Читать книгу Respiratory Medicine - Stephen J. Bourke - Страница 59

Clubbing is increased curvature of the nail, with loss of the angle between the nail and the nail bed (Fig. 2.2). It is a very important sign that is associated with a number of diseases (Table 2.3), most notably bronchial carcinoma, bronchiectasis and fibrotic lung disease, such as idiopathic pulmonary fibrosis. Clubbing also occurs in asbestosis, although usually only in more advanced disease. Advanced clubbing is sometimes associated with hypertrophic pulmonary osteoarthropathy, in which there is new bone formation in the subperiosteal region of the long bones of the arms and legs, which is detectable on X‐ray and is associated with pain and tenderness.

Next examine the head and neck. Check for elevation of jugular venous pressure or lymph node enlargement. In the face, seek signs of cyanosis and anaemia (pallor of conjunctiva). Be alert for uncommon signs such as Horner syndrome (ptosis, meiosis, enophthalmos, anhydrosis), which indicates damage to the sympathetic nerves by a tumour situated at the lung apex (see Chapter 4).