A 47-year-old patient came to see a doctor on the 7th day of disease. The disease developed very fast: after the chill body temperature rose to 40oC and lasted up to 7 hours, then dropped abruptly, which caused profuse sweat. There were three such attacks occur in once in two days. Two days ago the patient arrived from Africa. Objectively: pale skin, subicteric sclera, significantly enlarged liver and spleen. What is the cause of fever attacks in this disease?

Correct Answer: A

Rationale: The correct answer is A: Erythrocytic schizogony. In this case, the patient most likely has malaria, specifically caused by Plasmodium falciparum. The fever attacks every 2 days (tertian fever) are characteristic of P. falciparum infection. The cycle of erythrocytic schizogony in P. falciparum is around 48 hours, leading to the recurring fever pattern. Choices B, C, and D are incorrect as tissue schizogony does not cause the characteristic fever pattern, exotoxins are not typically involved in malaria fever, and gametocytes do not directly cause fever attacks.

Correct Answer: A

Rationale: The correct answer is A: Syphilis. Hutchinson's triad is a classic presentation of congenital syphilis in children. Barrel-shaped incisors, parenchymatous keratitis, and deafness are key manifestations. Barrel-shaped incisors result from mulberry molars, a type of abnormal tooth. Parenchymatous keratitis is an inflammation of the cornea, a common ocular sign in congenital syphilis. Deafness can occur due to damage to the auditory nerve caused by the infection. Choices B, C, and D are incorrect as they do not typically present with the specific triad of symptoms seen in congenital syphilis.

Correct Answer: D

Rationale: The correct answer is D. Isoniazid inhibits pyridoxal phosphate synthesis, which is the active form of vitamin B6. Pyridoxal phosphate is essential for various enzymatic reactions, including neurotransmitter synthesis and myelin formation. Therefore, isoniazid-induced pyridoxal phosphate deficiency can lead to neurological symptoms like polyneuritis, paresthesia, memory disorders, and convulsions. A: Disruption of cell membrane synthesis - This is not the mechanism of isoniazid side-effects. B: Inhibition of protein synthesis - Isoniazid does not directly inhibit protein synthesis. C: Inhibition of RNA-synthesis - Isoniazid does not inhibit RNA synthesis; it affects vitamin B6 metabolism.

Correct Answer: D

Rationale: The correct answer is D: All of these. HBV, HCV, and HDV can all lead to chronic carrier states due to their ability to establish persistent infections in the liver. HBV can result in chronic hepatitis, cirrhosis, and even liver cancer. HCV can also lead to chronic hepatitis and liver damage. HDV is a defective virus that requires HBV for replication and can worsen the outcome of HBV infection, potentially leading to chronic liver disease. Therefore, all three viruses have the potential to cause chronic carrier states.

Correct Answer: A

Rationale: The correct answer is A: Erythrocytic schizogony. In this case, the patient most likely has malaria, specifically caused by Plasmodium falciparum. The fever attacks every 2 days (tertian fever) are characteristic of P. falciparum infection. The cycle of erythrocytic schizogony in P. falciparum is around 48 hours, leading to the recurring fever pattern. Choices B, C, and D are incorrect as tissue schizogony does not cause the characteristic fever pattern, exotoxins are not typically involved in malaria fever, and gametocytes do not directly cause fever attacks.