National Board of Chiropractic Examiners (NBCE) Practice Test

A 33-year-old patient with a history of hereditary multiple exostoses has recently developed progressive, deep, unilateral hip pain with an associated soft tissue mass. What is the most likely diagnosis?

1. Osteosarcoma

2. Chondrosarcoma

3. Rhabdomyosarcoma

4. Reactive arthritis

The correct answer is: Chondrosarcoma

The diagnosis in this scenario points towards chondrosarcoma, particularly given the patient's history of hereditary multiple exostoses, which is a condition characterized by the development of multiple benign cartilaginous tumors (exostoses). Patients with hereditary multiple exostoses are at an increased risk for developing malignant transformations, especially chondrosarcoma, which arises from cartilage and can occur in areas where there are pre-existing cartilaginous lesions. The key features in this case include the patient's age, the progressive nature of the hip pain, and the presence of a soft tissue mass. Chondrosarcoma often presents with local pain and can be associated with soft tissue swelling or mass as the tumor expands. In younger adults, such tumors can arise and may not be as aggressive as in older populations but can still lead to significant morbidity. The other conditions listed do not align as well with the clinical findings. Osteosarcoma is typically an aggressive tumor more commonly seen in adolescents and young adults, often arising in the metaphysis of long bones and not particularly associated with hereditary multiple exostoses. Rhabdomyosarcoma, a soft tissue sarcoma, is more common in children and typically presents differently than the scenario described. Reactive arthritis