In idiopathic pulmonary fibrosis, which physical examination finding is commonly expected?

• A. Bilateral lungs clear to auscultation
• B. Clubbing of fingertips
• C. Decreased FEV1/FVC
• D. Pursed lip breathing

Answer: (B)

Digital clubbing of the fingertips is a classic finding in idiopathic pulmonary fibrosis. The long-standing interstitial changes and chronic hypoxemia seen in this disease can produce clubbing, reflecting altered blood flow and nutrient signaling to the finger nails. On exam you often also hear fine crackles at the lung bases, but the clubbing sign is a key peripheral feature that clinicians look for and associate with interstitial lung disease. In contrast, pursed-lip breathing points toward obstructive conditions like COPD rather than a fibrotic process. And while spirometry is used to evaluate body gas exchange, a decreased FEV1/FVC ratio signals obstruction; interstitial fibrosis generally causes a restrictive pattern with normal or increased FEV1/FVC, so that particular finding isn’t characteristic of IPF on physical examination.