A patient with interstitial lung disease who presents with hypoxemia due to diffusion defect would have which of the following clinical signs?

1. Fine bibasilar crackles
2. Clubbing of the finger nail beds
3. Jugular venous distention
4. Thrombocytopenia
a. 1 and 2 only
b. 1, 2, and 3 only
c. 3 and 4 only
d. 2, 3, and 4 only

ANS: B
Patients may have clubbing of the nail beds. Rheumatologic manifestations may be present if the underlying cause is a connective tissue disorder. Joint abnormalities, Reynaud disease, and telan-giectasia (a vascular lesion formed by dilatation of a group of small blood vessels) may be ob-served. The pallor of anemia can be a clue to poor gas exchange, although chronic hypoxemia may lead to polycythemia and possibly cyanosis. Pulmonary hypertension may present with signs of right heart failure such as edema, jugular vein distension, and a louder pulmonary component of the second heart sound.