes villous atrophy, crypt hyperplasia, and nutrient malabsorption.

Question 7

What enzyme modifies gliadin in celiac disease?

Answer 7

A: Tissue transglutaminase.

Question 8

What is classical celiac disease?

Answer 8

A: Celiac disease with symptoms like diarrhea, steatorrhea, and weight loss.

Question 9

What is asymptomatic celiac disease?

Answer 9

A: Identified by serology and villous atrophy without symptoms.

Question 10

Define refractory celiac disease (RCD).

Answer 10

A: Symptoms persist despite a gluten-free diet.

Question 11

What are common gastrointestinal symptoms?

Answer 11

A: Chronic diarrhea, steatorrhea, abdominal pain, and bloating.

Question 12

Name an associated dermatologic condition.

Answer 12

A: Dermatitis herpetiformis.

Question 13

What are extraintestinal manifestations in children?
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Answer 13

A: Growth failure and delayed puberty

Question 14

What is the first-line serologic test for celiac disease?

Answer 14

A: IgA tissue transglutaminase antibody (tTG IgA).

Question 15

What histological features confirm celiac disease?

Answer 15

A: Villous atrophy and crypt hyperplasia.

Question 16

What test is performed if IgA deficiency is suspected?

Answer 16

A: IgG-based tests like deamidated gliadin peptide (DGP).

Question 17

What is the Marsh classification used for?

Answer 17

A: Ranking histological severity in celiac disease.

Question 18

When is HLA testing useful?

Answer 18

A: For uncertain cases or patients on a gluten-free diet.

Question 19

What is the main treatment for celiac disease?
.

Answer 19

A: Lifelong gluten-free diet

Question 20

Why might lactose intolerance occur in celiac disease?

Answer 20

A: Secondary lactase deficiency due to mucosal damage.

Question 21

What supplements might be necessary for celiac patients?

Answer 21

A: Iron, folic acid, calcium, vitamin D, and B12.

Question 22

Name a malignancy associated with celiac disease.

Answer 22

A: Enteropathy-associated T-cell lymphoma (EATL).

Question 23

What causes refractory celiac disease type 2 (RCD2)?

Answer 23

A: Semi-malignant inflammatory conditions.

Question 24

Name a rare associated disorder in refractory celiac disease.
.

Answer 24

A: Collagenous sprue

Question 25

How soon do symptoms improve on a gluten-free diet? .

Answer 25

A: Within two weeks for most patients

Question 26

When should follow-up blood tests be performed?

Answer 26

A: At 3–6 months, 12 months, and annually.

Question 27

Which antibodies are monitored for compliance? .

Answer 27

A: IgA tTG or IgA (or IgG) DGP

Question 28

Name an endocrine association with celiac disease.

Answer 28

A: Autoimmune thyroid disease or type 1 diabetes.

Question 29

Which chromosomal syndromes are associated?

Answer 29

A: Turner syndrome and Down syndrome.

Question 30

Name a neuropsychiatric symptom of celiac disease.

Answer 30

A: Peripheral neuropathy or depression.

Question 31

Define latent celiac disease.

Answer 31

A: Positive serology but normal small intestine biopsy.

Question 32

What is nonceliac gluten sensitivity?

Answer 32

A: Symptoms triggered by gluten without celiac disease.

Question 33

Q: What is the hallmark of dermatitis herpetiformis?

Answer 33

A: Pruritic vesiculo-papular eruptions on extensor surfaces.

Question 34

How many biopsies should be taken for celiac diagnosis?

Answer 34

A: At least five, including one from the duodenal bulb.

Question 35

What can mimic villous atrophy on biopsy?

Answer 35

A: Bacterial overgrowth, tropical sprue, or giardiasis.

Question 36

Which cells mediate inflammation in celiac disease?

Answer 36

A: Pathogenic T cells.

Question 37

What part of the small intestine is most affected in celiac disease?

Answer 37

A: The distal duodenum and proximal jejunum.

Question 38

What role does tissue transglutaminase (tTG) play in celiac disease?

Answer 38

A: It modifies gliadin, making it antigenic.

Question 39

Why is total IgA testing recommended in celiac disease?

Answer 39

A: To detect IgA deficiency, which may affect antibody test accuracy.

Question 40

43. Q: What is the specificity of the tTG IgA test?

Answer 40

A: ≥ 96%.

Question 41

Why is antigliadin antibody testing no longer commonly used?

Answer 41

A: It is sensitive but not specific.

Question 42

What is the role of anti-endomysial antibody (EMA) testing?

Answer 42

A: A second-line confirmatory test due to its high specificity.

Question 43

What does intraepithelial lymphocytosis indicate in a biopsy?

Answer 43

A: Early or mild celiac disease.

Question 44

What compensates for villous atrophy in celiac disease?

Answer 44

A: Crypt hyperplasia.

Question 45

What chronic inflammatory changes occur in the lamina propria?

Answer 45

A: Lymphocytic and plasma cell infiltration.

Question 46

What nutritional deficiencies are common in celiac disease?

Answer 46

A: Iron, calcium, vitamin D, folate, and vitamin B12.

Question 47

What is ulcerative jejunoileitis?

Answer 47

A: A severe complication causing inflammation and ulceration of the small intestine.

Question 48

What is microscopic colitis, and how is it related?

Answer 48

A: An associated condition causing watery diarrhea.

Question 49

Q: Name a condition that mimics celiac disease symptoms.

Answer 49

A: Irritable bowel syndrome (IBS).

Question 50

How does hypogammaglobulinemic sprue differ from celiac disease?

Answer 50

A: It is associated with immunodeficiency rather than gluten sensitivity.

Question 51

What parasitic infection can mimic celiac histology? .

Answer 51

A: Giardiasis

Question 52

Why is a gluten challenge sometimes necessary?

Answer 52

A: To confirm diagnosis in patients already on a gluten-free diet.

Question 53

What should be checked during follow-up for celiac disease?

Answer 53

A: Complete blood count, iron studies, folate, B12, and liver chemistries.

Question 54

When is repeat biopsy recommended?

Answer 54

A: After two years on a gluten-free diet to assess mucosal healing.

Question 55

What indicates non-compliance with a gluten-free diet?

Answer 55

A: Persistently positive serologic tests.

Question 56

59. Q: What is RCD1?

Answer 56

A: Refractory celiac disease type 1, caused by high sensitivity to minimal gluten exposure.

Question 57

Q: What serious condition is associated with RCD2?

Answer 57

A: Enteropathy-associated T-cell lymphoma (EATL).

Question 58

What grains must celiac patients avoid?

Answer 58

A: Wheat, rye, barley, and spelt.

Question 59

What is secondary lactase deficiency?

Answer 59

A: Temporary lactose intolerance due to damaged intestinal mucosa.

Question 60

Why is vitamin D supplementation often necessary?

Answer 60

A: To address osteoporosis and hypocalcemia.

Question 61

What percentage of dermatitis herpetiformis patients have characteristic intestinal biopsy findings?

Answer 61

A: 85%.

Question 62

Where does dermatitis herpetiformis typically appear?

Answer 62

A: On the face, trunk, buttocks, sacrum, elbows, and knees.

Question 63

Which autoimmune diseases are often associated with celiac disease?

Answer 63

A: Type 1 diabetes mellitus and autoimmune thyroid disease.

Question 64

What is the relationship between celiac disease and selective IgA deficiency?

Answer 64

A: Celiac patients have a higher prevalence of IgA deficiency.

Question 65

What is autoimmune hepatitis, and how is it related?

Answer 65

A: A liver condition associated with celiac disease.

Question 66

What is the prognosis for patients adhering to a gluten-free diet?

Answer 66

A: Generally excellent, with reduced risk of complications and malignancies.