FMGE 2019

Q: A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?

Hep B vaccine+ IG. ***Hep B vaccine + IG*** - Neonates born to mothers with **positive hepatitis B surface antigen (HBsAg)** should receive both the **hepatitis B vaccine** and **hepatitis B immune globulin (HBIG)** within **12 hours of birth**. - This combination provides both **passive immunity** (from HBIG) and **active immunity** (from the vaccine) to rapidly protect the newborn from perinatal hepatitis B transmission. *Hep B vaccine only* - Administering only the **hepatitis B vaccine** would provide active immunity, but the **onset of protection is slower**, leaving the neonate vulnerable during the immediate high-risk period of exposure. - While essential for long-term protection, the vaccine alone is **insufficient for immediate post-exposure prophylaxis** in a high-risk scenario. *Only IG* - Administering only **HBIG** provides immediate passive immunity, offering short-term protection, but it **does not confer long-lasting immunity**. - Without the vaccine, the infant would remain susceptible to future HBV infection once the passive antibodies wane, which typically occurs within a few months. *First IG then Hep B vaccine after 1 month* - Delaying the **hepatitis B vaccine** by a month would leave the neonate inadequately protected against subsequent exposure or potential continued viral replication after the HBIG's passive immunity declines. - The goal in this high-risk situation is to initiate **both passive and active immunity as quickly as possible** to maximize protection against perinatal transmission.

Q: An injury to the shown area can lead to fracture of which bone?

Scaphoid. ***Scaphoid*** - The **anatomical snuffbox** is the most vulnerable area for scaphoid fractures, typically occurring after a **fall on outstretched hand (FOOSH)** injury. - **Tenderness in the anatomical snuffbox** and pain with **radial deviation** of the wrist are classic clinical findings of scaphoid fracture. *Lunate* - Lunate fractures are much **rarer** and typically occur with **high-energy trauma** or **perilunate dislocations**. - The lunate is **not directly palpable** in the anatomical snuffbox area, making it less susceptible to injury from this mechanism. *Hamate* - Hamate fractures commonly occur from **direct trauma** to the **hypothenar eminence** or **hook of hamate**. - The hamate is located on the **ulnar side** of the wrist and is not anatomically related to the snuffbox area. *Trapezium* - Trapezium fractures are typically associated with **Bennett's fracture** involving the **first metacarpal base**. - Located at the **base of the thumb**, the trapezium is not directly involved in anatomical snuffbox injuries.

272 Questions — Page 28 of 28

Obstetrics and Gynecology

1 questions

Q271

A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?

Orthopaedics

1 questions

Q271Easy

An injury to the shown area can lead to fracture of which bone?