Rosh Internal Medicine Boost Practice Exam

In chronic lung disease, the presence of clubbed digits and crackles suggest which type of pathology?

1. Obstructive lung disease

2. Restrictive lung disease

3. Vascular lung disease

4. Infectious lung disease

The correct answer is: Restrictive lung disease

The presence of clubbed digits and crackles in a patient with chronic lung disease suggests the involvement of restrictive lung disease. Clubbing can indicate long-standing hypoxia or chronic inflammation typically associated with diseases that affect the lung parenchyma, such as interstitial lung diseases or pulmonary fibrosis. These conditions lead to stiffening of the lung tissue, reducing lung compliance, which is characteristic of restrictive lung disease. Crackles, especially fine crackles heard on auscultation, are indicative of conditions where fluid or inflammation is present in the alveoli, which is often seen in restrictive pathology. When differentiating between types of lung disease, the combination of clubbing and crackles strongly points towards a restrictive process rather than obstructive lung disease, which typically does not present with clubbing or features these specific sounds. Vascular lung disease is more related to issues with blood flow and might show different clinical signs, while infectious lung disease could cause crackles but generally would not lead to clubbing unless there is a chronic component, such as lung abscesses or certain infections like tuberculosis. Thus, the combination of clubbing and crackles aligns most closely with restrictive lung disease.