Clubbing

Q: Clubbing is associated with all of the following EXCEPT? (select one)

A) bronchiectasis

B) idiopathic pulmonary fibrosis

C) lung cancer

D) COPD

Answer: D

Unfortunately, the art of detailed physical examination is dying. An astute clinician listens to heart and lung sounds and observes other related clinical features simultaneously. Patients with dyspnea may provide an important clue if clubbing is present on the hands.

Clubbing is found to be associated with bronchiectasis, idiopathic pulmonary fibrosis (IPF), lung cancer, and pediatric cyanotic heart disease. Interestingly, patients exclusively with asthma, COPD, or adult-onset hypoxemia usually do not develop clubbing.

#physical-exam

#pulmonary

Further reading:

1. Sarkar M, Mahesh DM, Madabhavi I. Digital clubbing. Lung India. 2012 Oct;29(4):354-62. doi: 10.4103/0970-2113.102824. PMID: 23243350; PMCID: PMC3519022.

2. Kanematsu T, Kitaichi M, Nishimura K, Nagai S, Izumi T. Clubbing of the fingers and smooth-muscle proliferation in fibrotic changes in the lung in patients with idiopathic pulmonary fibrosis. Chest. 1994 Feb;105(2):339-42. doi: 10.1378/chest.105.2.339. PMID: 8306725.

3. Sarkar M, Mahesh DM, Madabhavi I. Digital clubbing. Lung India. 2012 Oct;29(4):354-62. doi: 10.4103/0970-2113.102824. PMID: 23243350; PMCID: PMC3519022.