A patient presented with fever and cough. A sputum sample stained by Gram's method revealed Gram-positive diplococci with a capsule. What is the likely causative agent?

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: C

Rationale: The correct answer is C: Proteus mirabilis. This bacterium shows swarming on blood agar due to its ability to produce flagella and exhibit rapid and coordinated movement. Providencia stuartii and Providencia rettgeri are not known for swarming behavior on blood agar. Morganella morganii can exhibit swarming motility, but it is not as commonly associated with this characteristic compared to Proteus mirabilis, making C the most appropriate choice.

Correct Answer: C

Rationale: Granulomatosis infantiseptica is commonly caused by Listeria monocytogenes, a bacterium known to infect newborns. It can lead to granulomatous lesions in various organs. Staphylococcus aureus and Mycobacterium tuberculosis are not typical causes of this condition in infants. Choice D is incorrect as it suggests all listed bacteria are responsible, which is not accurate. Therefore, the correct answer is C as Listeria monocytogenes is the specific pathogen associated with granulomatosis infantiseptica.

Correct Answer: B

Rationale: The correct answer is B: Availability of cell-mediated immunity to tuberculosis. A negative Mantoux test indicates the presence of an immune response to the TB bacteria, as the test measures the body's delayed hypersensitivity reaction to TB antigens. This means the child has been exposed to TB in the past or has been vaccinated, resulting in the development of cell-mediated immunity against TB. Incorrect choices: A: No cell-mediated immunity to tuberculosis - This is incorrect as a negative Mantoux test actually indicates the presence of cell-mediated immunity. C: No antibodies to the tuberculosis bacteria - Mantoux test measures cell-mediated immunity, not antibody response. D: No anti-toxic immunity to tuberculosis - Mantoux test does not assess anti-toxic immunity, it specifically measures cell-mediated immunity.

Correct Answer: B

Rationale: The correct answer is B: prokaryotic. Bacteria are prokaryotic cells because they lack a true nucleus and membrane-bound organelles. They have a simple cell structure with genetic material floating freely in the cytoplasm. Choice A (eukaryotic) is incorrect because eukaryotic cells have a nucleus and membrane-bound organelles. Choice C (diploid) is incorrect as bacteria do not have a defined ploidy level like diploid organisms do. Choice D (haploid) is also incorrect as bacteria do not have a true haploid or diploid state due to their lack of a defined nucleus.

Correct Answer: A

Rationale: The correct answer is A: BK virus. BK virus is a common cause of hemorrhagic cystitis, especially in immunocompromised individuals. It infects the urinary tract, leading to inflammation and bleeding in the bladder. Enteroviruses, Flaviviruses, and Coronaviruses do not typically cause hemorrhagic cystitis. Enteroviruses usually cause respiratory and gastrointestinal infections, Flaviviruses are commonly associated with diseases like dengue fever and Zika virus, and Coronaviruses are known for causing respiratory illnesses such as COVID-19. Hence, the correct answer is A as it is the only virus among the options known to cause hemorrhagic cystitis.

Correct Answer: C

Rationale: The correct answer is C because there is no obligatory vaccine for Neisseria meningitidis in Bulgaria. The rationale for this is that while vaccines are available for meningococcal disease, they are not mandatory in Bulgaria. Therefore, this statement is incorrect. A: This statement is correct as Waterhouse-Friderichsen syndrome can occur during meningococcemia due to rapid progression of the infection leading to adrenal gland failure. B: This statement is incorrect as Neisseria meningitidis is most common in infants, children, and adolescents, with a second peak in young adults. D: This statement is correct as Neisseria meningitidis is transmitted through respiratory secretions, such as coughing or kissing, especially in close contacts like household members or roommates.

Correct Answer: D

Rationale: The correct answer is D (All of the above) because all three bacteria (Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus) are known to cause urinary tract infections. E. coli is the most common causative agent of UTIs due to its ability to colonize the urethra. P. aeruginosa can cause UTIs in hospitalized patients with catheters. S. aureus is less common but can lead to UTIs, especially in individuals with underlying health conditions. Therefore, all three bacteria are potential pathogens for UTIs. Choices A, B, and C are incorrect because each of these bacteria can individually cause UTIs, making the correct answer D.

Correct Answer: B

Rationale: The correct answer is B: adolescents. Infectious mononucleosis is commonly caused by the Epstein-Barr virus, which is transmitted through saliva. Adolescents are more likely to engage in activities like kissing and sharing drinks, increasing the chances of virus transmission. Infants have maternal antibodies for protection, young adults may have developed immunity, and the elderly have had more exposure to the virus and may have built immunity over time.