Answer to Case File #4

The patient has Cystic Fibrosis.

Next Step in Evaluation: Obtain a chest radiograph and perform a sweat chloride test.

Definitions:

Clubbing: Increase in the angle between the nail and nail base of 180 degrees or greater, and softening of the nail base to palpation. Although the condition can be familial, clubbing is uncommon in children, usually indicating chronic pulmonary, hepatic, cardiac, or GI disease.

Cystic Fibrosis: The major cause of chronic debilitating pulmonary disease and pancreatic exocrine deficiency in the first three decades of life. It is characterized by the triad of chronic obstructive pulmonary disease, pancreatic exocrine deficiency, and abnormally high sweat electrolyte concentrations. Characteristics pancreatic changes give the disease its name.