Finger and toe clubbing

Question 1

Causes of finger and toe clubbing

Answer 1

A) Chest condition

1. Chronic suppuratives chest disease (TB, Lung abcess, Bronchiectasis, lung Ca, Empyema
2. Chronic hypoxic conditions (Fibrosing alveolitis)

B) Cardiac conditions

1. Cyanotic heart disease
2. Infective endocarditis

C) Hepatic cirrhosis

D) Chronic IBD

E) Thyrotoxicosis

Question 2

Steps in examination of Clubbing

Answer 2

1. Examine the hand (Clubbing; palmar erythema; cyanosis; splinter haemorrhages, Osler’s nodes and Janway lesions in SBE
2. Comment about patient’s growth status
3. Look for cyanosis, dyspnoea and pallor
4. Mouth for ulcer in Crohn’s disease
5. Examine shin for spider angioma, erythema nodosum and pyoderma gangrenosum
6. Chest examination for signs of bronchiectasis or alveolitis
7. CVS for heart lesion
8. Abdomen for organomegaly, mass, features of portal hypertension, and look for peri anal lesions
9. Fundi examination for Roth spots in SBE
10. Urine examination for RBC