Tuesday, October 6, 2009


It's been some while since I last wrote. I have been busy with Neurology. Well, this patient is a 60 years old Malay man who was admitted to my ward with progressive L sided weakness over a week. He is non toxic looking and there is no stigmata of chronic liver disease. He has been a chronic smoker. To tell the truth, I was rather upset that 2 of my house officers could not come to a conclusion even after I mentioned the gross clubbing in this patient.
I hope medical students reading this will practice what has been learned in medical student years.
This is a clear cut case of Ca lung with metastasis to the brain.
What I would like to stress here is - Do not forget the causes of clubbing !

Respiratory :
Ca lung
Pulmonary fibrosis
Chronic suppurative lung diseases
Cystic fibrosis

Congenital cyanotic heart disease
Eisenmenger syndrome
Infective endocarditis

GI :
Chronic liver disease (Cirrhosis)
Inflammatory bowel disease

Thyrotoxicosis (pseudoclubbing - acropachy)