Tuesday, 7 September 2010

MRCP revision battle 4.5: Clubbing

This clinical sign should be on one of those 'you know you're a medic when...' lists, as in "you know you're a medic when clubbing relates to fingers rather than a night out..."

As an undergraduate you probably spent cumulative hours staring purposefully at fingers to convince the examiner you were looking for clubbing, and now at MRCP you need to think about it again..

Firstly, for a definition: clubbing is defined as loss of the obtuse angle between the nail and the dorsum, with thickening of the nail bed and increased curvature of the nail bed in both directions.  There may also be increased fluctuation of the nail bed and the finger can sometimes have a 'drumstick like' appearence.

A picture can be found here

And now, for some causes, and a cry of 'ACE MILC (milk) MCFAB'!

Cardiac causes:
  • atrial myxoma
  • cyanotic congenital heart disease
  • endocarditis
GI causes:
  • malabsorption
  • inflammatory bowel disease
  • lymphoma
  • cirrhosis
Lung causes:
  • mesothioloma
  • CF and cancer
  • fibrosis
  • abscess
  • bronchiectasis

Thats all for today, but if you participated in battle 3 yesterday and fancy testing yourself go on for a brief test here...