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 10mg/kg with a max dose of 600mg every 12 hours for four doses and this is 100% effective as far as we know. * Ceftriaxone 250mg IM can be given for one dose, which is 97-100% effective. * The least effective option is Ciprofloxacin 500mg PO for one 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. Teaching Image 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 Teaching Image 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 Teaching Image 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 Teaching Image Teaching Image Teaching Image Question 4 A 28-year old woman presents with several painful ulcers she has developed in the vaginal area. Examination reveals multiple 0.5 cm to 1.5 cm oval ulcers with sharply defined borders and a yellowish-white me...