A 70-year-old man was admitted to the hospital after suffering extensive third-degree burns. Three days later he spiked a fever and there was pus on the dressing that had blue-green colour. Gram stain of the pus revealed gram-negative rods. The most possible cause of these findings is:

Correct Answer: A

Rationale: The correct answer is A: The pyocyanin released by Pseudomonas aeruginosa. Pyocyanin is a blue-green pigment produced by Pseudomonas aeruginosa, a common cause of nosocomial infections in burn patients. The presence of blue-green pus and gram-negative rods in the wound along with fever suggests an infection with Pseudomonas aeruginosa. The other choices are incorrect because E. Coli typically causes gastrointestinal infections and releases enterotoxins, Staphylococcus aureus releases hemolysins causing hemolysis of red blood cells, and Shigella dysenteriae releases shigatoxin causing bloody diarrhea, none of which match the clinical presentation described in the question.

Correct Answer: A

Rationale: The correct answer is A: Benzylpenicillin sodium salt. Benzylpenicillin is a beta-lactam antibiotic that inhibits the synthesis of bacterial cell walls by disrupting the formation of murein (peptidoglycan), leading to bacterial cell death. This mechanism specifically targets the causative agent of syphilis, Treponema pallidum. - Choice B: Bijochinol is not a known drug used to treat syphilis. - Choice C: Ciprofloxacin is a fluoroquinolone antibiotic that works by inhibiting bacterial DNA replication and is not the first-line treatment for syphilis. - Choice D: Azithromycin is a macrolide antibiotic that interferes with bacterial protein synthesis and is commonly used to treat other infections but is not the preferred treatment for syphilis.

Correct Answer: C

Rationale: The correct answer is C because the main factor in the pathogenicity of diphtheria is the exotoxin produced by the bacterium Corynebacterium diphtheriae. This exotoxin inhibits protein synthesis in host cells, leading to tissue damage and the characteristic symptoms of diphtheria. A: The metachromatic bodies of Ernst-Babes are not the main factor in diphtheria pathogenicity. B: While endotoxins can contribute to the pathogenicity of some bacteria, in diphtheria, the main factor is the exotoxin. D: This is incorrect as the main factor in diphtheria pathogenicity is the exotoxin.

Correct Answer: D

Rationale: The correct answer is D: Thin mobile bacillus with central spore. This is because the causative agent of botulism, Clostridium botulinum, is a gram-positive bacillus that typically appears as a thin rod-shaped bacterium with a central endospore. This characteristic morphology is essential in the identification of Clostridium botulinum. A: Gram-positive bacillus with subterminal spore - This is incorrect as Clostridium botulinum typically has a central endospore, not a subterminal one. B: Thick gram-positive non-spore-forming bacillus - This is incorrect as Clostridium botulinum forms endospores, although they are not thick. C: Gram-positive bacillus with terminal spore - This is incorrect as the spore of Clostridium botulinum is typically central, not terminal.

Correct Answer: A

Rationale: The correct answer is A: Clostridium botulinum. This bacterium produces the neurotoxin responsible for botulism. Clostridium perfringens causes gas gangrene, not botulism. Escherichia coli and Salmonella enterica are not associated with botulism. Clostridium botulinum is the only bacterium known to produce the toxin causing botulism.

Correct Answer: A

Rationale: The most likely diagnosis is Actinomycosis. This is because the patient's presentation of a painful swelling with a fistula containing white granules and yellow-green honeycomb-like tissue is classic for Actinomycosis. Actinomyces is a gram-positive anaerobic bacterium that forms sulfur granules in tissues. Tuberculosis (B) typically presents with caseating granulomas, not sulfur granules. Leprosy (C) presents with skin lesions and nerve damage, not characteristic of this case. Syphilis (D) usually presents with painless ulcers and rash, not the painful swelling and fistula seen in this patient.

Correct Answer: A

Rationale: The correct answer is A: iatrogenic infections. Iatrogenic infections are those caused by medical interventions like catheter use. Catheters can introduce pathogens into the body, leading to infections. Local infections (B) refer to infections confined to a specific area, not necessarily caused by catheters. Exogenous infections (C) come from an external source, not specifically related to medical interventions. Endogenous infections (D) arise from the body's own flora and are not directly related to catheter use.

Correct Answer: C

Rationale: Rationale: 1. The male reproductive system is considered sterile as it does not have a natural microbiota. 2. Any presence of microorganisms in this system could indicate an infection or disease. 3. Therefore, choice C, sterile with no normal flora, is the best characterization. Summary: A: Incorrect - The male reproductive system does not typically have gram-positive rods. B: Incorrect - Acid-fast rods are not part of the normal flora in the male reproductive system. D: Incorrect - The male reproductive system does not typically have gram-positive spore formers.

Correct Answer: D

Rationale: The correct answer is D, chromoblastomycosis. This is a chronic localized subcutaneous infection caused by certain fungi, resulting in verrucoid lesions on the skin. The other choices are incorrect because: A: Candidiasis is a superficial fungal infection, not characterized by verrucoid lesions. B: Leprosy is a systemic bacterial infection, not localized to the skin with verrucoid lesions. C: Shingles is caused by the varicella-zoster virus, presenting as a painful rash with blisters, not verrucoid lesions.