Breast and endocrine surgery: prophylactic thyroidectomy in MEN 2B: 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 · Breast and endocrine surgery: prophylactic thyroidectomy in MEN 2B

Sample item

A 6-month-old infant is found by genetic testing to carry the RET M918T mutation of multiple endocrine neoplasia type 2B. According to the American Thyroid Association, when should prophylactic total thyroidectomy be done?

AAt pubertyBAt 5 years of ageCIn the first year of lifeDAfter calcitonin becomes elevated

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

The answer and the reasoning

C. In the first year of life

RET M918T carries the highest risk of aggressive medullary thyroid carcinoma. The American Thyroid Association recommends prophylactic total thyroidectomy in the first year of life, by an experienced surgeon, because the cancer can appear in infancy.

Option by option

A. At puberty
Waiting until puberty risks established metastatic disease in MEN 2B.
B. At 5 years of age
Surgery by age 5 is advised for the high-risk category, not the highest-risk M918T mutation.
C. In the first year of life (correct)
Correct. The highest-risk mutation warrants thyroidectomy in the first year of life.
D. After calcitonin becomes elevated
Waiting for a calcitonin rise delays surgery until cancer may already have spread.

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, In the first year of life. RET M918T carries the highest risk of aggressive medullary thyroid carcinoma.

Why is "At puberty" not the answer?

Waiting until puberty risks established metastatic disease in MEN 2B.

Why is "At 5 years of age" not the answer?

Surgery by age 5 is advised for the high-risk category, not the highest-risk M918T mutation.

Why is "After calcitonin becomes elevated" not the answer?

Waiting for a calcitonin rise delays surgery until cancer may already have spread.

What concept does this question test?

It tests Breast and endocrine surgery: prophylactic thyroidectomy in MEN 2B in General Surgery. The American Thyroid Association recommends prophylactic total thyroidectomy in the first year of life, by an experienced surgeon, because the cancer can appear in infancy.

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 Breast and endocrine surgery: prophylactic thyroidectomy in MEN 2B?

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.