Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (600 page)

   Salivary type of amylase is found in esophageal rupture and occasionally in carcinoma of the ovary or lung or in salivary gland tumor.

   Other chemical determinations

   C-reactive protein ranged from 10–20 mg/dL in transudates compared to 30–40 mg/dL in exudates in one small study. Parapneumonic effusions were highest (89 ± 16 mg/dL). The pleural fluid-to-serum ratio was 0.8 ± 0.5 mg/dL in transudates and 2.8 ± 0.7 mg/dL in exudates.

   Cholesterol and triglycerides.

   Routine tumor markers (e.g., CEA, cancer antigen-125, acid phosphatase in prostate cancer, hyaluronic acid in mesothelioma) are not generally recommended. CEA >10 ng/mL is suggestive but not diagnostic of malignant pleural fluid; usually <10 ng/mL in lymphomas, sarcomas, mesotheliomas.

   Immune complexes (measured by Raji cell, C1q component, radioimmunoassay, etc.) are often found in exudates due to collagen vascular diseases (SLE, RA). LA tests show frequent false-positive results and should not be ordered. Occasionally, LA for bacterial antigens is useful.

   
RHINITIS/PHARYNGITIS

DISORDERS OF THE NOSE AND THROAT ASSOCIATED WITH RHINITIS/PHARYNGITIS

THE COMMON COLD

   Definition

   This infection of ciliated epithelial cells in nasal mucosa results in nasal discharge due to the inflammatory process.

   It is most commonly the result of rhinovirus infection. Other viruses may cause rhinitis, including
Coronavirus
, parainfluenza, adenovirus,
Enterovirus
, influenza, and respiratory syncytial virus.

   Who Should Be Suspected?

   Symptoms are typically mild, including nasal congestion, rhinitis, and sneezing. Fever, headache, cough, sore throat, and malaise, if present, are usually mild.

   Symptoms usually resolve within 7–10 days.