Finger Clubbing is associated with...

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

Select the one best response. 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: a. Start ciprofloxacin b. Obtain chest x-ray c. Aspirate both wrists d. Begin gold therapy

Clinical history: A 25 year old female, with a long history of asthma, had repeated attacks during the 2 days prior to admission, and was treated with steroids, valium and bronchodilators. She lapsed in to a coma on the day before admission. On examination, she had gasping respiration, rate 50/min, with very poor air entry on auscultation. Blood gases: pH 7.07; base excess 8.2 meq/l; standard bicarbonate 18.2 meq/l; Pa CO2 88mm Hg; Pa O2 49mm Hg; oxygen 67%. She was given hydrocortisone and aminophylline intravenously, intubated, and ventilated by hand with 100% oxygen. Her level of consciousness improved, but spontaneous respiratory effort was poor. To facilitate a changeover from orotracheal to nasotracheal tube, morphine was given. Bronchospasm increased, cardiac arrest occurred, and she died. Macroscopic description: The lung is moderately collapsed and congested, due to absorption of alveolar air by unimpeded alveolar circulation consequent on bronchiolar obstruction. The large and medium-sized bronchioles are thick-walled and their lumina are occluded by greyish-white, opalescent, jelly-like mucus plugs. It is these plugs, rather than bronchospasm, that have caused the pulmonary collapse, unconsciousness, anoxaemia and acidosis, as indicated by the blood gas results. The pulmonary vessels in the vicinity of the bronchi contain postmortem clot. References: - Images of Disease