A 50 year old patient with long standing chronic obstructive lung disease develops the insidious onset of aching in the distal extremities, particularly the wrists bilaterally. There is a 10-lb weight loss. The skin over the wrists is warm and erythematous. There is bilateral clubbing. Plain film is read as periosteal thickening, possible osteomyelitis. You should:
Select the one best response.
a. Start ciprofloxacin
b. Obtain chest x-ray
c. Aspirate both wrists
d. Begin gold therapy
C