Celiac vs tropical sprue -- UWorld question

[Handinhand]

I just ran into a question on UWorld which I believe to have multiple answers.

I present you a female in her twenties with abdominal pain, diarrhea and weight loss. It then gives you an image of a biopsy taken from the jejunum (shown blunting/atrophy of the vili). It then asks you what could improve this patients symptoms, with two of the answers being special diet, and antibiotics.

I chose antibiotics, as jejunal atrophy is seen in tropical sprue and first aid states that tropical sprue can be treated with antibiotics.

What is incorrect about my thinking? There is nothing in the question that can lead you to one sprue over the other, and given that celiac more commonly effects the duodenum, I thought antibiotics to be a correct choice.

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[periaqueductal]

Did they give you recent travel history? if she hasn't been to an endemic area with tropical sprue then by far the most likely cause is celiac.
Uworld often has multiple answers that seem correct. So do the nbmes and I'm assuming so does the real exam. Look for things to rule out less likely answers.

 

[Flamen04]

@periaqueductal is right! You have to give the best answer. Sucks, but that's how real life is... If someone comes in with blood in their stool, you can't just say they have cancer.

 

[Dharma]

^ Nice contribution…

Periaqueductal nailed it though. Without any history of recent travel, odds are much more likely the patient is suffering from celiac. Look back at FA though; states that it primarily affects the jejunum, while tropical sprue is likely to affect the entire small bowel.

 

[Apoplexy__]

I guess the takeaway lesson here is that you should assume malabsorption w/ blunt villi = celiac. Then, if you get a Hx of recent travel, then you can now have the ability to consider Tropical Sprue. We always learn these two together, but I'm sure Tropical Sprue is more of a zebra.

Don't worry, I would have made the same mistake as you.

 

[Handinhand]

I guess I went off of what Pathoma said in that Duodenal biopsy is what you use to diagnose and that the jejunum and ileum are less involved, where as tropical sprue more commonly effects the jejunum and ileium. This is the sole reason why I chose anti-biotics, because UWorld was showing a jejunal biopsy.

Uptodate also says that tropical sprue rarely effects travelers to the endemic region; more commonly effecting the native population.

 

[Apoplexy__]

I guess I went off of what Pathoma said in that Duodenal biopsy is what you use to diagnose and that the jejunum and ileum are less involved, where as tropical sprue more commonly effects the jejunum and ileium. This is the sole reason why I chose anti-biotics, because UWorld was showing a jejunal biopsy.

Uptodate also says that tropical sprue rarely effects travelers to the endemic region; more commonly effecting the native population.

Yeah, I totally understood your logic. There are questions that rely on those sorts of jumps in logic on NBME's and UWorld. In fact, I just did a Q on UWorld where you had to assume H. pylori infection instead of autoimmune gastritis solely on the fact that the inflammation was antral. No other info given. You're not crazy.

 

[Handinhand]

Haha, quite ironic that my studying was detrimental to me on this question. A month ago I would have said celiac disease for sure and moved on. Instead I spent like 2 minutes on this question. Bah!

 

[Dharma]

Yeah, I totally understood your logic. There are questions that rely on those sorts of jumps in logic on NBME's and UWorld. In fact, I just did a Q on UWorld where you had to assume H. pylori infection instead of autoimmune gastritis solely on the fact that the inflammation was antral. No other info given. You're not crazy.

I had an Rx question that presented similarly. I kicked myself afterwards for not remembering that ABBA mnemonic!

 

[addy]

I got this one wrong, too!! Reading this made me feel a lot better haha

 

[DrPettans]

I had an Rx question that presented similarly. I kicked myself afterwards for not remembering that ABBA mnemonic!

what ABBA mnemonic? xD