Recognize  features of hypertrophic pulmonary  osteoarthropathy.

Explanation:

This is usually a sign indicating a poor prognosis. Patients have advanced clubbing. It is most commonly associated with lung cancer. Most commonly with ADENOCARCINOMA of lung. It is painful and the key to diagnosis is SUB-PERIOSTEAL NEW BONE FORMATION ON X-RAY OF THE BONE AFFECTED. MOST FREQUENTLY THE WRIST (but any long bone may be affected). Bone scans are positive.