A patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. Dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?

Correct Answer: A

Rationale: The most likely diagnosis is A: Leptospirosis. Leptospirosis is caused by the spirochete Leptospira interrogans and is commonly transmitted through contact with water contaminated by animal urine, such as in this case of fishing. The symptoms described match those of leptospirosis, including high fever, headache, muscle pain, jaundice, hemorrhagic rash, and bloody urine. The calf muscle pain is a characteristic symptom of leptospirosis known as "Weil's disease." Yersiniosis (B) typically presents with abdominal symptoms, Salmonellosis (C) with gastrointestinal symptoms, and Brucellosis (D) with flu-like symptoms. Therefore, based on the symptoms and history provided, Leptospirosis is the most likely diagnosis.

Correct Answer: A

Rationale: The correct answer is A: Trichomonas vaginalis. Trichomonas vaginalis is a flagellated protozoan parasite commonly found in vaginal infections. The presence of flagellated bacteria in the vaginal discharge stained with Romanovsky-Giemsa method indicates a protozoan infection, ruling out bacterial or viral causes. Choices B, C, and D are not correct as Leishmania donovani causes leishmaniasis, Trypanosoma gambiense causes African sleeping sickness, and Trihomonas hominis is a non-pathogenic flagellate found in the human intestine, not typically associated with vaginal infections.

Correct Answer: A

Rationale: The correct answer is A: Toxoplasma. Toxoplasma gondii causes Toxoplasmosis, a protozoan disease that can affect the brain and lead to vision loss. The halfmoon-shaped unicellular organisms with pointed ends described in the blood analysis are characteristic of Toxoplasma parasites. Toxoplasma infection commonly occurs through ingestion of contaminated food or water, or contact with infected cat feces. Leishmania causes Leishmaniasis, Lamblia causes Giardiasis, Amoeba causes Amebiasis, and Trichomonad causes Trichomoniasis, none of which match the symptoms and blood analysis findings described in the question.

Correct Answer: A

Rationale: The most likely diagnosis is Reiter's syndrome. This is suggested by the presence of joint pain, fever, elevated ESR and CRP levels, and chlamydia infection. Reiter's syndrome is a reactive arthritis triggered by an infection elsewhere in the body, such as chlamydia. The patient's symptoms of joint pain and swelling, along with the positive chlamydia test, support this diagnosis. Rheumatic arthritis (Choice B) is not associated with chlamydia infection, making it less likely. Gout (Choice C) typically presents with elevated uric acid levels, which are normal in this case. Bechterew's disease (Choice D) primarily affects the spine and sacroiliac joints, not the sternoclavicular and knee joints as seen in this patient.

Correct Answer: D

Rationale: The correct answer is D: Proteus mirabilis. The patient's symptoms of lower abdominal pain, back pain, frequent/painful urination, and the presence of gram-negative oxidase-positive bacilli forming green mucoid colonies with a specific smell suggest a urinary tract infection caused by Proteus mirabilis. This bacterium is known for causing UTIs and is characterized by its swarming motility and distinctive odor. A: Pseudomonas aeruginosa is commonly associated with hospital-acquired infections but does not typically cause UTIs with the specific characteristics described. B: Mycoplasma pneumonia is a bacterium that causes respiratory infections, not UTIs. C: Str.pyogenes (Streptococcus pyogenes) is a common cause of strep throat and skin infections, not UTIs. D: Helicobacter pylori is associated with gastritis and peptic ulcers, not UTIs.