Clubbing occurs when
a. purpura or ecchymosis develops under the nail plate.
b. the nail separates from the nail bed.
c. depression ridges develop horizontally down the middle of the nail.
d. the nail base is spongy and the angle is greater than 160°.
D
Findings of clubbing occur when the angle of the nail base is greater than 160° and the nail bed is spongy. Clubbing occurs with chronic congenital cyanotic heart disease, emphysema, chronic bronchitis, and lung cancer. Purpura or ecchymosis under the nail plate is caused by a subungual hematoma from trauma to the digit and nail. Separation of the nail from the nail bed is called onycholysis and can result from hypothyroidism and hyperthyroidism, repeated trauma, Raynaud's disease, syphilis, eczema, and acrocyanosis. Numerous horizontal depression ridges or a depression down the middle of the nail is caused by continuous picking of the cuticle and nail by a finger of the same hand. Trauma ensues to the nail base and nail matrix.
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