{"id":2732,"date":"2018-09-04T18:30:26","date_gmt":"2018-09-04T22:30:26","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=2732"},"modified":"2018-09-04T18:30:26","modified_gmt":"2018-09-04T22:30:26","slug":"podcast-ep-47-salicylate-toxicity-carbon-monoxide-poisoning-dizziness-painful-ulcers-peritonitis-infantile-spasms","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/podcast-ep-47-salicylate-toxicity-carbon-monoxide-poisoning-dizziness-painful-ulcers-peritonitis-infantile-spasms\/","title":{"rendered":"Podcast Ep 47: Salicylate Toxicity, Carbon Monoxide Poisoning, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_47_Roshcast_Emergency_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>If you fell down yesterday, stand up today.<\/p><cite> \u2013H. G. Wells<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to RoshCast for Episode 47!&nbsp;Let\u2019s kick off this episode with a review of <em>Neisseria meningitides<\/em>, an important topic for clinical practice and personal safety.<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"178\" height=\"66\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview_50.png\" alt=\"\" class=\"wp-image-1608\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><span style=\"font-weight: 400\"><strong><em>Neisseria meningitides<\/em><\/strong> is highly contagious and <strong>antibiotic prophylaxis<\/strong> is indicated for <strong>close contacts<\/strong> of an infected patient, including those in contact with <strong>secretions<\/strong> as well as members of the <strong>same household<\/strong> or <strong>daycare center<\/strong>.<\/span><\/li><li><span style=\"font-weight: 400\"><\/span><span style=\"font-weight: 400\"><strong>Healthcare workers<\/strong> with <strong>close contact<\/strong> with the <strong>patient<\/strong>\u2019<strong>s secretions<\/strong> should also <strong>receive prophylaxis<\/strong>.<\/span><\/li><li><span style=\"font-weight: 400\"><\/span>There are three <strong>options<\/strong> for <strong>prophylaxis<\/strong>: <ul><li><strong>Rifampin<\/strong> is administered at a dose of <strong>10 mg\/kg<\/strong> with a max dose of 600 mg <strong>every 12 hours for 4 doses<\/strong>, and this is <strong>100% effective<\/strong> as far as we know.<\/li><li><strong>Ceftriaxone 250 mg IM<\/strong> can be given for <strong>1 dose<\/strong>, which is <strong>97\u2013100% effective<\/strong>.<\/li><li>The least effective option is <strong>Ciprofloxacin 500 mg<\/strong> <strong>PO<\/strong> for <strong>1 dose<\/strong>, and that\u2019s <strong>90\u201395% effective<\/strong>. <\/li><\/ul><\/li><li>Even though <strong>rifampin<\/strong> is the most effective, be wary of its side effects, which include turning secretions like <strong>tears<\/strong> and <strong>urine<\/strong> <strong>orange<\/strong>. Contact lens wearers should be warned of permanent staining.<\/li><\/ul>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Chemoprophylaxis-Neisseria-Meningitis.jpg\">Teaching Image<\/a><\/p>\n\n\n\n<p><span><b>Now onto this week\u2019s podcast<\/b><\/span><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 1<\/strong><\/p>\n\n\n\n<p>A 33-year-old woman presents to the ED with agitation and severe respiratory distress. She has been taking a significant amount of \u201cpain medication\u201d for low back pain, according to her son. The patient is screaming about her \u201cears ringing.\u201d Vital signs are BP 100\/60 mm Hg, HR 140 beats per minute, RR 35 breaths per minute, and T 100.1\u00b0F. Which of the following complications is she at risk of developing?<\/p>\n\n\n\n<p>A. Hemodynamically significant lower gastrointestinal bleeding<\/p>\n\n\n\n<p>B. Increased intracranial pressure<\/p>\n\n\n\n<p>C. Noncardiogenic pulmonary edema<\/p>\n\n\n\n<p>D. Urinary retention requiring catheterization<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Aspirin-Toxicity.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 2<\/strong><\/p>\n\n\n\n<p>Which of the following is associated with carbon monoxide poisoning?<\/p>\n\n\n\n<p>A. Bilateral basal ganglia hypodensities<\/p>\n\n\n\n<p>B. Elevated pH<\/p>\n\n\n\n<p>C. Low PO2<\/p>\n\n\n\n<p>D. Odor of bitter almonds<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Carbon-Monoxide-Poisoning.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 3<\/strong><\/p>\n\n\n\n<p>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?<\/p>\n\n\n\n<p>A. Acoustic neuroma<\/p>\n\n\n\n<p>B. Labyrinthitis<\/p>\n\n\n\n<p>C. Meniere disease<\/p>\n\n\n\n<p>D. Vestibular neuritis<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Vestibular-Schwannoma.png\">Teaching Image<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Labyrinthitis.png\">Teaching Image<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Meniere-Disease.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 4<\/strong><\/p>\n\n\n\n<p>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 membrane. She denies recent sexual activity. Except for recurring aphthous ulcers of her mouth, her past history is unremarkable. At this time, which of the following is the most likely diagnosis?<\/p>\n\n\n\n<p>A. Behcet syndrome<\/p>\n\n\n\n<p>B. Herpes simplex<\/p>\n\n\n\n<p>C. Reactive arthritis<\/p>\n\n\n\n<p>D. Syphilis<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Behcet-Syndrome.jpg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 5<\/strong><\/p>\n\n\n\n<p>A 65-year-old man on peritoneal dialysis presents because his dialysis effluent is cloudy. You send it for culture and Gram staining, which returns with a preliminary result of gram-positive cocci in clusters. Vital signs are BP 125\/70 mm Hg, HR 80 bpm, RR 14\/min, and T 98.5\u00b0F. Other than abdominal ascites, the physical exam is unremarkable. Which of the following is the most appropriate management for this condition?<\/p>\n\n\n\n<p>A. Inpatient management with antibiotics and temporary hemodialysis<\/p>\n\n\n\n<p>B. Inpatient management with IV antibiotics<\/p>\n\n\n\n<p>C. Outpatient management with intraperitoneal antibiotics<\/p>\n\n\n\n<p>D. Outpatient management with oral antibiotics<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Peritoneal-Dialysis.jpg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 6<\/strong><\/p>\n\n\n\n<p>Which of the following historical features is most consistent with infantile spasms?<\/p>\n\n\n\n<p>A. Occur in clusters lasting a few minutes at a time<\/p>\n\n\n\n<p>B. Occur more frequently during sleep<\/p>\n\n\n\n<p>C. Onset between 12 and 18 months of age<\/p>\n\n\n\n<p>D. Precipitated by loud noises or handling<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep47-Infantile-Spasms.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"178\" height=\"66\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview_50.png\" alt=\"\" class=\"wp-image-1608\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><span style=\"font-weight: 400\"><strong> Salicylates<\/strong>, <strong>opioids<\/strong>, <strong>naloxone<\/strong>, <strong>phencyclidine<\/strong>, and <strong>meprobamate<\/strong> can cause <strong>noncardiogenic pulmonary edema<\/strong>.<\/span><\/li><li>Patients with <strong>acute salicylate toxicity with levels greater than 100 mg\/dL<\/strong> and <strong>chronic toxicity with levels greater than 60 mg\/dL<\/strong> require <strong>dialysis<\/strong>.<\/li><li><strong>Neurologic sequelae<\/strong> from <strong>carbon monoxide poisoning<\/strong> can be identified <strong>radiographically within 12 hours<\/strong> of exposure as symmetric <strong>hypodense lesions in the basal ganglia<\/strong>.<\/li><li><strong>Meniere disease<\/strong> is a set of <strong>episodic<\/strong> symptoms including <strong>vertigo<\/strong>, <strong>hearing loss<\/strong>, <strong>tinnitus<\/strong>, and a sense of <strong>fullness<\/strong> in the ear. &nbsp;Episodes last anywhere from 20 minutes to 4 hours.<\/li><li><strong>Behcet syndrome<\/strong> presents as <strong>recurring genital and oral ulcerations<\/strong> and also relapsing <strong>uveitis<\/strong>.<\/li><li><strong>Peritonitis<\/strong> is the <strong>most common complication<\/strong> of <strong>peritoneal dialysis<\/strong>, and it can often be treated with <strong>intraperitoneal<\/strong> <strong>antibiotics<\/strong> as an outpatient.<\/li><li><strong>Infantile spasms<\/strong> present <strong>before the age of one<\/strong> and <strong>EEG shows hypsarrhythmia<\/strong>. This is <strong>treated<\/strong> with <strong>corticotropin<\/strong>.<\/li><\/ul>\n\n\n\n<p>That wraps up RoshCast Episode 47!&nbsp;Be sure to also check out the rest of the&nbsp;<a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/\" target=\"_blank\">Rosh Review Blog&nbsp;<\/a>for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don\u2019t forget to follow us on twitter <a href=\"https:\/\/twitter.com\/roshcast?lang=en\">@RoshCast<\/a>. And you can always email us at <a href=\"mailto:roshcast@roshreview.com\">RoshCast@RoshReview.com<\/a>&nbsp;with any feedback, corrections, or suggestions.&nbsp;<\/p>\n\n\n\n<p>You can also help us pick questions by identifying ones you would like us to review. Write \u201cRoshCast\u201d in the Submit Feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/roshcast\/id1156487141?mt=2\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">iTunes<\/a>&nbsp;to help spread the word about RoshCast.<\/p>\n\n\n\n<p>Megha and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you fell down yesterday, stand up today. \u2013H. G. Wells Welcome back to RoshCast for Episode 47!&nbsp;Let\u2019s 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 <a href=\"https:\/\/www.roshreview.com\/blog\/podcast-ep-47-salicylate-toxicity-carbon-monoxide-poisoning-dizziness-painful-ulcers-peritonitis-infantile-spasms\/\">read more&#8230;<\/a><\/p>\n","protected":false},"author":11,"featured_media":2637,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2163,2221,2230,2323,2759,2871,2873,3020,3103,3290,3411,3475,3503,3660,3669,3748],"coauthors":[],"class_list":["post-2732","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-antibiotic-prophylaxis","tag-basal-ganglia","tag-behcets","tag-carbon-monoxide-poisoning","tag-hearing-loss","tag-infantile-spasms","tag-infectious-diseases","tag-menieres-disease","tag-neisseria-meningitidis","tag-peritonitis","tag-pulmonary-edema","tag-rifampin","tag-salicylates","tag-tinnitus","tag-toxicology","tag-vertigo"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.7 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Podcast Ep 47: Salicylate Toxicity, Carbon Monoxide Poisoning &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 47), the first question and answer style emergency medicine podcast. 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