KROK 2 Pediatrics

Practice session

An 18-month-old girl is evaluated for chronic diarrhea, abdominal distension, and poor weight gain. She was exclusively breastfed until 6 months of age, when cereals (wheat and oat porridge) were introduced. Over the last 5 months, she has had 4 to 6 loose, pale, foul-smelling stools daily, accompanied by progressive anorexia, irritability, and muscle wasting over the gluteal region ('flat buttocks'). Examination reveals a distended abdomen with prominent tympany and marked wasting of the extremities. What is the most appropriate initial diagnostic laboratory screening test for this condition?

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