Breast and endocrine surgery: hyperparathyroidism: 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: hyperparathyroidism

Sample item

A man with chronic kidney disease for 12 years had a renal transplant, but his serum calcium remains high with elevated PTH despite a well-functioning graft. Which diagnosis explains this?

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

The answer and the reasoning

A. Tertiary hyperparathyroidism

Long-standing secondary hyperparathyroidism in renal failure can lead to autonomous glands that continue to secrete PTH and cause hypercalcaemia even after transplant. This is tertiary hyperparathyroidism, and subtotal parathyroidectomy is the treatment for persistent disease.

Option by option

  • A. Tertiary hyperparathyroidism (correct)

    Correct. Autonomous glands after prolonged renal failure give tertiary disease.

  • B. Secondary hyperparathyroidism

    Secondary disease has low or normal calcium and resolves with a working graft.

  • C. Solitary parathyroid adenoma

    A single adenoma is the usual cause of primary disease and not this setting.

  • D. Hypercalcaemia of malignancy

    Malignancy suppresses PTH rather than raising it.

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 A, Tertiary hyperparathyroidism. Long-standing secondary hyperparathyroidism in renal failure can lead to autonomous glands that continue to secrete PTH and cause hypercalcaemia even after transplant.

Why is "Secondary hyperparathyroidism" not the answer?

Secondary disease has low or normal calcium and resolves with a working graft.

Why is "Solitary parathyroid adenoma" not the answer?

A single adenoma is the usual cause of primary disease and not this setting.

Why is "Hypercalcaemia of malignancy" not the answer?

Malignancy suppresses PTH rather than raising it.

What concept does this question test?

It tests Breast and endocrine surgery: hyperparathyroidism in General Surgery. This is tertiary hyperparathyroidism, and subtotal parathyroidectomy is the treatment for persistent disease.

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: hyperparathyroidism?

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.