Thyroid: MEN2 prophylaxis: 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 · Thyroid: MEN2 prophylaxis

Sample item

A 3-year-old child is found by family screening to carry a RET codon 634 mutation (MEN2A). Calcitonin is normal and the neck is clinically normal. What is the recommended management of the thyroid?

ABilateral adrenalectomy firstBWaiting until a thyroid nodule appearsCProphylactic total thyroidectomy at or before 5 years of ageDAnnual ultrasound only until adulthood

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

The answer and the reasoning

C. Prophylactic total thyroidectomy at or before 5 years of age

Medullary thyroid carcinoma develops in virtually all RET carriers, and the age of onset correlates with the codon. For codon 634 (high-risk), total thyroidectomy is advised at or before age 5, guided by calcitonin, while codon 918 (highest-risk) mutations need surgery in the first year of life. Phaeochromocytoma is screened for before any surgery.

Option by option

A. Bilateral adrenalectomy first
The adrenal is not the first priority, since prophylactic thyroid surgery is driven by medullary carcinoma risk.
B. Waiting until a thyroid nodule appears
Waiting for a nodule risks metastatic disease, because spread can precede a palpable lump.
C. Prophylactic total thyroidectomy at or before 5 years of age (correct)
Correct. Early prophylactic total thyroidectomy prevents or cures the medullary carcinoma.
D. Annual ultrasound only until adulthood
Surveillance alone does not remove the near-certain risk of carcinoma.

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, Prophylactic total thyroidectomy at or before 5 years of age. Medullary thyroid carcinoma develops in virtually all RET carriers, and the age of onset correlates with the codon.

Why is "Bilateral adrenalectomy first" not the answer?

The adrenal is not the first priority, since prophylactic thyroid surgery is driven by medullary carcinoma risk.

Why is "Waiting until a thyroid nodule appears" not the answer?

Waiting for a nodule risks metastatic disease, because spread can precede a palpable lump.

Why is "Annual ultrasound only until adulthood" not the answer?

Surveillance alone does not remove the near-certain risk of carcinoma.

What concept does this question test?

It tests Thyroid: MEN2 prophylaxis in General Surgery. For codon 634 (high-risk), total thyroidectomy is advised at or before age 5, guided by calcitonin, while codon 918 (highest-risk) mutations need surgery in the first year of life. Phaeochromocytoma is screened for before any surgery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Thyroid: MEN2 prophylaxis?

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.