Inspect the Hands

Is clubbing of the fingernails present? The technique for evaluating clubbing is described in Chapter 8, The Skin. The earliest finding of clubbing is loss of the angle between the nail and the terminal phalanx. Look at Figure 8-12, in which a normal index fingernail is compared with a severely clubbed index fingernail of a patient with bronchogenic carcinoma.

Clubbing has been associated with a number of clinical disorders, such as the following:

Intrathoracic tumors Mixed venous-to-arterial shunts Chronic pulmonary disease Chronic hepatic fibrosis

The pathogenesis of clubbing is unclear. In many conditions, however, arterial desaturation occurs. This, in some way, may be the underlying problem. In some individuals, clubbing may be inherited without any pathologic process.

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How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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