Question

While caring for a patient known to have hepatitis​ B, you are splattered across the face with blood. You were not wearing eye protection at the time and some of the blood got onto your eyeball. You have never received your hepatitis B vaccination. Which of the following postexposure actions would not lower your risk of developing hepatitis​ B?

A. Receiving immune globulin B. Taking antiviral medication C. Having the vaccination D. Washing your eye with water

Which of the following patients is at the lowest risk of developing​ sepsis?

A. A pediatric patient who has developed pneumonia in both lungs B. An elderly patient who is recovering from abdominal surgery C. A patient with a compromised immune system who has a permanent gastrostomy tube D. A​ college-aged patient who breaks his arm in a skateboard crash

You have been called to the scene of an​ 83-year-old woman with a high fever who reports chills and shortness of breath. She is tachypneic and showing signs of pain upon inspiration. You talk with her a bit and she seems confused and unaware of where she​ is, who she​ is, or who you are. Based on this​ presentation, the patient likely​ has:

A. tuberculosis. B. croup. C. pneumonia. D. pertussis.

Answer 1

Given question is based on the postexposure prophylaxis that we take in an exposure to a patient with Hepatitis B

Hepatitis B can be transmitted via vertically(from mother to child) percutaneously(as in this case ) and sexually.

The postexposure prophylaxis depends upon whether the patient was vaccinated or not against hepatitis B in his life.
so vaccination is really a protective factor and is of importance as far as prophylaxis is concerned.

now coming to the postexposure prophylaxis ,
we can divide the exposed person into those who are vaccinated and those who are not vaccinated.
In unvaccinated patients we have to give immediate immunoglobulin and first dose of vaccine .(this should be done as soon as possible in vertical transmission and within one week in percutaneous and within two weeks in sexual transmission)

now in patients those who are vaccinated, we have to look the anti hbs(antibody produced due to the vaccination) level in the blood ,
if it is more than 10 International unit per ml its protective and nothing has to be done.
if it is less than 10, booster dose of vaccine should be given.

so here as we see in the answer we are giving immunoglobulins and vaccine as part of prophylaxis .we also have to understand that it is part of immediate care that we have to wash the face and wash all the areas which are exposed with soap and water so that the viral load can be decreased,

so analysing all the options here the answer is that anti viral drugs has no effect as for as postexposure prophylaxis of hepatitis B is concerned.

The above said facts are summarised as a flow chart below

2nd question

The second question is regarding the development of sepsis in patients .
First of all ,what we have to understand is that it's is usually when the body is immunity fails to fight against the microbial organism we get sepsis (which is the microorganism affecting almost all organs of the body ),
so any condition predisposing to reduced immunity will also predispose to sepsis so here immunocompromised conditions, elderly age and paediatric age are risk factors for the development of sepsis .

In the options given the first one is of a child developing pneumonia a child has less immunity compared to an adult and thus is at risk for the development of sepsis the second one is abdominal surgery in an elderly patient which can again both the surgery( if aseptic precautions aren't taken) and the age of the patient are risk factors for sepsis
third one is the most common cause for sepsis in the given options, that is immunocompromised patient.
the fourth option which is a fracture injury or curing in a college is good and also fracture going to sepsis Is rare (if managed well).

3rd question

the given scenario is of a patient with pneumonia.
here the patient has predominantly respiratory symptoms which makes us think about respiratory problem.

and then going to the options ,croup and pertussis is a disease particularly of children and their presentation is different.
tuberculosis usually presents with night sweats and evening rise of temperature.
so this presentation,with respiratory symptoms and particularly with altered sensorium is seen in pneumonia.(altered sensorium is due to uremia in pneumonia)