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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Dieting Dilemma and Skinny Solutions

Dieting Dilemma and Skinny Solutions

The captivating thing about diets is that you don't get what is researched or predicted or calculated but rather, you get precisely what you expect. If the diet resonates with you then it will likely work, if it doesn't resonate, it won't.

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