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Retired NBME 24 Answers

nbme24/Block 1/Question#36 (reveal difficulty score)
A 4-year-old girl is brought to the physician ...
Villous atrophy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +9  upvote downvote
submitted by โˆ—neonem(629)
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Anti-endomysial and anti-tissue glutaminase antibodies are pathognomonic for Celiac disease, a hypersensitivity to the gliadin antigen of wheat. It mainly manifests in the jejunum and ileum. In adults, it presents as chronic steatorrhea and bloating, while in children it does the same but also causes failure to thrive. Histologically, it is identified by crypt hyperplasia and villous flattening. If you damage your villi, you can't absorb fat through the lacteals of the small intestine --> malabsorption.

PAS-positive granules in macrophages in lamina propria = Whipple disease, an infection with Tropheryma whipplei, an intracellular gram-positive organism. This would similarly cause a malabsorptive state but is not associated with particular antibodies, and might also manifest as arthralgias, cardiac, and neurologic symptoms.

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ugly_but_my_hoes_not  Damage is most prominent in the distal duodenum +3
ruready4this  where would you see eosinophilic infiltration of the mucosa of the small intestine? +2
ih8payingfordis  FA 2019 Pg 375 +



 +0  upvote downvote
submitted by โˆ—abkapoor(20)
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This is a horrendously worded question.

Villous atrophy is not the CAUSE of celiac's disease, its a manifestation

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beeseltz  I think they meant what's the cause of the foul smelling stools ie malabsorption due to villous atrophy as a result of celiac. I agree not great wording though. +



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