Answer:USMLE step 2 Mcq 115:A 2yr old child presented with presented with large, bulky, greasy stools and failure to thrive

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Correct Answer: A

Explanation:
Anemia associated with steatorrhea is most often macrocytic but sometimes is caused by iron deficiency or is a mixed type due to various degrees of deficiency of folic acid, vitamin B12, and iron. Calcium may be decreased both from GI loss due to diarrhea and from artifact due to hypoalbuminemia. Celiac sprue or gluten sensitive enteropathy is a chronic disease due to sensitivity to gluten of wheat and other closely related grains like oat, barley and rye. The sensitivity to gluten results in malabsorption and associated intestinal injury.The child presents with the characteristic history of malabsorption manifested by large bulky and greasy stools which begin along with the weaning diet. The malabsorption causes failure to thrive in the child.On an intestinal biopsy the characteristic intestinal lesions are seen as diffuse enteritis with atrophy and absence of intestinal villi. This probably occurs due to immune-mediated intestinal injury


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