Breast and endocrine surgery: parathyroid carcinoma: 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: parathyroid carcinoma

Sample item

A 55-year-old man has serum calcium of 15 mg/dL, a markedly raised PTH, nephrolithiasis and bone disease. He has a palpable firm neck mass and hoarseness. Which operation is most appropriate?

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

The answer and the reasoning

D. En bloc resection of the tumour with the ipsilateral thyroid lobe

Parathyroid carcinoma is rare and presents with severe hypercalcaemia, a palpable mass and sometimes recurrent laryngeal nerve palsy. The treatment is en bloc resection with the ipsilateral thyroid lobe and adjacent involved structures, without breaching the capsule, which is the main determinant of cure.

Option by option

  • A. Total thyroidectomy alone

    Thyroidectomy alone does not remove the parathyroid tumour.

  • B. Focused parathyroid adenomectomy

    Simple adenomectomy leaves tumour behind and risks local recurrence.

  • C. Subtotal parathyroidectomy

    Subtotal parathyroidectomy is for multigland hyperplasia.

  • D. En bloc resection of the tumour with the ipsilateral thyroid lobe (correct)

    Correct. Wide en bloc removal without capsule rupture gives the best chance of cure.

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 D, En bloc resection of the tumour with the ipsilateral thyroid lobe. Parathyroid carcinoma is rare and presents with severe hypercalcaemia, a palpable mass and sometimes recurrent laryngeal nerve palsy.

Why is "Total thyroidectomy alone" not the answer?

Thyroidectomy alone does not remove the parathyroid tumour.

Why is "Focused parathyroid adenomectomy" not the answer?

Simple adenomectomy leaves tumour behind and risks local recurrence.

Why is "Subtotal parathyroidectomy" not the answer?

Subtotal parathyroidectomy is for multigland hyperplasia.

What concept does this question test?

It tests Breast and endocrine surgery: parathyroid carcinoma in General Surgery. The treatment is en bloc resection with the ipsilateral thyroid lobe and adjacent involved structures, without breaching the capsule, which is the main determinant of cure.

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 Breast and endocrine surgery: parathyroid carcinoma?

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.