A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?

Correct Answer: B

Rationale: The correct answer is B: Acute purulent lymphadenitis. The symptoms described indicate an acute bacterial infection of the lymph nodes. The presence of painful lymph nodes, erythema, and shiny appearance of the skin overlying the nodes suggest an inflammatory process. The rise in temperature and frequent pulse indicate an active infection. The white-coated tongue may be a sign of systemic involvement. The shaky gait may indicate systemic toxicity. Bubonic plague (A) presents with buboes, not just painful lymph nodes. Lymphogranulomatosis (C) is a type of lymphoma and would not present with these acute bacterial infection symptoms. Anthrax (D) typically presents with a black eschar and is less likely in this context.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pneumoniae. The presence of Gram-positive diplococci with a capsule is characteristic of S. pneumoniae. This bacterium is a common cause of pneumonia, especially in patients with fever and cough. It is also known for causing infections such as otitis media and sinusitis. Staphylococcus aureus (B) is a Gram-positive cocci but does not typically form diplococci or have a capsule. Neisseria meningitidis (C) is a Gram-negative diplococcus commonly associated with meningitis, not pneumonia. Klebsiella pneumoniae (D) is a Gram-negative rod, not a diplococcus, and is more commonly associated with pneumonia in immunocompromised patients.

Correct Answer: D

Rationale: The correct answer is D, Formation of CD4+ cells. In autoimmune reactions, CD4+ cells are actually involved in the immune response. Here's the rationale: 1. CD4+ cells are helper T cells that play a crucial role in activating other immune cells in autoimmune reactions. 2. Decreased functional activity of T-suppressors (Choice A) is typical in autoimmune reactions as it leads to unchecked immune responses. 3. Loss of tolerance for T-helpers and B-lymphocytes (Choice B) is common in autoimmune reactions, where the immune system mistakenly attacks self-cells. 4. Ag released by normally isolated tissues (Choice C) is a typical mechanism in autoimmune reactions where self-antigens trigger immune responses.

Correct Answer: C

Rationale: The correct answer is C: Helicobacter pylori. This bacterium is a well-known cause of peptic ulcers due to its ability to survive in the acidic environment of the stomach and produce enzymes that weaken the protective mucous layer of the stomach lining. Treponema pallidum (choice A) causes syphilis, Vibrio cholerae (choice B) causes cholera, and Escherichia coli (choice D) can cause various infections but is not a common cause of peptic ulcers. Therefore, Helicobacter pylori is the correct answer as it is specifically associated with peptic ulcer formation.

Correct Answer: B

Rationale: The correct answer is B: Tuberculosis. The case describes a man with a perforation in the hard palate and features of caseous necrosis with granulation tissue, endovasculitis, and a cellular infiltration mainly of lymphocytes, epithelioid cells, and plasma cells. These findings are classic for tuberculosis infection, commonly seen in extrapulmonary sites like the oral cavity. Syphilis (choice A) typically presents with a painless ulcer and different histopathological features. Leprosy (choice C) presents with granulomas containing foamy macrophages. Scleroma (choice D) is caused by Klebsiella rhinoscleromatis and presents with chronic granulomatous inflammation.