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: Vibrios. Vibrios are gram-negative curved bacteria that are motile and do not form spores or capsules. The description of the bacteria in the question fits the characteristics of Vibrios. Vibrios are commonly found in aquatic environments and some species can cause gastrointestinal infections in humans. B: Spirochetes are also gram-negative curved bacteria, but they are spiral-shaped and have unique axial filaments for motility. The description in the question does not match the characteristics of spirochetes. C: Clostridia are gram-positive, spore-forming bacteria. The question specifically states that the bacteria are gram-negative and do not form spores, ruling out Clostridia. D: Corynebacteria are gram-positive, non-spore-forming bacteria. The description in the question does not match the characteristics of Corynebacteria.

Correct Answer: B

Rationale: The correct answer is B: Staphylococcus aureus. This bacterium is commonly found in hospital environments due to its ability to colonize human skin and mucous membranes. It is a leading cause of hospital-acquired infections. Borrelia burgdorferi is mainly associated with Lyme disease transmitted by ticks, not commonly found in hospitals. Bacillus cereus is a foodborne pathogen, not typically prevalent in hospital settings. Staphylococcus haemolyticus is a coagulase-negative staphylococcus species, less pathogenic and less common in hospitals compared to Staphylococcus aureus.

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 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: C

Rationale: The correct answer is C: Increased active efflux from the bacterial cell. This is the most important mechanism of tetracycline resistance because it involves the bacteria actively pumping out the antibiotic, reducing its intracellular concentration. This prevents tetracycline from effectively targeting bacterial ribosomes. Choice A is incorrect as tetracycline resistance typically involves active efflux rather than reduced influx. Choice B is incorrect because tetracycline resistance mechanisms do not primarily involve altered cell membrane components affecting passive influx. Choice D is also incorrect as tetracycline resistance mechanisms do not typically involve direct enzymatic inactivation of the antibiotic.

Correct Answer: B

Rationale: The correct answer is B: Precipitins. When a granular sediment forms at the bottom of the test-tubes, it indicates the formation of antigen-antibody complexes that are insoluble and precipitate out of the solution. Precipitins are antibodies that specifically react with antigens to form insoluble complexes. Agglutinins cause clumping of cells, opsonins enhance phagocytosis, and bacteriolysins lyse bacteria. These processes do not result in the formation of a granular sediment, making them incorrect choices in this context.

Correct Answer: D

Rationale: The correct answer is D: Monoclonal antibodies to anthrax causative agent. Monoclonal antibodies are highly specific for detecting anthrax spores, providing quick and accurate results. They bind only to the anthrax causative agent, allowing for precise identification. Choice A (Anti-anthrax fluorescent serum) is incorrect because it is not as specific and sensitive as monoclonal antibodies. Choice B (Standard anthrax antigen) is incorrect as it is used to stimulate antibody production in the body, not for direct detection of spores. Choice C (Anti-anthrax immunoglobulin) is incorrect as it is a general term for antibodies and may not be specific to anthrax spores. In summary, monoclonal antibodies are the most suitable option for quick and accurate detection of anthrax spores due to their high specificity and sensitivity.

Correct Answer: A

Rationale: The correct answer is A: Infectious process. The term "infection" refers to the invasion of a host organism's body tissues by disease-causing agents, such as bacteria, viruses, or parasites. It encompasses the entire process from the initial entry of the pathogen to the host's response and resolution. Choice B, "Infectious disease," is incorrect as it specifically refers to the clinical manifestation of an infection. Choice C is irrelevant, and Choice D is incorrect as the term "infection" is indeed equivalent to the infectious process.