you are performing general examination , and come to the hands , search for clubbing ,
clubbing cause at simple ( c=cyanotic heart disease , cystic fibrosis , cirrhosis of liver | L = lung ca , lung abccess | U = ulcerative colitis | B= bronchiectasis | b = benign mesothelioma | I = infective endocarditis , idiopathic pulmonary fibrosis | N = neurogenic tumor | G = gastrointestinal disease (crohn's )
in other hand
cardiac = infective endocarditis , cyanotic heart disease , atrial myxoma
lung = fibrosis , abccess , mesothelioma , ca , bronchiectasis
thyroid = hyperthyroidism
git = crohn's , ulcerative colitis , celiac , cirrhosis
familial = primary hypertrophic osteoarthropathy (our case here )
first step : gross look , is there Clubbing in the fingers ?
second step : press in the nail , is there fluctuation ? {grade 1}
third step : schamroth's sign , if no gab between the nail {grade 2}
fourth step : if the nail like drumstick , parrot beak , this {grade 3}
fifth step : press on the tip end of tibia, fibula , ulna , radius , and look at pt face , if there pain , that {grade4} which indicate hypertrophic osteoarthropathy