skip to main content

Respiratory exchange ratio — MRCP Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardExercise PhysiologyRespiratory exchange ratioMRCP Part 1

A 34-year-old has advanced medullary thyroid carcinoma with a pathogenic RET mutation. Systemic treatment remains necessary after progression on vandetanib. Which targeted medicine now meets NICE sequencing?

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

Reveal the answer and explanation

Correct answer: D — Offer selpercatinib after previous vandetanib for RET-mutant medullary cancer

The best answer is “Offer selpercatinib after previous vandetanib for RET-mutant medullary cancer”. TA1038 permits selpercatinib from age 12 for advanced RET-mutant medullary thyroid cancer needing systemic treatment after cabozantinib or vandetanib. The separate RET-fusion follicular-derived pathway requires radioiodine refractoriness and prior sorafenib or lenvatinib. Medullary carcinoma is not treated on the assumption of radioiodine avidity.

Reference: NICE TA1038, Selpercatinib after targeted treatment for RET-altered advanced thyroid cancer: https://www.nice.org.uk/guidance/ta1038/chapter/1-Recommendations