ssrpk
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A 50 year old patient with long-standing chronic obstructive lung disease develops the insidious onset of aching in the distal extremeties, particularly the wrists bilaterally. There is a 10 pound weight loss. Skin over the wrists is warm and erythematous. There is bilateral clubbing. Plain film of the wrists shows "periosteal thickening, possible osteomyelitis". What will be the next step in management?
a) Start ciprofloxacin
b) Obtain chest X-Ray
c) Aspirate both wrists
d) Begin gold therapy
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| yasmeen
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B bronchonic ca
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| AAzad
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yasmeen
please explain more,
what is the relation between wrists findings and ca
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| ssrpk
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way to go yasmeen, this was real tricky!
i bet u can explain as well! 
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| Aashi
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It called as hypertrophic osteoarthropathy,associated with bronchogenic CA,except in small cell CA of lung,where can see more of paraneoplastic syndromes..
GL
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| ssrpk
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kool 
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| engel20
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honey, you can see that info in the ACCP pulmonary board review 2006 (paraneoplasic syndromes).
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