A 12-year-old boy presents with nausea, frequent repeated vomiting that first occurred after eating canned vegetables. Objectively: the patient has dry mucous membranes, muscular hypotonia, anisocoria, mydriasis, dysphagia and dysarthria. What is the most likely diagnosis?

Correct Answer: A

Rationale: The most likely diagnosis is A: Botulism. The symptoms, such as nausea, vomiting after eating canned vegetables, dry mucous membranes, muscular hypotonia, anisocoria, mydriasis, dysphagia, and dysarthria, are classic signs of botulism poisoning. Botulism is caused by the neurotoxin produced by Clostridium botulinum bacteria found in improperly canned or preserved food. The neurotoxin affects the nervous system, leading to symptoms like those described. Shigellosis (B), Salmonellosis (C), and Cholera (D) typically present with different symptoms such as diarrhea, fever, and abdominal pain, which are not seen in this patient.

Correct Answer: A

Rationale: The correct answer is A: Neisseria meningitidis. This is because Neisseria meningitidis is a Gram-negative diplococcus known to cause bacterial meningitis, presenting with fever, headache, and neck stiffness. It is a common cause of meningitis in young adults and teenagers. Streptococcus pneumoniae (B) is a Gram-positive bacteria and a common cause of bacterial pneumonia, not meningitis. Haemophilus influenzae (C) is a Gram-negative coccobacillus that can cause meningitis, but it is less common in adults. Klebsiella pneumoniae (D) is a Gram-negative bacillus known to cause pneumonia and urinary tract infections, not meningitis.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pyogenes. 1. Gram-positive cocci in chains: characteristic of Streptococcus species. 2. Catalase-negative: Streptococcus species are catalase-negative. 3. Beta-hemolytic: S. pyogenes is beta-hemolytic on blood agar. Therefore, S. pyogenes fits all these criteria. B: Streptococcus pneumoniae is catalase-negative but alpha-hemolytic, not beta-hemolytic. C: Enterococcus faecalis is catalase-negative, but not typically beta-hemolytic or in chains. D: Staphylococcus aureus is catalase-positive and not in chains.

Correct Answer: D

Rationale: The correct answer is D because all of the mentioned bacteria (Escherichia coli, Salmonella enterica, and Pseudomonas aeruginosa) are gram-negative bacteria that produce endotoxins in their cell walls. Endotoxins are released when the bacteria are destroyed, leading to the activation of the immune system and potentially causing septic shock. Escherichia coli and Salmonella enterica are common causes of gastrointestinal infections, while Pseudomonas aeruginosa is known for causing infections in immunocompromised individuals. Therefore, all three bacteria can produce endotoxins that contribute to septic shock. Choices A, B, and C are incorrect because each of these bacteria individually can produce endotoxins that lead to septic shock.

Correct Answer: B

Rationale: The correct answer is B: protein filaments made of flagellin. Bacterial flagella are composed of flagellin proteins arranged in helical filaments. This structure allows for movement and propulsion of bacteria. A: 9+2 microtubule arrangement is incorrect because this structure is typically found in eukaryotic flagella, not bacterial flagella. C: Lipid bilayer is incorrect as it is a structural component of cell membranes, not bacterial flagella. D: Peptidoglycan layer is incorrect as it is a component of bacterial cell walls, not flagella.