A 38-year-old male complains of tonic tension of the masticatory muscles, so that he cannot open his mouth. 12 days before, he was bitten by an unknown dog. Objectively: there is pronounced tension and twitching of the masticatory muscles. What is the most likely diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Tetanus. The symptoms of tonic tension of the masticatory muscles following a dog bite are indicative of tetanus, caused by the bacterium Clostridium tetani. The incubation period of tetanus is usually 3-21 days, consistent with the patient's history of being bitten 12 days ago. Tetanus toxin causes muscle stiffness and spasms, leading to the inability to open the mouth. Rabies (B) presents with hydrophobia and neurological symptoms. Hysteria (C) is a psychological condition. Trigeminal neuralgia (D) is characterized by severe facial pain, not muscle stiffness.

Correct Answer: A

Rationale: The correct answer is A because Gram-negative bacteria have a unique cell envelope structure consisting of a cytoplasmic membrane, a peptidoglycan layer, and an outer membrane. The cytoplasmic membrane is the innermost layer that separates the cytoplasm from the external environment. The peptidoglycan layer provides structural support to the cell. The outer membrane acts as an additional protective barrier and contains lipopolysaccharides. Choice B is incorrect because Gram-negative bacteria have an outer membrane in addition to the cytoplasmic membrane and peptidoglycan layer. Choice C is incorrect because Gram-negative bacteria have more than just a peptidoglycan layer in their cell envelope. Choice D is incorrect as the cell envelope of Gram-negative bacteria does have specific components.

Correct Answer: D

Rationale: The correct answer is D (All of the above) because all three bacteria listed produce exotoxins that cause severe gastrointestinal illness. Clostridium botulinum produces botulinum toxin causing botulism. Vibrio cholerae produces cholera toxin leading to cholera. Escherichia coli can produce various exotoxins causing different types of severe gastrointestinal illnesses like E. coli O157:H7 causing bloody diarrhea. Therefore, all choices A, B, and C are correct in this case as they all produce exotoxins causing severe gastrointestinal illness.

Correct Answer: C

Rationale: The correct answer is Shigella (Choice C) because it matches the description of being Gram-negative rods and lactose non-fermenters. Shigella is a non-lactose fermenting, Gram-negative rod that typically produces colorless colonies on Endo agar. Salmonella (Choice A) and Escherichia coli (Choice B) are both lactose fermenters and would produce pink colonies on Endo agar. Proteus (Choice D) is also a lactose fermenter and would appear pink on Endo agar. Therefore, based on the characteristics provided, Shigella is the most likely microorganism in this scenario.

Correct Answer: B

Rationale: The correct answer is B: biofilms. Biofilms refer to complex communities of microorganisms that adhere to surfaces. They are characterized by a protective matrix that allows the microorganisms to communicate and cooperate. Colonies (A) typically refer to groups of a single species, not diverse communities. Biospheres (C) refer to the regions of the Earth where life exists, not specific microbial communities. Flora (D) generally refers to the plant life in a particular region, not microbial communities on surfaces.

Correct Answer: B

Rationale: The correct answer is B: Alpha-hemolytic streptococci. Streptococcus pneumoniae are classified as alpha-hemolytic streptococci based on their ability to partially break down red blood cells, causing a greenish discoloration on blood agar plates. This distinguishes them from beta-hemolytic streptococci, which completely break down red blood cells. Streptococcus pneumoniae are not resistant to bile (choice A), as they are bile soluble. They are not stained by the Ziehl-Neelsen staining method (choice C), which is used for acid-fast bacteria such as Mycobacterium tuberculosis. They are sensitive to optochin (choice D), which is a key differentiating factor in identifying them from other alpha-hemolytic streptococci.

Correct Answer: D

Rationale: The correct answer is D because all the choices can contribute to hospital-acquired infections. New patients in the incubation period can spread infections, medical staff can inadvertently transmit infections, and contaminated medical instruments can also be a source of infections. Therefore, it is important to consider all these factors to prevent and control the spread of infections in a hospital setting.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pyogenes. 1. Gram-positive cocci in chains suggest streptococci. 2. Beta-hemolytic activity indicates Streptococcus pyogenes. 3. Streptococcus pyogenes is commonly associated with sore throat (pharyngitis) and fever. 4. Streptococcus pneumoniae (choice B) is alpha-hemolytic and mainly causes pneumonia. 5. Enterococcus faecalis (choice C) is not typically associated with sore throat. 6. Staphylococcus aureus (choice D) is not commonly beta-hemolytic and is not a typical cause of pharyngitis.

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.