Endocrine surgery: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Endocrine surgery

Sample item

A 48-year-old woman has recurrent renal stones and bone pain. Serum calcium is 11.8 mg/dL, phosphate is low and PTH is elevated. After biochemical confirmation, which investigation best localises the lesion before surgery?

ACT of the abdomenBBone scanCUltrasound neck with Tc-99m sestamibi scanDI-131 whole body scan

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Ultrasound neck with Tc-99m sestamibi scan

Primary hyperparathyroidism is caused by a single adenoma in about 85% of cases. Sestamibi scintigraphy with neck ultrasound localises the adenoma and permits focused minimally invasive parathyroidectomy. Localisation is done after biochemical diagnosis and does not make the diagnosis.

Option by option

A. CT of the abdomen
Abdominal CT is not used to localise parathyroid adenomas.
B. Bone scan
Bone scanning does not localise the gland.
C. Ultrasound neck with Tc-99m sestamibi scan (correct)
Correct. Sestamibi with ultrasound localises an abnormal parathyroid gland.
D. I-131 whole body scan
I-131 scanning evaluates thyroid cancer and hyperthyroidism, not parathyroid disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Ultrasound neck with Tc-99m sestamibi scan. Primary hyperparathyroidism is caused by a single adenoma in about 85% of cases.

Why is "CT of the abdomen" not the answer?

Abdominal CT is not used to localise parathyroid adenomas.

Why is "Bone scan" not the answer?

Bone scanning does not localise the gland.

Why is "I-131 whole body scan" not the answer?

I-131 scanning evaluates thyroid cancer and hyperthyroidism, not parathyroid disease.

What concept does this question test?

It tests Endocrine surgery in General Surgery. Sestamibi scintigraphy with neck ultrasound localises the adenoma and permits focused minimally invasive parathyroidectomy. Localisation is done after biochemical diagnosis and does not make the diagnosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrine surgery?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.