Podcast Ep 5: Neisseria meningitidis, Bell’s Palsy, Peripartum Hemorrhage, & More

“The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.”   -Osler 

Welcome back to another episode of Roshcast. This week are adding a new level of spaced repetition by doing a brief review of previous week’s key take away points before diving into the new material.  

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• The most common causes of small bowel obstructions are (1) adhesions and then (2) cancer. In comparison, large bowel obstructions are caused most frequently by (1) cancer and then (2) volvulus.
• Nursemaid’s elbow is treated by either supination followed by elbow flexion or hyperpronation.
• Nitrates reduce both preload and afterload by dilating vascular smooth muscle.
• Lithium toxicity can cause bradycardia, t wave flattening and QTc prolongation.
• The most common finding in aortic dissection is hypertension.

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And please leave us comments. We want to hear from you. 

Let’s get going with the new material from Episode 5.

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Question 1

Which of the following requires chemoprophylaxis for meningitis exposure?

A. Breastfeeding mother of an infant with E. coli meningitis

B. Classmates of a 7-year-old with S. pneumoniae meningitis

C. Respiratory therapist for a 10-year-old with H. influenzae meningitis

D. Roommate of a 19-year-old with N. meningitides

Teaching image

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Question 2

What is the most likely cause of a patient presenting with bilateral facial nerve palsy?

A. Borrelia burgdorferi

B. Herpes simplex virus

C. Leukemia

D. Mycoplasma pneumonia

Teaching image 1

Teaching image 2

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Question 3

Which of the following is the most common cause of maternal mortality during delivery?

A. Hemorrhage

B. Infection

C. Preeclampsia

D. Pulmonary embolism

Teaching image

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Question 4

A 4-year old boy presents with a facial laceration. He has been ill with an upper respiratory infection. Procedural sedation with ketamine is planned for his wound repair. Which of the following is a potential serious adverse reaction?

A. Elevated intracranial pressure

B. Laryngospasm

C. Myoclonus

D. Seizure

Teaching image

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Question 5

Which of these statistical terms describes the risk of committing a Type I error?

A. Alpha

B. Beta

C. p value

D. Power

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Question 6

A 22-year-old man presents after encountering a Portuguese man-of-war in the ocean. He reports significant stinging to his leg with some paresthesias. Which of the following has been shown to be most effective to neutralize additional nematocysts?

A. Cold fresh water

B. Hydrogen peroxide

C. Salt water

D. Vinegar

Teaching image

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Question 7

A 33-year-old woman, with chronic persistent asthma, presents with palpitations. Her vital signs are HR 210, BP 118/73, and pulse oxygenation of 97% on room air. An ECG is shown above. Which of the following treatments is contraindicated in the treatment of this patient’s disorder?

A. Beta-blocker

B. Calcium channel blocker

C. Digoxin

D. Synchronized cardioversion

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• Prophylaxis for Neisseria Meningitidis should be offered to high-risk contacts, including household members, school contacts in the prior 7 days, and those with direct exposure to patients.
• The preferred antibiotic regimen for prophylaxis is two days of rifampin. Ceftriaxone and ciprofloxacin may also be used but they are slightly less effective.
• The most common cause of a bilateral Bell’s Palsy is Lyme disease.
• Peripheral facial nerve palsies can be distinguished from central ones based on involvement of the forehead.
• The most common cause of maternal mortality during delivery is maternal hemorrhage.
• Maternal hemorrhage can be caused by uterine atony, which is treated with oxytocin or uterine massage. Genital trauma is treated with pressure or ligation. Retained products require removal of the products to control the hemorrhage.
• One of the potentially serious adverse reactions to ketamine is laryngospasm, which is treated with bag valve mask ventilation. Always remember to set up your procedural sedations with all of your airway equipment at the bedside just as you would for a planned intubation.
• The emergence reaction from ketamine is the most common adverse effect. Ketamine can be given IV or IM and can be used for analgesia in lieu of opiates at a dose of 0.1-0.3 mg/kg.
• The statistical term alpha describes a type 1 error: detecting an effect that is not present.
• A type 2 error, or beta, is failing to detect an effect that is present.
• Nematocyst envenomation is treated by immediate removal of the nematocyst followed by salt-water wash.
• In asthmatic with tachydysrhythmias, such as AVNRT, beta-blockers should be avoided.
• AVNRT can be treated with beta-blockers, calcium channel blockers, digoxin, or electrical synchronized cardioversion for hemodynamically unstable or refractory cases.

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Hope you enjoyed this week’s episode. Let us know what you think about the intro rapid review. Remember, this podcast is meant to maximize your learning, so send us a message, and let us know how to optimize our approach. For those of you listening in real time, do not forget the 2017 Emergency Medicine In-service exam is scheduled for Wednesday, February 22. No better time than now to start churning through the Rosh Review Emergency Medicine Question Bank.

Remember to leave comments. We want to hear from you. 

Until next time,
Jeff and Nachi

P.S. If you missed our previous episodes they can all be found at Roshcast.