If you fell down yesterday, stand up today. –H. G. Wells

Welcome back to RoshCast for Episode 47! Let’s kick off this episode with a review of Neisseria meningitides, an important topic for clinical practice and personal safety.

• Neisseria meningitides is highly contagious and antibiotic prophylaxis is indicated for close contacts of an infected patient, including those in contact with secretions as well as members of the same household or daycare center. Healthcare workers with close contact with the patient’s secretions should also receive prophylaxis. There are three options for prophylaxis: * Rifampin is administered at a dose of 10 mg/kg with a max dose of 600 mg every 12 hours for 4 doses, and this is 100% effective as far as we know. Ceftriaxone 250 mg IM can be given for 1 dose, which is 97–100% effective. The least effective option is Ciprofloxacin 500 mg PO for 1 dose, and that’s 90–95% effective. * Even though rifampin is the most effective, be wary of its side effects, which include turning secretions like tears and urine orange. Contact lens wearers should be warned of permanent staining.

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Now onto this week’s podcast

Question 1

A 33-year-old woman presents to the ED with agitation and severe respiratory distress. She has been taking a significant amount of “pain medication” for low back pain, according to her son. The patient is screaming about her “ears ringing.” Vital signs are BP 100/60 mm Hg, HR 140 beats per minute, RR 35 breaths per minute, and T 100.1°F. Which of the following complications is she at risk of developing?

A. Hemodynamically significant lower gastrointestinal bleeding

B. Increased intracranial pressure

C. Noncardiogenic pulmonary edema

D. Urinary retention requiring catheterization

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Question 2

Which of the following is associated with carbon monoxide poisoning?

A. Bilateral basal ganglia hypodensities

B. Elevated pH

C. Low PO2

D. Odor of bitter almonds

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Question 3

A 62-year-old woman presents to the emergency department with dizziness. She describes the events as a spinning sensation that is worse with position changes. The dizziness is associated with hearing loss as well as tinnitus and vomiting. She notes it started three days ago and that she has had multiple episodes all lasting less than a day since that time. On physical examination, horizontal nystagmus is present as is decreased hearing on the left. The remainder of the ear and neurologic examination is within normal limits. A head CT and brain MRI are performed and are negative. Which of the following is the most likely diagnosis?

A. Acoustic neuroma

B. Labyrinthitis

C. Meniere disease

D. Vestibular neuritis

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