Comlex 3 Flashcards
Day of Gonococcal conjunctivitis and RX
Day 2-7. Rx is Ceftriaxone/ Cefotaxime
When is Chlamydial Conjunctivitis usually present and Rx ?
Day 5-14 Rx is PO erythromycin
BLAStomycosis
Bone, Lung Andskin, - Fever, cough, weight loss, chest pain, arthralgia, Verrucous skin lesion. Rx is Itraconazole. IF disseminated then Amphotericin
Cavernous Hemangioma when is Surgery indicated
Surgery is indicated only if its symptomatic or more than 5 CM. Otherwise just watch.
Multiple Myloma features.
Can present with decreased anion gap. bence jones proteins, hypercalcemia. pancytopenia. increased plasma cells in the bone marrow.
Carpel Tunnel what nerve, what fingers. ?
Median Nerve, First 3 fingers
Cubital Tunnel. What nerve, what fingers.
Ulnar nerve, last 2 fingers ( Ring and little ). worse with elbow flexion.
When should you check TSH level after starting someone on Levothyroxine
In 6 weeks.
ACL injury
*Most commonly injured when playing soccer/football and hit from side. Patient usually reports a POP sound with tear and significant joint swelling within hours.
Unhappy Triad
ACL, MCL and Medial Meniscus
Most common causes of Dilated cardiomyopathy
Alcohol, Chagas and Doxorubucin
Constructive pericarditis
Calcification around heart - need surgery
Holosystolic murmur best heard at the lower left sternal boarder that increases with inspiration
TR
Indications for weight loss surgery
BMI > 40 or BMI > 35 with a comorbidity ( such as HTN, CHF, DM ESRD, depression.. list go on)
How do you diagnose Endometriosis
Laparoscopy
Vit B12 def
Elevated MMA and Homocysteine. Vit B12 can be normal !!! WTF
Vit V9 dEf
Elevated Homocysteine, Normal MMA
Risk factors associated with shoulder dystocia
Macrosomia, > 4 Kg, prolonged second stage of delivery, maternal diabetes, multiparity, Rx is Flex mom’s knee to abdomen and apply suprapubic pressure.
How do you treat Wilson disease
Penicillamine
Characteristics of Wilson disease
Decreased ceruloplasmin-> Cu accumulation, Kayser-Flasicer ring, parkinson like features, depression, Elevated AST, decreased albumin
How do you treat Hemochromotosis
Phlebotomy
CD5 positive and smudge cells means
CLL Rx is supportive.
Tension Pneumothorax Classical findings
Hypotension, JVD, Tracheal deviation to opposite side, hyperresonance and absent breath sounds on affected side.
Most affected pancreatic part in cancer is
Head
Trousseau’s syndrome- Migratory thrombophlebitis
Can be seen in pancreatic cancer
Small greasy, scaly plaque on face with erythema
Seborrhoeic dermatitis
Seborrheic dermatitis RX
hydrocortisone ointment with ketoconazole oinment
What is the most important first test to order in a patient with syncope
ECG
How to do you treat DI
Desmopressin
What are the prophylactic treatments for cluster headache
CCB( Verapamil), Prednisone, Valproic acid, topiramate, and ergotamine.
Acute treatment of cluster headache
100 % oxygen, sumatriptan intranasal lidocaine
what type of Gastric ulcer associated with NSAIDS
Type V ( anywhere)
What type of gastric ulcers are associated with hypersecretion of acids
Type II and III
Type II gastric ulcer is located where
Body - associated with duodenal ulcer as well
Type III gastric ulcer is located where
Pre pyloric
Gastric ulcer types
Type 1- on lesser curvature - most common, Type II- on Body and duodenum- Type III- Pre pyloric Type IV- gastroesophageal junction Type V- can be anywhere
Treatment of choice for acromegaly
Transsphenoidal resection. Octreotide is only if patient is not a surgical candidate.
Patient is diagnosed with Lobular Carcinoma In Situ, What to do next ?
Excisional Biopsy. to rule out ductal carcinoma. Surgery is not indicated since this is just increases the cancer risk.
Anti Glomerular basement membrane abs positive in
Good pasteur
Treatment of Scabies
Permethrin cream applied neck down
Numerous Hamartomas + Pigmented melanotic(black) spots on the lips
Peutz-Jeghers
The most common risk factor for dementia is
Age
Hereditary Nonpolyposis Colorectal Cancer/Lynch syndrome
Colon Cancer + Multiple other cancers ( Ovarian, endometrial, billiary) etc
Plummer- Vinson Syndrome
Fe Def Anemia -> Microcytic anemia, Spoon shaped finger nails ( Koilonychia), Esophageal webs and PICCA
Three per second spike and wave pattern on EKG
Absence seizure.
how long strep throat patients should stay home after starting abx
1-2 days - Its contagious !
Lupus Anticoagulant and Anti Cardiolipin Abs
Antiphospholipid syndrome.
Anti histone Abs
Drug induced Lupus
Cu def
Microcytic anemia, neutropenia and thrombocytopenia and fatigue, osteoporosis
Fetal heart rate tracing pneumonic
VEAL CHOP
Urine Coproporphyrin 1 80 % and Coproporphyrin III is 20 %
Dubin Johnson syndrome
Urine Coproprophyrin 1 is 20 % and Coproprophyrin III 80 %
Rotor Syndrome
Absolute Contraindications to Breast feeding
HIV, TB, Varicella on breast, Chemo/Radiation, Active drug use and Galactosemia
What should be supplemented to New born infants
Vitamin D if they are breastfeed
10 day old patient present with Hepatomegaly, vomiting, jaundice and cataract. What is the diagnosis?
Galactosemia
Lens dislocation, osteoporosis, Hypercoagulability, tall stature what is the diagnosis.
Homocystinuria. Rx is Vit B6
Mentally retarded patients with musty order and hypopigmentation
PKU Rx. is Phenylalanine.
48 Hr old infant is crying high pitch, tachypnea, vomiting, diarrhea, what did the mother use
Morphine
High pitch cry, increased alertness, decreased weight and head circumference of the baby. What did the mother use
Cocaine
Smudge cells and increased alk phos and lymphocytes showing CD5 what is the diagnosis
CLL
How do you treat Hep A
Reassurance.
what are the contra indications for post menopauseal HRT
History of breast cancer, or increased risk of clotting ( Current smoker, hereditary clotting disorders )
What is the treatment for post menopausal symptoms in a patient who is non smoker and with no hysterectomy
Oral combined estrogen and progesterone
3 Conditions where you use IVIG
Kawasaki disease, ITP and GBS
How do you treat Essential Tremor
BB
Only anemias with Increased RDW
Fe Def and Hemolytic anemias
Main difference between Fe def and ACD
TIBC , High in Fe def. Both can present and Microcytic
what to check for Carcinoid syndrome
5 Hydroxy indol acetic acid ( 5 HIA) in the urine
How do you treat Carcinoid syndrome that is non resectable
Octreotide.
PTSD RX
SSRI
Organophosphate toxicity
Cholinergic Toxicity- Diarrhea, miosis, salivation, lacrimation Rx is Atropine
TCA Toxicity
QRS, QT prolongation, anti choliergic toxicity CNS problems.
Digoxin Toxicity
Bradycardia. CNS problems. Green yellow color blindness.
Bulls eye Calcification B/M?
Benign- Granuloma
Pop Cron Calcification B/M ?
Benign- Hamartoma
Panic Attack first line
SSRI
Pheo, Medullary Thyroid Cancer, Mucosal neuromas and Marfanoid habitus
MEN II B
How do you diagnose Intestinal malrotation
Upper GI Sereis
How do you diagnose Intussusception and Hirschsprung disease
Contrast Enema
How do you treat Cavernous sinus thrombosis
IV ABX
B3 def
Pellagra- Diarrhea, dermatitis, dementia
Treatment of Polycythemia vera
In High Risk - Hydroxyurea, In Low risk- Serial Phlebotomy.
Patient presents with Diarrhea, Steorrhea, DM, Hepatomegaly, Cholylithiasis and Hypocholrhydria and weight loss. What is the diagnosis ?
Somatostatinoma.
Right 2nd intercostal crescendo- Decrescendo murmur
AS- Pulsus parvus et tardus
Murmurs that increases with Valsalva
MVP and HOCM
Murmurs that increases with inspiration
Right sided murmurs
Murmurs that increases with expiration
Left sided murmurs
Treatment of Choice of Endometriosis
OCP + NSAIDS
How do you differentiate Syphilis from Chancroid and Herpes
Syphilis is painless and herpes and chancroid are painful with painful LAD
How do you diagnose Primary syphills
Dark field microscopy /Fluorescent ab testing
How do you diagnose Secondary or tertiary syphilis
RPR/VDRL–> FTA ABS / Darkfield microscopy
Syphilis RX
Primary/Secondary - Single PCN G
Tertiary syphilis - 3 doses of PCN G
Neurosyphilis– PCN G Infusion
Patient with Vertigo, Hearing loss and Tinnitus
Meniere’s disease
First line treatment for Graft vs Host disease, Second line
IV Steroids. Second line Tacrolimus, Mycophenolate mofetil. Cyclosporine.
Prophylactic for Graft vs Host disease
MTX + Cyclosporine, Tacrolimus + Sirolimus
Head injury– LOC lucid phase and LOC
Epidural hematoma - MMA Biconvex
Subdural hematoma, what artery, how do they look
Bridging vein Crescent shaped.
Men over 50 what routine test to be done
HIV, Zoster vaccine, Tetanus booster, Hep C, colonoscopy, DM every 3 years and FLP every 5 years.
Earliest Xray finding in Osteomyelitis
Elevation of periosteum
Initial test of choice in Osteomyelitis
Xray
IE prophylaxis
Heart criteria –> 1. Artificial valve, 2. History of endocarditis, 3. History of heart transplant. 4. Non repaired congenital heart problems
Procedure Criteria - Respiratory and infected skin ( I&D) Tissues just under the skin, msk. Dental procedures.
Cystoscopy, EGD and Colonoscopy DO NOT require ppx.
When do you expect Alcoholic DTS ( Time )
after 48 hours usually with autonomic instability.
Palpable purpura in the LE, Abdominal pain, Athralgias
HSP - Ig A deposit in the mesangium
Most specific test for Pancreatic Cancer
ERCP
Most Sensitive test for Pancreatic Cancer
CT abdomen
Patient present with jaundice what is the best next step?
Abdominal ultrasound
What are the associations of Adult polycystic Kidney disease
Berry aneurysm, Hepatic cyst and Thoracic Aortic Aneurysm.
Esophageal Web Proximal vs Distal naming
Proximal - Plummer Vinson syndrome, Distal- Schatzi ring
What is the abx of choice for SBP
3rd generation Cephalosporin
Sinusoidal Fetal heart rate pattern indicate what ?
Fetal Anemia
PUD associated with pain that is worse with food
GAstric ulcer Associated with Type A blood group
PUD associated with less pain with food but pain after 1-2 hours after food and during night
Duodenal ulcer Associated with Type O blood group
Medications that causes prolactinoma
Antipsychotics
FENa in ATN
> 2 %
Ottis Externa Rx
Topical Cipro drops and hydrocortisone ( Tympanic membrane is freely movable vs otitis media) and pushing the tragus increases the pain
Leg Clave PErthe Disease
Young male ( 4-10), femoral head necrosis - Hip, groin, thigh and knee pain.
When do you treat ITP
When Platelet is less than 30K or with bleeding. Starte with steroids, then Rituximab/splenectomy, IVIG.
What is the most appropriate diagnostic test in
- Diverticulosis
- Diverticulitis
- Colonoscopy
2. CT with Contrast.
Felty Syndrome
RA + Thrombocytopenia + Splenomegaly
Normal Cardiac parameters in pregnancy
increased blood volume, increased HR, Increased Stroke volume, Increased CO. Decreased SR, Decreased BP and Anemia.
Cancers that met to bone
BLT with Mayo and Kosher Pickle ( Brest, Lungs, Thyroid, MM, Kidney and Prostate ).
BLT M and K are osteolytic
B and P are osteoblastic
B is both
Tourette syndrome Rx
Clonidine, Haldol
Overflow incontinence
Women with post voidal residual urine, hesitancy, incomplete emptying, nocturia, dribbling Rx is Self Cath .
Indications for CABG
Left main disease > 50 %, or triple vessel disease.
Deficiency of what causes, alopecia, depression, dermatitis, central and peripheral neuropathy, nausea and vomiting
Biotin/Vitamin B7
Pauci articular vs Poliarticular juvenile onset RA
PAuci 4 or less joints, poly is 5 or more. Both are in girls <5 years and RF is negative. Usually with uveitis, Asymmetrical leg length- Rx is NSAIDS
Stress incontinence Rx
First line is Kegel exercise, Second line is Anticholinergic and TCA ( Oxybutynin )
Urge incontinence PAthology
Detrusor muscle hyperactivity Rx is life style changes first ( frequent urination ) and then Anticholinergics.
OVerflow incontinence Rx
intermittent Self cath
Erythematous annular lesion with raised edges and fine scales on the forearm what is the diagnosis and Rx
Ring worm _ Tenia corporis Hand - Tenia Mannus, head- Tinea Capitis nail - Onychomycosis Groin - Tenia Cruis
Rx - Tenia Corporis , Mannus and Cruis - Topical Azole
Tenia Capitis, Onychomycosis, and extensive tenia corporis - Griseofulvin
Bone fracture + Blue Sclera + and Hearing loss
Osteogenis Imperfecta
First Line of treatement for Ankylosing Spondylitis
NSAIDS, ( Diclofenac)
Oral Thrush in Adult
Clotrimazole and Nystatin
First line treatment for Psoriasis
Topical Steroids –> UVB then PUVA
WHen would you treat Subclinical Hypothyroidism
TSH > 10, Symptomatic, Pregnant, positive TPO abs
How do you treat Superficial Thrombophlebitis ( Venous stasis )
NSAIDS, Leg elevation and compression stockings. Do Serial physical examination as it can progress to DVT.
Positive Skewed distribution relationship of mean, median and mode
Mean>Median>Mode Also known as Right sided distribution.
How do you treat B/L Adrenal Hyperplasia
Spirinolactone
What nerve problem causes Erb Duschene palsy
C5-C6
WHat nerve problem cause Klumpksy palsy
C8- T1
How do you treat Dermatitis Herpetiformis ?
Dapsone
First line treatment of Sideroblastic Anemia
Vit B6
Warfarin effects on PT/ platelet count and bleeding time
PT is increased. Bleeding time and platelet counts are not affected.
How do you screen for Pb poisoning
Blood lead level
Erythema nodosum is seen on what ? Give 2 examples
Sarcoidosis duh and Coccidiomycosis ( Rx with Amphotericin)
Myasthenia Gravis is due to abs affecting what ? Be specific
Auto Abs against Post synaptic Nicotinic Acythel choline receptors.
Reed Sternberg cells are seen in what ? RX
Hodgkins lymphoma Rx is Chemo ( ABVD)
What cancer risk increases in women who take HRT ( E+P)
Breast Cancer
What type of cancer is increased if you use HRT ( with Estrogen alone )
Endometerial
Acute bronchitis Rx
Antitussive ( Dextromethorphan ), Decongestant ( pseudoephedrine ) and Tylenol or NSAIDS. No SABA or ABX.
Neural tube defect how to diagnose
Increased Maternal and amniotic AFP , increased AchE
Five Different types of Fine needle aspiration types of Thyroid nodule
- Benign- repeat ultrasound in 6 months,
- Atypia- Repeat FNA in 6 months
3-5. Follicular, Suspicious, Malignant- Sx
How do you treat PSGn
Supportive only ( No steroids indicated )
WHen do you check babies for HIV with Elisa and western blot
exposed babies ( during pregnancy ) after 18 months. initially do a HIV PCR at 1-3 months.
when to do surgery for hepatic adenoma
When > 5 CM, symptomatic or if they do not regress after OCP use.
RTA
RTA II Urine ph < 5 ( inability to absorb bicarb )
RTA I DCT ( Urine Ph > 6 ( Inability to secrete Acid)
RTA IV - Hyperkalemia
what need to be started on patietns with Turnurs syndrome who is < 5 in height
Growth hormone and
Estrogen/progestin
Hemophilia Lab abnormaliteis
Factor 8 or 9 def, PTT is prolonted, PT, Bleedig time, platlet is not affected
Von Willebrand’s disease lab abnormalities
Prolonged bleeding time and PTT, mucosal bleeding
Bronchiolitis s/s what cause it
RSV, Fever first then 2 days after, URI, nasal flaring, expiratory wheeezing, cynaosis - No need for CXR,
what need to be checked in a patient with Poly arteritis nodosa
Hep B
Medium vessel vasculitis - Abdominal pain with food, levedo reticularis,
RX for Nephrogenic DI
Amlodride, and NSAIDS
How do you diagnose Esophageal perforation ?
Contrast Esophageogram ( Iodine/gastrograffrin )
Concussin Grades
Grade 1- less than 15 min - may return to sport after 15 mint
Grade 2- More than 15 min- May return after 1 week
Grade 3- LOC- May return to work in 2 week
Second time concussin - move 1 grade
Child 2-14 month with first UTI. What test to order ?
Renal and bladder ultrasound- Abnormal or Second UTI - Do a voiding cystourethrogram
Difference between Z and T score
Z score are based on actual value, T score are based on Estimates
Treatment of choice for Insulinoma
Surgery
If you suspect Urethral injury, what test to order
Retrograde urethrogram. Foley is contraindicated
If you suspect bladder injury, what test to order
Cystogram first, then order a retrograde cystourethrogram before putting foley to make sure urethra is intact.
BPPV Diagnosis test
Dix Hall pike manuver
BPPV Treatement
Eply manuver
Best test to do after an abnormal LSIL, HSIL ASC- G and AGC
Colposcopy
Most common location of Diverticula is
Sigmoid colon
Child with intracranial calcification on the basal ganglia, hydrocephalus and chorioretinitis what is the causative organism?
Toxoplasma - Rx is pyrimethamine and Sulfadiazine.
How do you treat Sigmoid Volvulus
Sigmoidoscopy
s/s of Cocaine withdrawl
sleepy, hunger and dysphoria
S/s of Opioid withdrawl
Lacrimation, rhinorrhea, N/V, Abdominal and leg cramps and piloerection and dilated pupil
Treatment of PBC
Cholestyramine for pruritus and Ursodeoxycholic acid to prevent disease progression .
During pregnancy what happens to thyroxine
Total thyroxine increases, Free thyroxine is normal ( although TBG increases )
however in hypothyroids you need to increase the levothyroxine due to decreased response.
Side effects of ECT
Anterograde and retrograde amnesia, HA, postictal confusion and nausea
Pregnant female with Syphilis, What is the treatment of choice.
What if patient is allergic to PCN?
PCN, Desensitize and give PCN
Unilateral bloody discharge from a breast indicate what type of cancer
Intraductal papilloma
What is the drug of choice for OCD
SSRI or TCA ( clomipramine )
Malignant transformation of a chronic wound especially after a burn
Marjolin’s ulcer- Majority are squamous cell carcinoma -
What drug toxicity causes, Ataxia, Hyperreflexia, tremor, confusion, dysarthria
Lithium
Contraindications for vaginal delivery
Placenta previa, vasa previa, Active herpes, breech presentation, umbilical chord prolapse.
First line for GAD
SSRI/SNRI. Buspirone is only 2nd line
Rx of Testicular Torsion
Surgical Detorsion of the testicle and BILATERAL orchiopexy ( Testicular fixation )
Patient with 10% pneumothorax, Now what ?
so no intervention unless > 15. so give supplemental oxygen and closely monitor. repeat CXR in 24 hours.
What abx to use for superficial bite by a dog ?
No abx !! Got ya Only in cat bite
WHat lymph nodes drains the gonads ?(Overy and testes )
Para aortic lymph nodes.
Pheo Rule of 10s
Malignant, Familial, B/L, In children, extra adrenal , occur after sx.
What test to be done for Conns syndrome after you find a elevated aldo/renin ratio?
Na loading test.
Pityriasis Rosa Rx
Emollients.
First line treatment of TTP
Plasma exchange . Not steroids. Remember TTP by FAT RN Fever Anemia Thrombocytopenia Renal Failure Neurological problems
What is the antidote for methanol poisoning
Fomepizole.
Treatment of choice for Pemphigus vulgaris
IV steroids.
Rx for gastrin secreting tumor ( Zollinger Ellison )
PPI –once you localize then Surgery ( Use octreotide scan )
Status epilepticus treatement
Benzo–> Fos Phenytoin–> Barbiturates–> Propofol
Treatment of choice for pustular psoriasis
ORAL retinoids. Methotrexate, TNF alpha inhibitor. Cyclosporine etc
What test can be used to determine the difference between maternal and neonatal blood ( when an infant vomits blood within hours after delivery )
APTTEST
Prolactinoma patient on Bromocriptine- Does Not work now what ?
TRy cabergoline before attempting surgery
Most common cause of epididymitis is
< 35 - Chlamydia
> 35 E. Coli
Morning after pill ( Progestin only pill ) is effective upto what time after sex?
72 hours
Allergic Rhinitis Rx
Intranasal corticosteroids
Treatment of Aplastic Crisis
Blood transfusion
Treatment for Precocious puberty
GnRH analog- Leuprolide, histrelin, Nafarelin.
Infertility timing
need to be at least 1 year to say that they are infertile
Diagnostic Modality for posterior urethral valve
Voiding cystourethrogram
Erythema multiformae minior major, TEN and Steven johnson diffrences ?
Erythmea multiforme minor- Targatoid lesion on extermities.
Erythema multiformae major - Targatoid lesions on the exteremities and mucosal involement ( less than 10 %)
Steven johnson - Wide speread blisters on face, trucnk ( less than 10 % )
Toxic epidermal necrolysis ( wide spread blisters on trunk and face > 35 %
What is the diagnosis when an infant presents with cyanosis that is worse with feeding and improves with crying ?
Conchal atresia - Dx NG tube
Most common cause of death in ESRD
MI
Acute MS Rx and Chronic MS Rx
Acute - STeroids, Chronic - Beta interferon, Glatiramer
How long is Measles contagious for after the onset of the rash ?
4 days.
Rx for Seratonin Syndrome
Cyproheptadine
Best way to prevent tumor lysis syndrome
IV hydraion, Then allopurinol , Rasburicase in patients without G6 PD def
Long thoracic Muscle innervates what muscle
serratus anterior and causes winging of scapula
Difference between klatskin and Krukenberg tumor
Klatskin is cholangiocarcinoma of the bile duct.
Krukenberg is GI tumor that mets to ovary
When would you refer a child with umbilical hernia for surgery
After 4 years of age.
Parkland formula
% of BSA X wt in kg X 4 cc. This should be given in the first 24 hours. of which give half in the first hours and rest in the next 16 hours.
Churg- Strauss Syndrome
Allergic rhinitis, Eosinophilia, Asthma and p ANCA
Treatment of choice for Tinea versicolor
Numerous white spot that don’t tan. caused by malassezia fur fur. Spaghetti meat ball. Rx is Topical Selenium sulfide.
What would you do if a person who received rabies vaccination get bitten by a bat
Give him Rabies vaccine as post exposure prophylaxis
Klumpke’s paralysis is what
Horner’s syndrome, intrinsic hand muscle paralysis and loss of sensation in the ulnar distribution. C8- T1
What is the treatment of choice for molluscum contagiosum ?
Very close monitoring ! Just observation.
how do you treat hirsutism in a patient with PCOS
Spironolactone
characteristics of RA pleural effusion
Low glucose.
First line treatment for Epiglottis
Secure the airway then ABX
What is the most common cause of pancreatitis
Gall stones
What is the treatment for PID in a patient who cannot tolerate PO intake
Gentamicin and Clindamycin
where would you see auto abs against myeloperoxidase and proteinase 3 ?
pANCA and cANCA
how do you treat Diabetic Gastroparesis?
Reglan or Erythromycin
Blood types associated with gastric and duodenal ulcers
gAstric -A, duOdenal - O
Appearance of Tetralogy of fallot on Xray
Boot shaped heart
Appearance of TAPVR on Xray
Snowman
Appearance of Transposition of great vessels on Xray
Egg on a string
When should you repair cleft lip and cleft palate
Cleft lip - non problem with sucking - aT 3 months
Cleft palate- Problems with sucking- give a special nipple and surgical repair at 9- 12 months
Most common cause of prosthetic valve endocarditis
Early within 1 year - Staph epidermis
Late after 1 year - STreph viridans
Seminoma facts
most common testicular tumor, bHCG is elevated. If AFP is elevated not really seminoma.
Fried egg appearance.
Yolk sac tumor
AFP is elevated. Schiller- Duvalll bodies.
CXR of Silicosis
nodular opacities of the upper lobe
Silicoisis - Sand blasting. Glass, granite
Berylliosis CXR finding
B/L hilar LAD
Berylliosis- Electric, Nuclear workers, aerospace.
Asbestos CXR finding
B/l opacities with pleural plaques.