Continuing Medical Education Questions: September 2022 : Official journal of the American College of Gastroenterology | ACG

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CME QUESTIONS

Continuing Medical Education Questions: September 2022

Patnana, Srikrishna V. MD

Author Information
The American Journal of Gastroenterology: September 2022 - Volume 117 - Issue 9 - p 1408
doi: 10.14309/ajg.0000000000001920
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Abstract

LEARNING OBJECTIVE

After this activity, the participant will be able to recognize the association between hypothyroidism and persistent positive celiac serology among both pediatric and adult patients with positive celiac serology and/or celiac disease.

QUESTION 1

A 15-year-old girl with a history of celiac disease is in your clinic for a follow-up visit. She was diagnosed with celiac disease 5 years ago based on positive IgA tissue transglutaminase antibody (IgA-tTG) and positive duodenal biopsies during esophagogastroduodenoscopy (EGD). She is not on a strict gluten-free diet. Her most recent IgA-tTG 1-year ago was still positive. She is complaining of new onset constipation, fatigue, and a 10 lb weight gain over the last 6 months. She denies rectal bleeding and has no family history of colon cancer. Her vital signs and physical exam are unremarkable.

What is the next best step in this patient’s management?

  • A. Schedule a colonoscopy
  • B. Repeat the IgA-tTG test
  • C. Repeat the EGD
  • D. Check Thyroid Stimulating Hormone (TSH)

QUESTION 2

A 44-year-old woman with history of well-controlled celiac disease is in your clinic for a follow-up visit. She has been on a strict gluten-free diet since diagnosis of celiac disease 20 years ago and has no current symptoms. She denies any comorbidities. Her vital signs and physical exam are unremarkable. Her IgA-tTG has been negative for the last 15 years. She is concerned about her family’s risk of developing hypothyroidism after reading news reports. She has 2 children with celiac disease. The first is a 19-year-old female who is not on strict gluten-free diet, has persistently positive IgA-tTG, and also has insulin-dependent diabetes mellitus. She also has a 12-year-old boy with well-controlled celiac disease and a recent negative IgA-tTG. This child does not have diabetes. Her spouse, a 46-year-old man, has no medical problems. Her 40-year-old sister has celiac disease with persistently positive IgA-tTG.

Based on this study, what should you inform the patient about her family’s risks of developing hypothyroidism?

  • A. Her daughter has a higher risk of developing hypothyroidism than her son
  • B. She is at a lower risk for hypothyroidism compared to her husband
  • C. Her sister has a higher risk of developing hypothyroidism than her children
  • D. She has a lower risk of developing hypothyroidism than her sister

QUESTION 3

According to the authors, which of the following statements is correct?

  • A. Patients with type I diabetes mellitus and subclinical celiac disease on a gluten-free diet did not have better glycemic control than those on regular diet
  • B. Celiac serology normalization is not associated with improvement in non-gastrointestinal conditions
  • C. Patients who have anti-tTG antibodies are at an increased risk for cardiovascular disease, cancer, and mortality
  • D. Pediatric and adult cohorts in this study have similar biologic characteristics

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