Malabsorption syndromes Quiz: Ace Your Exams
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A 47-year-old man comes to the primary care PA for evaluation of abdominal cramps, bloating, and diarrhea. The symptoms began several weeks ago. He describes the diarrhea as “greasy and difficult to flush.” He has unintentionally lost 13-lb over this time period and has also felt significantly more fatigued. The patient has not had any recent rashes, joint pains, or blood in the diarrhea. He has been sexually active with 3 partners over the past year and uses condoms inconsistently. Past medical history is noncontributory. He frequently travels to the Dominican Republic. Temperature is 37.0°C (98.6°F), pulse is 94/min, respirations are 14/min, and blood pressure is 122/84 mmHg. Physical examination reveals conjunctival pallor. Mild abdominal tenderness is elicited with palpation, and bowel sounds are hyperactive. Fecal occult blood test is negative, and stool microscopy shows no parasites or leukocytes. Laboratory testing reveals the following findings:
Upper endoscopy reveals flattening of the duodenal folds. Biopsy of the small intestine shows blunted villi and elongated crypts with increased inflammatory cells. A peripheral blood smear shows hypersegmented neutrophils. Which of the following is the most likely diagnosis?
| Anti-tissue transglutaminase antibodies (IgA, IgG) | Negative |
| Anti-endomysial antibody (IgA) | Negative |
| Deamidated gliadin peptide (IgG) | Negative |
| HIV-1/2 PCR | Negative |
Upper endoscopy reveals flattening of the duodenal folds. Biopsy of the small intestine shows blunted villi and elongated crypts with increased inflammatory cells. A peripheral blood smear shows hypersegmented neutrophils. Which of the following is the most likely diagnosis?
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