Parathyroid: indications for 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 · Parathyroid: indications for surgery

Sample item

Four patients have asymptomatic primary hyperparathyroidism. Which one meets a standard criterion for parathyroidectomy?

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

The answer and the reasoning

C. A 44-year-old with serum calcium 0.3 mg/dL above the upper limit and a normal bone density

Accepted criteria for surgery in asymptomatic disease include age under 50, serum calcium more than 1 mg/dL above the upper limit, a T-score of -2.5 or lower or a fragility fracture, eGFR below 60 mL/min, 24-hour urinary calcium above 400 mg, or nephrolithiasis. Only the 44-year-old satisfies one of these through age alone.

Option by option

  • A. A 66-year-old with calcium 0.4 mg/dL above the upper limit, T-score -1.8 and normal eGFR

    The T-score of -1.8 is above the -2.5 threshold, and calcium excess is under 1 mg/dL.

  • B. A 58-year-old with calcium 0.7 mg/dL above the upper limit, T-score -1.2 and eGFR 85

    Calcium excess is under 1 mg/dL, the T-score is above -2.5 and renal function is preserved.

  • C. A 44-year-old with serum calcium 0.3 mg/dL above the upper limit and a normal bone density (correct)

    Correct. Age under 50 is a sufficient indication regardless of how mild the hypercalcaemia is.

  • D. A 70-year-old with calcium 0.5 mg/dL above the upper limit, urinary calcium 280 mg/day and eGFR 72

    Urinary calcium is below 400 mg/day and no other criterion is met.

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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, A 44-year-old with serum calcium 0.3 mg/dL above the upper limit and a normal bone density. Accepted criteria for surgery in asymptomatic disease include age under 50, serum calcium more than 1 mg/dL above the upper limit, a T-score of -2.

Why is "A 66-year-old with calcium 0.4 mg/dL above the upper limit, T-score -…" not the answer?

The T-score of -1.8 is above the -2.5 threshold, and calcium excess is under 1 mg/dL.

Why is "A 58-year-old with calcium 0.7 mg/dL above the upper limit, T-score -…" not the answer?

Calcium excess is under 1 mg/dL, the T-score is above -2.5 and renal function is preserved.

Why is "A 70-year-old with calcium 0.5 mg/dL above the upper limit, urinary c…" not the answer?

Urinary calcium is below 400 mg/day and no other criterion is met.

What concept does this question test?

It tests Parathyroid: indications for surgery in General Surgery. 5 or lower or a fragility fracture, eGFR below 60 mL/min, 24-hour urinary calcium above 400 mg, or nephrolithiasis. Only the 44-year-old satisfies one of these through age alone.

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 Parathyroid: indications for 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.