kham tim pptx

 Clubbing develops in five steps:[1]  Fluctuation and softening of the nail bed (increased ballotability)  Loss of the normal <165° angle ("Lovibond angle") between the nailbed and the fold (cuticula)  Increased convexity of the nail fold  Thickening of the whole distal finger (resembling a drumstick)  Shiny aspect and striation of the nail and skin The ratio of the anteroposterior diameter of the finger at the nail bed (a–b) to that at the distal interphalangeal joint (c–d) is a simple measurement of finger clubbing. It can be obtained readily and reproducibly with calipers. If the ratio is > 1, clubbing is present. Finger clubbing is also characterized by loss of the normal angle at the nail bed. PECTUS EXCAVATUM