Parathyroid: MEN1: 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: MEN1

Sample item

A 30-year-old man with a pituitary adenoma and a family history of pancreatic tumours has hypercalcaemia with raised PTH. Imaging suggests several enlarged glands. What is the preferred parathyroid operation?

AMinimally invasive excision of the single largest glandBTotal parathyroidectomy without autotransplantationCSubtotal (3.5-gland) parathyroidectomy with transcervical thymectomyDObservation until symptoms develop

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

The answer and the reasoning

C. Subtotal (3.5-gland) parathyroidectomy with transcervical thymectomy

In MEN1, primary hyperparathyroidism is a multiglandular hyperplasia, so removing a single gland leaves a high recurrence rate. The standard approach is subtotal parathyroidectomy leaving a remnant of about half a gland, with thymectomy to remove supernumerary or ectopic glands.

Option by option

A. Minimally invasive excision of the single largest gland
A focused single-gland operation suits sporadic adenoma, not multigland MEN1 disease.
B. Total parathyroidectomy without autotransplantation
Total removal without autotransplantation causes permanent hypoparathyroidism.
C. Subtotal (3.5-gland) parathyroidectomy with transcervical thymectomy (correct)
Correct. Subtotal removal treats multigland disease while preserving some function.
D. Observation until symptoms develop
Symptomatic young patients with MEN1 should not be left untreated.

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, Subtotal (3.5-gland) parathyroidectomy with transcervical thymectomy. In MEN1, primary hyperparathyroidism is a multiglandular hyperplasia, so removing a single gland leaves a high recurrence rate.

Why is "Minimally invasive excision of the single largest gland" not the answer?

A focused single-gland operation suits sporadic adenoma, not multigland MEN1 disease.

Why is "Total parathyroidectomy without autotransplantation" not the answer?

Total removal without autotransplantation causes permanent hypoparathyroidism.

Why is "Observation until symptoms develop" not the answer?

Symptomatic young patients with MEN1 should not be left untreated.

What concept does this question test?

It tests Parathyroid: MEN1 in General Surgery. The standard approach is subtotal parathyroidectomy leaving a remnant of about half a gland, with thymectomy to remove supernumerary or ectopic glands.

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 Parathyroid: MEN1?

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.