Systemic paediatrics: coeliac disease with IgA deficiency: practice question

A Pediatrics 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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Pediatrics · Systemic paediatrics: coeliac disease with IgA deficiency

Sample item

A child with chronic diarrhoea and poor growth has a negative IgA anti-tissue transglutaminase and an undetectable total serum IgA. What is the best next test?

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

The answer and the reasoning

C. IgG anti-tissue transglutaminase or IgG deamidated gliadin peptide

IgA-based tests are falsely negative in IgA deficiency, which is more common in coeliac disease. IgG-based tests should then be used, and biopsy confirms. Total IgA should be checked along with the IgA anti-tTG.

Option by option

  • A. Anti-endomysial IgA

    Anti-endomysial IgA is also an IgA test and fails in IgA deficiency.

  • B. Repeat IgA anti-tTG

    Repeating an IgA test cannot work without IgA.

  • C. IgG anti-tissue transglutaminase or IgG deamidated gliadin peptide (correct)

    Correct. IgG tests are valid when IgA is absent.

  • D. Gluten challenge without testing

    A gluten challenge does not test for the disease.

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.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, IgG anti-tissue transglutaminase or IgG deamidated gliadin peptide. IgA-based tests are falsely negative in IgA deficiency, which is more common in coeliac disease.

Why is "Anti-endomysial IgA" not the answer?

Anti-endomysial IgA is also an IgA test and fails in IgA deficiency.

Why is "Repeat IgA anti-tTG" not the answer?

Repeating an IgA test cannot work without IgA.

Why is "Gluten challenge without testing" not the answer?

A gluten challenge does not test for the disease.

What concept does this question test?

It tests Systemic paediatrics: coeliac disease with IgA deficiency in Pediatrics. IgG-based tests should then be used, and biopsy confirms. Total IgA should be checked along with the IgA anti-tTG.

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 Systemic paediatrics: coeliac disease with IgA deficiency?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.