Answer 4 Chest radiograph. The presence of clubbing in a patient with COPD should prompt a work-up for occult malignancy, including a chest radiograph. Although PDGF and HGF are implicated in the pathogenesis of digital clubbing, there is no role for measuring these factors in patient evaluation. Although pulmonary function testing is appropriate for a patient with COPD, it would not help in the investigation for occult malignancy. Click here to return to the questions

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