Gastroenterology and hepatology: tropical sprue: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology and hepatology: tropical sprue

Sample item

A man who has lived in Chennai for many years develops chronic diarrhoea with steatorrhoea, weight loss and macrocytic anaemia. Duodenal biopsy shows villous flattening, and tissue transglutaminase antibody is negative. Which treatment is most appropriate?

AMetronidazole aloneBOral prednisoloneCTetracycline with folic acidDStrict gluten-free diet

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Tetracycline with folic acid

Tropical sprue produces malabsorption with villous changes in people living in or returning from the tropics and responds to a prolonged course of tetracycline with folic acid. A negative coeliac serology and the geographic history separate it from coeliac disease.

Option by option

A. Metronidazole alone
Metronidazole treats giardiasis or amoebiasis and does not correct folate deficiency or sprue.
B. Oral prednisolone
Steroids are not standard treatment and would not clear the underlying enteric process.
C. Tetracycline with folic acid (correct)
Correct. Tropical sprue responds to tetracycline plus folate supplementation.
D. Strict gluten-free diet
A gluten-free diet treats coeliac disease, which is excluded by negative serology and the exposure history.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Tetracycline with folic acid. Tropical sprue produces malabsorption with villous changes in people living in or returning from the tropics and responds to a prolonged course of tetracycline with folic acid.

Why is "Metronidazole alone" not the answer?

Metronidazole treats giardiasis or amoebiasis and does not correct folate deficiency or sprue.

Why is "Oral prednisolone" not the answer?

Steroids are not standard treatment and would not clear the underlying enteric process.

Why is "Strict gluten-free diet" not the answer?

A gluten-free diet treats coeliac disease, which is excluded by negative serology and the exposure history.

What concept does this question test?

It tests Gastroenterology and hepatology: tropical sprue in General Medicine. A negative coeliac serology and the geographic history separate it from coeliac disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology and hepatology: tropical sprue?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.