A patient who has recently come from an endemic area presents with elevated body temperature, headache, chills, malaise, that is with the symptoms which are typical for a common cold. What laboratory tests are necessary to confirm or to refute the diagnosis of malaria?

Correct Answer: A

Rationale: The correct answer is A: Microscopy of blood smears. Malaria diagnosis is confirmed by identifying the Plasmodium parasite in a blood smear. This step is crucial as it directly visualizes the causative agent. The other choices are incorrect as they do not directly detect malaria parasites. B: Studying lymph node punctate is not specific for malaria. C: Urinalysis does not show malaria parasites. D: Studying cerebrospinal fluid is used to diagnose conditions affecting the brain and spinal cord, not malaria.

Correct Answer: C

Rationale: The correct answer is C: Streptococcus. Streptococcus pneumoniae is the most common etiological factor for community-acquired pneumonia in young adults. The symptoms described align with typical pneumococcal pneumonia presentation. Presence of pleural friction rub and infiltration in the X-ray support the diagnosis. The blood work showing elevated WBC count with a left shift (increased neutrophils and low lymphocytes) and elevated ESR is consistent with a bacterial infection. Legionella and Mycoplasma typically present with atypical pneumonia symptoms such as headache, confusion, and GI symptoms, which are not described in the case. Staphylococcus pneumonia is not a common cause of community-acquired pneumonia in young adults.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. Helicobacter pylori, the bacteria causing helicobacteriosis, is microaerophilic, requiring low oxygen levels. 2. Cultivation conditions must mimic the natural environment of the bacteria. 3. Failure to provide a microaerophilic environment can hinder bacterial growth. 4. Thus, the ability to cultivate these bacteria requires consideration of their microaerophilic nature. Summary: - Choice A is correct because Helicobacter pylori is a microaerophilic bacteria. - Choice B (Presence of urease) is incorrect as it is a characteristic used for diagnosis, not cultivation. - Choice C (Absence of spores and capsules) is incorrect as it does not relate to cultivation requirements. - Choice D (Colonization of gastral cells) is incorrect as it pertains to bacterial behavior, not cultivation needs.

Correct Answer: D

Rationale: The correct answer is D: icosahedral structure. Icosahedral symmetry is common in viruses due to its efficient packing of genetic material. It consists of 20 equilateral triangular faces and 12 vertices. This symmetry allows viruses to have a stable structure and optimal capacity for encapsulating their genetic material. A: Tetrahedral structure is incorrect as it consists of 4 faces and is not commonly found in viruses. B: Hexahedral structure is incorrect as it consists of 6 faces and is not a common symmetry type in viruses. C: Dodecahedral structure is incorrect as it consists of 12 faces and is not typically seen in viruses. In summary, the icosahedral structure is the correct choice due to its stability, efficient packing, and common presence in viral structures compared to the other options.

Correct Answer: A

Rationale: The correct answer is A: Cytopathic effect. This is because polioviruses cause visible changes in infected cells, leading to cell damage and death, known as cytopathic effect. This is a key characteristic of viral infection. Choice B (Cytotoxic effect) is incorrect as it refers to the toxicity of a substance to cells, not the specific effect of polioviruses. Choice C (Cytolytic effect) is incorrect as it specifically refers to cell lysis, which is not the primary mechanism of poliovirus infection. Choice D (They Don't Change The Cell Cultures) is incorrect because polioviruses do indeed cause changes in cell cultures due to their cytopathic effect.

Correct Answer: D

Rationale: The correct answer is D because a fourfold increase in titer in the second serum sample indicates a significant rise in specific antibodies, which is crucial for diagnosing viral infections accurately. This increase is considered significant in serologic reactions as it shows a strong antibody response to the virus. A: A threshold increase may not be substantial enough to confirm a diagnostic antibody response. B: Dismissing the increase in titer would overlook important diagnostic information. C: A twofold increase may not be as indicative of a strong antibody response compared to a fourfold increase.

Correct Answer: B

Rationale: The correct answer is B: Azotobacter species. Azotobacter are known for their ability to fix nitrogen through the process of nitrogen fixation, converting atmospheric nitrogen into a form that plants can use. Bacillus cereus is not known for nitrogen fixation. Clostridium botulinum is a bacterium that causes botulism and does not fix nitrogen. Escherichia coli is a common gut bacterium but does not have the ability to fix nitrogen. Thus, Azotobacter species is the correct choice based on its unique ability to fix nitrogen.

Correct Answer: A

Rationale: The correct answer is A: Lamblia. The description matches the characteristics of Giardia lamblia - a protozoan parasite that causes giardiasis. The piriform bodies, 4 pairs of filaments, and two symmetrically located nuclei are specific to Giardia lamblia. It is important to differentiate it from the other choices. Dysentery ameba (choice B) typically has a single nucleus and lacks the specific characteristics described. Trichomonas (choice C) is a flagellated protozoan with different morphology and does not match the given description. Intestinal ameba (choice D) such as Entamoeba histolytica usually has a single nucleus and different body shape compared to the described organism.

Correct Answer: D

Rationale: The correct answer is D: Clindamycin. Clindamycin is a lincosamide antibiotic that is safe to use in patients with a history of anaphylaxis to beta-lactam antibiotics like cefaclor. Clindamycin is effective against streptococcus pyogenes and is a suitable alternative in this case. Amoxicillin (choice A) is a beta-lactam antibiotic similar to cefaclor and may cause a cross-reactive allergic reaction. Meropenem (choice B) is a carbapenem antibiotic and not typically used for acute pharyngitis. Cephalexin (choice C) is a cephalosporin antibiotic and may also cause cross-reactivity in patients with a history of anaphylaxis to cefaclor.