A 45-year-old patient has foul-smelling diarrhea. Stool examination revealed large ciliated protozoa with a kidney-shaped macronucleus. What is the causative agent?

Correct Answer: A

Rationale: The correct answer is A: Balantidium coli. This large ciliated protozoa with a kidney-shaped macronucleus is characteristic of Balantidium coli, an intestinal parasite known to cause foul-smelling diarrhea in humans. Balantidium coli is the only option among the choices that fits this specific description. Entamoeba histolytica causes amoebic dysentery, Giardia lamblia causes giardiasis, and Trichomonas hominis is a non-pathogenic protozoa found in the intestinal tract. Therefore, based on the morphology described in the question, Balantidium coli is the correct causative agent.

Correct Answer: A

Rationale: The correct answer is A: Balantidium coli. This large ciliated protozoa with a kidney-shaped macronucleus is characteristic of Balantidium coli, an intestinal parasite known to cause foul-smelling diarrhea in humans. Balantidium coli is the only option among the choices that fits this specific description. Entamoeba histolytica causes amoebic dysentery, Giardia lamblia causes giardiasis, and Trichomonas hominis is a non-pathogenic protozoa found in the intestinal tract. Therefore, based on the morphology described in the question, Balantidium coli is the correct causative agent.

Correct Answer: D

Rationale: The correct answer is D because a fourfold increase in titer in the second serum sample indicates a significant rise in specific antibodies, which is crucial for diagnosing viral infections accurately. This increase is considered significant in serologic reactions as it shows a strong antibody response to the virus. A: A threshold increase may not be substantial enough to confirm a diagnostic antibody response. B: Dismissing the increase in titer would overlook important diagnostic information. C: A twofold increase may not be as indicative of a strong antibody response compared to a fourfold increase.

Correct Answer: A

Rationale: The correct answer is A: Type 1 hypersensitivity reaction. In this type of reaction, allergens trigger the production of IgE antibodies, leading to mast cell and basophil degranulation and release of inflammatory mediators like histamine. This causes immediate allergic symptoms. Seafood and eggs are common allergens that can elicit this response. B: Type 2 hypersensitivity reaction involves antibodies targeting cell surface or extracellular matrix antigens, leading to cell destruction or dysfunction. This is not the mechanism in seafood or egg allergies. C: Type 3 hypersensitivity reaction involves immune complex deposition in tissues, leading to inflammation and tissue damage. This is not the mechanism in seafood or egg allergies. D: Type 4 hypersensitivity reaction is cell-mediated and involves T cells causing inflammation and tissue damage. This is not the mechanism in seafood or egg allergies.

Correct Answer: A

Rationale: The correct answer is A: Complex. Poxviruses have a complex nucleocapsid symmetry due to their unique structure with multiple layers of proteins and genetic material. Isohedral symmetry (B) refers to a regular polyhedron shape, which is not characteristic of poxviruses. Helical symmetry (C) is found in viruses like tobacco mosaic virus, not poxviruses. "All of the above" (D) is incorrect because poxviruses do not exhibit isohedral or helical symmetry.

Correct Answer: A

Rationale: The correct answer is A: Clostridia. Fusiform spore-forming microorganisms that stain violet-blue with Gram's stain are characteristic of Clostridia. Clostridia are anaerobic, rod-shaped bacteria known for their ability to form spores and cause diseases such as tetanus and botulism. Summary of other choices: B: Streptococci are spherical, not fusiform, and typically do not form spores. C: Spirochaete are spiral-shaped bacteria and do not typically form spores. D: Actinomycete are filamentous bacteria that do not typically form spores and do not stain violet-blue with Gram's stain.

Correct Answer: A

Rationale: The correct answer is A: Treponema pallidum. This bacterium is responsible for causing syphilis due to its unique spiral shape and ability to penetrate intact mucous membranes. It is transmitted through sexual contact or from mother to child during pregnancy. Neisseria gonorrhoeae causes gonorrhea, Chlamydia trachomatis causes chlamydia, and Escherichia coli is a common bacterium found in the gut and not associated with syphilis. Treponema pallidum's specific characteristics and mode of transmission distinguish it from the other choices, making it the correct answer.

Correct Answer: D

Rationale: The correct answer is D: Genus Aspergillus. Aflatoxins are toxic compounds produced by certain species of fungi, particularly Aspergillus species. Aspergillus flavus and Aspergillus parasiticus are well-known producers of aflatoxins. These fungi can contaminate crops such as peanuts, corn, and tree nuts, leading to potential health risks. Cryptococcus (A), Actinomyces (B), and Streptococcus (C) are not known to produce aflatoxins. It is important to be aware of the sources and implications of aflatoxin contamination to ensure food safety and public health.

Correct Answer: D

Rationale: The correct answer is D: Clindamycin. Clindamycin is a lincosamide antibiotic that is safe to use in patients with a history of anaphylaxis to beta-lactam antibiotics like cefaclor. Clindamycin is effective against streptococcus pyogenes and is a suitable alternative in this case. Amoxicillin (choice A) is a beta-lactam antibiotic similar to cefaclor and may cause a cross-reactive allergic reaction. Meropenem (choice B) is a carbapenem antibiotic and not typically used for acute pharyngitis. Cephalexin (choice C) is a cephalosporin antibiotic and may also cause cross-reactivity in patients with a history of anaphylaxis to cefaclor.