brucella2007
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1.in pneumonia is A-a gradient increased?
2.is clubbing present in emphysema ( it isnt in asthma, but it is present in chronic bronchitis) ?
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| ssrpk
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A-a gradient can increase in Lobar pneumonia, as consolidation wud be analogous to have a right to left shunt....but not with bronchopneumonia!
isn't clubbing present in cyanotic diseases! i am not sure!
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| tolito
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clubbing of pulmonary etiology is seen in chronic oxygen insufficiency it will be seen in chronic bronchitis but maybe not in emphsema ( am not sure about its presence in emphsema cos these ones are referred to as pink puffers while CB are blue bloaters). it is not seen in asthma cos asthma is a reversible condition and the hypoxemia is not permanent adn does not last as long.
it is seen in cyanotic diseases for the reason of persistent chronic hypoxia.
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| brucella2007
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thanx a lot...
sorry ppl the list does not end here 
3. do the newer generation quinolones cover atypicals?
4. most sensitive investigation for establishing the dx of reflux esophagitis?
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| brucella2007
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this is what emedicine had to say ..
"Clubbing may be hereditary, but, more often, it is acquired and is associated with a number of infectious, inflammatory, neoplastic, and vascular disorders. Although it may occur with several lung diseases (ie, lung cancer, tuberculosis, lung abscess, bronchiectasis, cystic fibrosis, idiopathic pulmonary fibrosis), clubbing is a distinctly unusual finding in chronic obstructive pulmonary disease and should prompt a search for other causes (particularly lung cancer"
http://www.emedicine.com/DERM/topic547.htm#sectio...
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| brucella2007
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well the majority of sites i visited said that clubbing is not a feature of emphysema either.
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| tolito
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3. i know that they are used as out patient for community acquired pneumonia particularly in the elderly. a UW q said so and it is also in kaplan. tehy are also used for inpat care. i will look up my infectious disease once more and get back within 24hrs if nobody else clarifies this
4. esophageal ph monitoring.
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| Sea_gull
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Brucella2007
you are absolutely right .Clubbing not a feature of COPD.If you see clubbing in a patient of chronic bronchitis (which by itself usually due to smoking),then definitely there is some complication like Ca lung.
Best of luck
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| brucella2007
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thanx tolito, ure angelic 
actually iwas going thru UW explanations and they mention that macrolides and doxy for out pts, whilst i tot that levo was also doc for out pt CAp.
as far as 4. this is what struck me by surprise.hence i posted it..in a uw explaantion ( of a respo q) they say that the most sensitive test for reflux esophagitis is ENDOSCOPY.
Esophagoscopy negative
24 hr pH monitoring
Can record acid reflux at the esophageal site.
perhaps what they mean here is that esophagitis is different from GERD. esophagoscopy wud demonstrate esophagitis whilst pH monitoring wud help establish the dx of reflux]...
heres another point they mentioned in the same q btw
[Mucosal biopsy, Barium swallow, Bernstein test, Esophageal manometry
Help establish dx of gerd, but are less specific and usually not helpful in demonstrating pharyngeal reflux.]
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| brucella2007
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5. Ca, Po4 and ALkaline phosphatase levels in
a)Pagets
b) MM
c) osteopetrosis
d) Vit D def
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| ssrpk
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a) and b) all three eill be elevated!
c) Cs and PO4 shud decrease due to decreased resorption, while alkaline phosphatase shud increase!
d) vit d def. ---> sec. hyperparathyroidism. and Ca and PO4 decreases. and high alkaline phosphatase.!
btw very nice q's!
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| tolito
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be careful now about terminology. reflux esophagitis is different from esophagitis.
reflux is an acid disease while esphagitis can be erosive, inflamatory, infective etc. reflux is always diagnosed by 24hr ph monitoring cos the endoscopy may be normal in the early stages while esophagitis is diagnosed by endoscopy to see the lesion. endoscopy is altimately performed for reflux in order to biopsy and rule out barrett or some other esophageal condition but the most accurate test to diagnose reflux remains 24hr ph monitoring.
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| ssrpk
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so whtz the consensus?
a) for reflux, its 24 hr pH monitoring.
b) for esophagitis, its esophagoscopy.
c) but for reflux esophagitis, it is ????
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| brucella2007
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i realy dont know ssprk though i have found the answers to a few of the Q 5
in osteoporosis, ca ,Po4 and PTH levels are normal ( not sure abt al phos yet)
in most cases of paget's Ca and PO4 are normal too..
just to add in rickets and vit D def, ca and po4 are low.
Edited by brucella2007 on 10/10/06 - 04:39 PM
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| brucella2007
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serum ALP and urinary hydroxyproline levels, markers of bone formation and resorption, respectively, are aised in paget's dz
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| brucella2007
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in fact, the discovery of hypercalcemia, even in the presence of immobilization, should prompt a search for another cause of hypercalcemia.
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| brucella2007
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in MM hypercalcemia wud typically occur. dunno abt alp.since bone formation is not occuring, it probably wouldnt
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