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Stable Lung Nodule — RACP Adult Medicine MCQ

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HardRespiratoryStable Lung NoduleRACP Adult Medicine

A patient with MEN2A and a RET C634 variant requires elective parathyroid surgery. He has no adrenergic symptoms and normal blood pressure. Which assessment must be completed before proceeding?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Plasma free or urine fractionated metanephrines to exclude phaeochromocytoma

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

E is correct. MEN2-associated phaeochromocytoma can be clinically silent yet cause catastrophic perioperative crisis, so biochemical exclusion precedes surgery. A and B imaging follow biochemical suspicion rather than replace screening. C calcitonin does not assess adrenal catecholamine risk. D normal blood pressure and absent symptoms do not reliably exclude phaeochromocytoma.

Reference: eviQ, RET (MEN2) risk management: https://www.eviq.org.au/cancer-genetics/adult/risk-management/1526-ret-men2-risk-management