A child with fever and swollen lymph nodes had a Gram-stained smear revealing Gram-negative rods with a safety pin appearance. What is the causative agent?

Correct Answer: A

Rationale: The correct answer is A: Yersinia pestis. This bacterium causes the plague, which presents with fever and swollen lymph nodes. The safety pin appearance on Gram stain is characteristic of Yersinia pestis. B: Francisella tularensis causes tularemia, which presents differently and does not show safety pin appearance on Gram stain. C: Brucella abortus causes brucellosis, which does not typically present with the same symptoms as described in the question. D: Clostridium botulinum causes botulism, which does not show safety pin appearance on Gram stain and does not typically present with fever and swollen lymph nodes.

Correct Answer: C

Rationale: The correct answer is C: Respiratory tract. The respiratory tract is likely the most frequently used portal of entry for pathogens because it is constantly exposed to the external environment and has a large surface area lined with mucous membranes that can trap and facilitate the entry of pathogens. Additionally, the respiratory tract serves as a direct pathway for pathogens to reach the bloodstream and other organs. Skin (choice A) is a physical barrier that can prevent pathogen entry, while the gastrointestinal tract (choice B) has acidic pH and enzymes that can kill many pathogens. Conjunctiva (choice D) is a less common portal of entry compared to the respiratory tract due to its smaller surface area and protective mechanisms such as tears.

Correct Answer: C

Rationale: The correct answer is C: Quinine. Quinine is known for its destructive effect on erythrocytic forms of malarial plasmodia and dysenteric amoebae. It is commonly used for the treatment and prevention of diseases such as malaria, amebiasis, and interstitial disease. Quinine works by interfering with the parasite's ability to break down hemoglobin in red blood cells, ultimately leading to their destruction. Incorrect choices: A: Chingamin - Chingamin is not typically used to treat malaria, amebiasis, or interstitial disease. B: Emetine hydrochloride - Emetine hydrochloride is primarily used for treating amoebic dysentery and is not commonly used for malaria treatment. D: Erythromycin - Erythromycin is an antibiotic used to treat bacterial infections, not parasitic infections like malaria or amebiasis.

Correct Answer: A

Rationale: The correct answer is A: Escherichia coli. E. coli is a Gram-negative rod that ferments lactose, leading to red colonies on Endo agar. This bacterium is commonly found in the human gut and is known for its ability to ferment lactose. Salmonella and Shigella are also Gram-negative rods but do not ferment lactose, so they would not produce red colonies on Endo agar. Proteus is a Gram-negative rod that is not known for its lactose-fermenting ability and would not produce red colonies on Endo agar. Therefore, based on the characteristics provided, E. coli is the most likely microorganism responsible for the red colonies on Endo agar.

Correct Answer: A

Rationale: The correct answer is A: Pseudomonas. Rationale: 1. Mobile nonspore-forming gram-negative bacteria with a capsule substance indicate Pseudomonas. 2. Pseudomonas grow well on ordinary nutrient media, matching the description. 3. The secretion of a blue-green pigment is a characteristic feature of Pseudomonas. 4. Proteus is a gram-negative bacterium but does not match all the given properties. 5. Clostridium is a gram-positive bacterium that forms spores. 6. Shigella is a gram-negative bacterium but does not have the other characteristics mentioned. Therefore, based on the properties described, the most likely genus of the microorganism is Pseudomonas.

Correct Answer: B

Rationale: The correct answer is B: Thick gram-positive non-sporeforming bacilli. In botulism, the causative agent, Clostridium botulinum, is a thick gram-positive bacilli that does not form spores. This is a key characteristic morphologic feature. A: Gram-positive spore-forming bacilli with subterminal spore - This is incorrect as Clostridium botulinum does not have subterminal spores. C: Gram-positive spore-forming bacilli with terminal spore - Incorrect because Clostridium botulinum does not form spores. D: Thin mobile spore-forming bacilli with central spore - Incorrect because Clostridium botulinum is not thin, mobile, or spore-forming. In summary, the most characteristic morphologic feature of the botulism agent is being thick, gram-positive, and non-sporeforming, making choice B the correct answer.

Correct Answer: B

Rationale: The correct answer is B: Klebsiella pneumoniae. This bacterium is gram-negative, capsulated, and forms lactose-positive colonies. It was first isolated in pneumonia but is more commonly associated with urinary infections, otitis, meningitides, sepsis, and nosocomial infections. Klebsiella pneumoniae fits all the characteristics mentioned in the question, making it the correct choice. Incorrect choices: A: Staphylococcus aureus is gram-positive and does not have a capsule. C: Streptococcus pneumoniae is also gram-positive and does not fit the description given. D: Mycobacterium tuberculosis is an acid-fast bacterium associated with tuberculosis, but it is neither gram-negative nor lactose-positive.

Correct Answer: D

Rationale: The correct answer is D (All of the above) because different bacteria can cause pneumonia. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. Mycobacterium tuberculosis causes tuberculosis, which can lead to pneumonia. Pseudomonas aeruginosa is a common cause of hospital-acquired pneumonia. Therefore, all three bacteria can be responsible for causing pneumonia in different contexts. Choices A, B, and C are incorrect because each bacterium individually can cause pneumonia, so selecting only one option would not cover the full spectrum of bacterial causes of pneumonia.

Correct Answer: A

Rationale: The correct answer is A: Acid resistance. The Ziehl-Neelsen staining technique is specifically used to detect acid-fast bacteria like Mycobacterium tuberculosis, which is resistant to acid decolorization. This property allows the tuberculosis bacillus to retain the stain even after exposure to acid-alcohol, appearing red under the microscope. Explanation of incorrect choices: B: Alkali resistance - This property is not relevant in the context of Ziehl-Neelsen staining for acid-fast bacteria. C: Alcohol resistance - While alcohol resistance is related to acid-fastness, it is not the specific property highlighted by Ziehl-Neelsen staining. D: Capsule formation - Capsule formation is a different characteristic and not directly related to the staining behavior of acid-fast bacteria in the Ziehl-Neelsen technique.