A patient with a severe case of pneumonia had sputum stained using the Gram method. The smear revealed Gram-positive cocci arranged in pairs with a capsule. What is the most likely causative agent?

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pneumoniae. This bacterium is a common cause of pneumonia and is characterized by being Gram-positive cocci arranged in pairs with a capsule, as described in the question. The presence of a capsule is a key characteristic of Streptococcus pneumoniae, distinguishing it from the other choices. Staphylococcus aureus (B) is a Gram-positive cocci, but it typically forms clusters, not pairs. Klebsiella pneumoniae (C) is a Gram-negative rod, not a Gram-positive cocci. Enterococcus faecalis (D) is a Gram-positive cocci, but it does not typically present with a capsule in the same way Streptococcus pneumoniae does.

Correct Answer: A

Rationale: The correct answer is A: Clostridium perfringens. This bacterium is an anaerobic, Gram-positive rod that forms terminal spores and produces gas. It is commonly associated with wound infections and gas gangrene. Clostridium botulinum causes botulism and does not typically present with gas production. Bacillus anthracis is an aerobic, Gram-positive spore-forming bacterium causing anthrax. Clostridium tetani causes tetanus and does not produce gas. Thus, based on the characteristics described in the question, Clostridium perfringens is the most likely causative agent.

Correct Answer: B

Rationale: The correct answer is B: Gram-negative bacteria. Gram-negative bacteria have an outer membrane containing lipopolysaccharides (LPS). In the Gram staining technique, these bacteria appear pink/red due to the thin peptidoglycan layer, which allows the crystal violet stain to be washed out, revealing the safranin counterstain. Gram-positive bacteria (choice A) have a thick peptidoglycan layer but lack an outer membrane with LPS. Choice C is incorrect since only Gram-negative bacteria possess LPS in their outer membrane. Choice D is incorrect as all bacteria can be classified as either Gram-positive or Gram-negative based on their cell wall structure.

Correct Answer: A

Rationale: Rationale for correct answer (A: Escherichia coli): 1. Endo agar selects for Gram-negative bacteria. 2. Red colonies on Endo agar indicate lactose fermentation, characteristic of E. coli. 3. E. coli is a common cause of pneumonia, especially in immunocompromised patients. Summary of why other choices are incorrect: - B: Klebsiella pneumoniae: Typically forms mucoid colonies on agar. - C: Pseudomonas aeruginosa: Produces characteristic greenish-blue colonies on agar. - D: Proteus mirabilis: Does not typically ferment lactose, so would not produce red colonies on Endo agar.

Correct Answer: D

Rationale: The correct answer is D: Proteus vulgaris. This is because Proteus species are non-lactose-fermenting, Gram-negative rods that produce gas in nutrient broth. They are known to cause severe abdominal pain due to their ability to invade the intestinal mucosa. A: Salmonella enterica is a lactose-fermenting organism and typically does not produce gas in nutrient broth. B: Shigella dysenteriae is a lactose-negative organism but does not produce gas in nutrient broth. C: Escherichia coli is a lactose-fermenting organism and does not typically produce gas in nutrient broth. In summary, the presence of non-lactose-fermenting, gas-producing Gram-negative rods points towards Proteus vulgaris as the most likely causative agent of the severe abdominal pain.