A 33 year old patient was delivered to the infectious diseases department on the 7-th day of disease. He complained about great weakness, high temperature, pain in the lumbar area and leg muscles, icteritiousness, dark color of urine, headache. The acute disease started with chill, body temperature rise up to 40oC, headache, pain in the lumbar area and sural muscles. Icterus turned up on the 4th day, nasal and scleral haemorrhages came on the 5th day. Fever has lasted for 6 days. Diuresis - 200 ml. What is the most probable diagnosis?

Correct Answer: A

Rationale: The most probable diagnosis is Leptospirosis. The symptoms described align with the classic presentation of Leptospirosis, such as fever, muscle pain, headache, jaundice, and hemorrhages. The initial symptoms of chills, high fever, and muscle pain followed by jaundice and hemorrhages are characteristic of Leptospirosis. The presence of dark urine and low diuresis also point towards kidney involvement, which is common in Leptospirosis due to renal failure. Additionally, the patient's history of potential exposure to contaminated water or soil supports the diagnosis, as Leptospirosis is commonly transmitted through contact with infected animal urine. Summary of other choices: - Typhoid fever typically presents with sustained fever, abdominal pain, and constipation, not matching the symptoms described. - Virus A hepatitis usually presents with jaundice, but other symptoms such as muscle pain and hemorrhages are not typical. - Sepsis is a systemic response

Correct Answer: A

Rationale: The correct answer is A: Bacterial endospores. Bacterial endospores have a higher resistance to environmental stresses due to their unique structure, which includes a tough outer layer that protects the spore from harsh conditions such as heat, chemicals, and radiation. This protective layer allows endospores to remain dormant and survive in unfavorable environments until conditions improve. Summary: B: Fungal spores - While fungal spores can also survive in harsh conditions, they are generally not as resistant as bacterial endospores due to differences in their protective structures. C: Enveloped viruses - Enveloped viruses are susceptible to environmental stresses as their lipid envelope can easily be damaged by heat, chemicals, and other factors. D: Vegetative bacterial cells - Vegetative bacterial cells are more susceptible to environmental stresses compared to endospores, as they do not have the same level of protective mechanisms to survive in unfavorable conditions.

Correct Answer: B

Rationale: The correct answer is B: Treponema pallidum. The scenario describes symptoms of primary syphilis, which is caused by Treponema pallidum. The presence of a painless ulcer (chancre) and enlarged inguinal lymph nodes are characteristic of syphilis. Dark field microscopic examination showing motile, curved spirochetes is highly specific for Treponema pallidum. Incorrect explanations: A: Chlamydia trachomatis typically causes urethritis or cervicitis, not painless ulcers. C: Neisseria gonorrhoeae causes gonorrhea, which presents with purulent discharge, not painless ulcers. D: Herpes simplex virus type 2 causes genital herpes, leading to painful ulcers and vesicles, not painless ulcers seen in syphilis.

Correct Answer: A

Rationale: The most probable diagnosis is Leptospirosis. The symptoms described align with the classic presentation of Leptospirosis, such as fever, muscle pain, headache, jaundice, and hemorrhages. The initial symptoms of chills, high fever, and muscle pain followed by jaundice and hemorrhages are characteristic of Leptospirosis. The presence of dark urine and low diuresis also point towards kidney involvement, which is common in Leptospirosis due to renal failure. Additionally, the patient's history of potential exposure to contaminated water or soil supports the diagnosis, as Leptospirosis is commonly transmitted through contact with infected animal urine. Summary of other choices: - Typhoid fever typically presents with sustained fever, abdominal pain, and constipation, not matching the symptoms described. - Virus A hepatitis usually presents with jaundice, but other symptoms such as muscle pain and hemorrhages are not typical. - Sepsis is a systemic response

Correct Answer: A

Rationale: The correct answer is A: enriched media. Enriched media contain additional nutrients such as blood to support the growth of fastidious bacteria. This allows for the cultivation of a wider range of microorganisms. General-purpose media (B) contain basic nutrients for a variety of bacteria. Reducing media (C) create anaerobic conditions, not necessarily rich in organic substances. Differential media (D) contain indicators to distinguish between different types of microorganisms, not necessarily enriched with organic substances.

Correct Answer: D

Rationale: The correct answer is D: Immunocomplex. In this case, the patient's symptoms of fever, joint pains, rash, and itch along with leukopenia and thrombocytopenia indicate a serum sickness reaction. This is a type III hypersensitivity reaction where antigen-antibody complexes deposit in tissues, leading to inflammation and tissue damage. The symptoms typically occur 1-2 weeks after exposure to the antigen. Anaphylactic reaction (choice A) is immediate and involves IgE antibodies. Cytotoxic reaction (choice B) involves destruction of cells by antibodies. Delayed hypersensitivity (choice C) usually takes 48-72 hours to develop and involves T-cells. Therefore, the correct answer is D as it aligns with the symptoms and timeline of a type III hypersensitivity reaction.

Correct Answer: A

Rationale: The correct answer is A: Serological. Serological testing involves analyzing blood samples for specific antibodies produced in response to the pertussis infection. This method can detect past infections by identifying the presence of antibodies against the pertussis bacteria in the blood. In this case, since the doctor suspects pertussis infection in both children, serological testing can confirm if they have been exposed to the bacteria. Summary: B: Biological testing does not specifically target pertussis antibodies in the blood. C: Bacteriological testing involves culturing bacteria from samples, which may not be as sensitive for retrospective diagnosis. D: Molecular biological testing focuses on genetic material of the bacteria, which may not provide direct evidence of past infection.

Correct Answer: A

Rationale: The correct answer is A: Klebsiella pneumoniae. This bacterium is commonly associated with pneumonia in elderly patients. Klebsiella pneumoniae is a Gram-negative, non-motile, rod-shaped bacterium that frequently causes pneumonia in individuals with underlying health conditions. It is known for its ability to produce a distinctive mucoid capsule. Pseudomonas aeruginosa (B) is more commonly associated with hospital-acquired infections, particularly in immunocompromised individuals. Escherichia coli (C) is a common cause of urinary tract infections but is less likely in this case due to the symptoms and sputum sample results. Haemophilus influenzae (D) is another common respiratory pathogen, but in this scenario, Klebsiella pneumoniae is the most likely causative agent based on the patient's age, symptoms, and the characteristics of the bacteria described in the sputum sample.

Correct Answer: A

Rationale: The correct answer is A: Teratogenesis. Teratogenesis refers to the process of abnormal development of the fetus leading to congenital defects due to exposure to harmful agents during pregnancy. In this case, toxoplasmosis infection during pregnancy can lead to teratogenesis, causing multiple congenital defects in the child. Other choices are incorrect because B: Cancerogenesis refers to the process of cancer formation, C: Recombination is a genetic process unrelated to congenital defects, and D: Chemical mutagenesis refers to mutations caused by chemical agents, not necessarily congenital defects.