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Bronchiectasis Clubbing — RACP Adult Medicine MCQ

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EasyRespiratoryBronchiectasis ClubbingRACP Adult Medicine

A 40-year-old woman with cystic fibrosis presents with chronic productive cough, clubbing, and bilateral lower lobe bronchiectasis on HRCT. She has been colonised with Pseudomonas aeruginosa since age 20. FEV₁ is 55% predicted. She has no new symptoms. What is the most common benign respiratory cause of clubbing?

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Correct answer: D — Bronchiectasis

Bronchiectasis is the most common benign pulmonary cause of clubbing (present in ~30-40% of bronchiectasis patients). In this CF patient, the clubbing is from chronic bronchiectasis. CF is itself a cause of bronchiectasis. The mechanism of clubbing involves platelet-derived growth factor (PDGF) released from megakaryocyte fragments that bypass pulmonary filtration through intrapulmonary shunts or bypass damaged pulmonary vasculature.

Reference: eTG Respiratory – 2024 – Bronchiectasis; CF Australia 2024