A 45-year-old patient, a sailor, was hospitalized on the 2nd day of the disease. A week ago he returned from India. Complains of body temperature of 41oC, severe headache, dyspnea, cough with frothy rusty sputum. Objectively: the patient is pale, mucous membranes are cyanotic, breathing rate - 24/min, tachycardia is present. In lungs: diminished breath sounds, moist rales over both lungs, crepitation. What is the most likely diagnosis?

Correct Answer: A

Rationale: The most likely diagnosis is A: Pneumonic plague. The patient's symptoms align with the presentation of pneumonic plague, caused by the bacterium Yersinia pestis. Symptoms include high fever, severe headache, dyspnea, cough with bloody sputum, and cyanosis. The characteristic bubonic plague lymphadenopathy may be absent in the pneumonic form. The patient's recent travel history to India also raises suspicion, as plague is endemic in some regions. The other choices can be ruled out based on the patient's symptoms and presentation. Miliary tuberculosis typically presents with diffuse miliary nodules on imaging. Influenza typically presents with more generalized symptoms and does not usually cause rusty sputum. Ornithosis is caused by Chlamydophila psittaci and usually presents with pneumonia-like symptoms after exposure to infected birds.

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 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: 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: B

Rationale: The correct answer is B: Syphilis. The Wasserman reaction is a test for syphilis, specifically for detecting antibodies against the bacterium Treponema pallidum. In a 30-year-old man with a markedly positive Wasserman reaction, it indicates an active syphilis infection. Brucellosis (Choice A) is not diagnosed using the Wasserman reaction. Poliomyelitis (Choice C) is a viral infection affecting the spinal cord, not diagnosed using the Wasserman reaction. Influenza (Choice D) is a respiratory viral infection, not associated with the Wasserman reaction.