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General Medicine · Rheumatology: hypertrophic osteoarthropathy
Sample itemA 62-year-old smoker has finger clubbing, painful swollen wrists and ankles, and radiographs showing linear new bone formation along the shafts of the tibia and radius. Which underlying disease should be sought first?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Bronchogenic carcinoma
Clubbing with painful joints and periostitis of long bones describes hypertrophic osteoarthropathy. Most often it accompanies lung cancer, and it can regress after the tumour is resected.
Option by option
A. Hypothyroidism
Hypothyroidism may cause arthralgia but not periosteal new bone and clubbing.
B. Gout
Gout causes punched-out erosions with overhanging edges and does not cause periostitis.
C. Bronchogenic carcinoma (correct)
Correct. Periosteal new bone with clubbing in a smoker points to a lung tumour.
D. Rheumatoid arthritis
Rheumatoid arthritis causes erosions and joint space loss without shaft periostitis.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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