Orthopaedic Nurses Certification Board (ONCB) Metabolic/Inflammatory/Tumors Practice Exam

A 13-year-old patient presents with fever and increased ESR. What condition is likely confirmed by bone marrow biopsy?

1. Osteosarcoma

2. Ewing's sarcoma

3. Multiple myeloma

4. Schwannoma

The correct answer is: Ewing's sarcoma

In this scenario, the symptoms of fever and increased erythrocyte sedimentation rate (ESR) point toward an inflammatory or neoplastic process. Ewing's sarcoma is a type of primitive neuroectodermal tumor that typically affects children and adolescents and is characterized by localized pain, swelling, and systemic symptoms such as fever. Bone marrow biopsy in cases of Ewing's sarcoma can reveal infiltration by malignant cells, which supports the diagnosis. This tumor is notable for its aggressive behavior and the presence of characteristic translocations visible on genetic testing, which can sometimes accompany histological findings from a biopsy. The age of the patient, combined with the clinical presentation, aligns well with Ewing's sarcoma being a strong contender as the underlying condition suggested. In contrast, osteosarcoma is typically associated with localized pain and may not prominently feature systemic symptoms like fever and elevated ESR. Multiple myeloma is more common in adults and would be less likely in a 13-year-old; it usually presents with bone pain, anemia, and other systemic features but is rare at this age. Schwannoma, a nerve sheath tumor, does not typically present with systemic symptoms like fever or elevated ESR, making it an unlikely diagnosis for the patient