Bone tumours: unplanned excision of a sarcoma: practice question

A Orthopaedics 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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Orthopaedics · Bone tumours: unplanned excision of a sarcoma

Sample item

A 55-year-old had excision of a presumed lipoma of the thigh at a district hospital. Histology reports a high-grade sarcoma with positive margins. What is the next step?

AObservation with review in three monthsBMRI staging, then re-excision of the tumour bed with wide marginsCImmediate hip disarticulationDChemotherapy alone, as the tumour is already removed

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

The answer and the reasoning

B. MRI staging, then re-excision of the tumour bed with wide margins

An unplanned excision that leaves positive margins contaminates the surgical bed. The patient is referred to a sarcoma centre for MRI and staging, and the scar and tumour bed are re-excised with wide margins, with radiotherapy as indicated. Observation risks local recurrence.

Option by option

A. Observation with review in three months
Observation leaves residual tumour and leads to early local recurrence.
B. MRI staging, then re-excision of the tumour bed with wide margins (correct)
Correct. The residual disease and contaminated bed must be re-excised after staging.
C. Immediate hip disarticulation
Disarticulation is excessive and is reserved for cases where limb salvage cannot achieve clearance.
D. Chemotherapy alone, as the tumour is already removed
Chemotherapy cannot replace clearance of positive margins in a soft tissue sarcoma.

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 Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, MRI staging, then re-excision of the tumour bed with wide margins. An unplanned excision that leaves positive margins contaminates the surgical bed.

Why is "Observation with review in three months" not the answer?

Observation leaves residual tumour and leads to early local recurrence.

Why is "Immediate hip disarticulation" not the answer?

Disarticulation is excessive and is reserved for cases where limb salvage cannot achieve clearance.

Why is "Chemotherapy alone, as the tumour is already removed" not the answer?

Chemotherapy cannot replace clearance of positive margins in a soft tissue sarcoma.

What concept does this question test?

It tests Bone tumours: unplanned excision of a sarcoma in Orthopaedics. The patient is referred to a sarcoma centre for MRI and staging, and the scar and tumour bed are re-excised with wide margins, with radiotherapy as indicated. Observation risks local recurrence.

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 Bone tumours: unplanned excision of a sarcoma?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics 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.