A patient with a severe sore throat had a throat smear revealing Gram-positive cocci in pairs with a capsule. What is the most likely causative agent?

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pneumoniae. The presence of Gram-positive cocci in pairs with a capsule is characteristic of Streptococcus pneumoniae. This bacterium is a common cause of bacterial pharyngitis, leading to a severe sore throat. Staphylococcus aureus (B) does not typically present in pairs or have a capsule. Neisseria meningitidis (C) is a Gram-negative diplococcus, not a Gram-positive cocci. Klebsiella pneumoniae (D) is a Gram-negative bacillus, not a cocci. Thus, based on the characteristics described in the question, Streptococcus pneumoniae is the most likely causative agent.

Correct Answer: D

Rationale: Conjugation involves direct cell-to-cell contact for the transfer of genetic material, typically through a pilus. This process is well-documented in bacterial genetics. Transformation (A) involves uptake of free DNA from the environment. Transduction (B) is genetic transfer by a viral vector. Replication (C) is the process of producing identical copies of DNA or RNA. Therefore, the correct answer is D (conjugation) as it specifically refers to the one-way transfer of genetic material through direct cell-to-cell contact.

Correct Answer: D

Rationale: The correct answer is D (4) because biosafety levels range from 1 to 4, each corresponding to the level of containment required when handling different types of organisms. BSL-1 is for low-risk agents, while BSL-4 is for dangerous pathogens. Choice A (1) is incorrect as there are multiple levels, not just one. Choice B (2) and C (3) are incorrect as they do not account for all the levels of biosafety required for handling various organisms. Therefore, D is the correct answer as it encompasses the full range of biosafety levels.

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: A

Rationale: Rationale for Correct Answer A (Lamblia): 1. Pyriform protozoa with twin nuclei, four pairs of flagella, and a suctorial disc match the characteristics of Giardia lamblia. 2. The presence of two supporting filaments between the nuclei is a unique feature of Giardia lamblia. 3. Giardia lamblia is known to infect the duodenum and cause symptoms such as diarrhea and abdominal pain. Summary of Incorrect Choices: B: Toxoplasma - Toxoplasma gondii is not characterized by four pairs of flagella or supporting filaments in the nuclei. C: Leishmania - Leishmania species do not typically have the described morphology or location in the duodenum. D: Intestinal trichomonad - Intestinal trichomonads do not exhibit the specific features mentioned in the question, such as twin nuclei and supporting filaments.

Correct Answer: D

Rationale: The correct answer is D: Middlebrook's medium. This medium is specifically designed for the growth of Mycobacterium tuberculosis due to its low concentration of malachite green, which inhibits the growth of other bacteria but not Mycobacterium species. Middlebrook's medium also contains various nutrients that support the growth of Mycobacterium tuberculosis. A: Middlebrook's medium is the correct answer, not incorrect. B: Heart infusion broth is a general-purpose medium, not specific for Mycobacterium tuberculosis. C: MacConkey agar is selective for gram-negative bacteria and would not support the growth of Mycobacterium tuberculosis. In summary, Middlebrook's medium is the ideal choice for cultivating Mycobacterium tuberculosis due to its specific formulation that promotes the growth of this pathogen while inhibiting other bacteria.

Correct Answer: A

Rationale: The correct answer is A: Vibrio cholerae. This bacterium is the likely causative agent because it is known to cause severe diarrhea, and it is characterized by its motile, comma-shaped Gram-negative rods. Vibrio cholerae produces cholera toxin, leading to profuse watery diarrhea. Shigella dysenteriae causes dysentery with bloody diarrhea, Salmonella typhi causes typhoid fever, and Escherichia coli can cause various types of diarrhea but typically does not have a comma shape.

Correct Answer: A

Rationale: Step-by-step rationale for why A is correct: 1. Clostridium tetani is known to produce tetanus toxin. 2. The tetanus toxin causes muscle rigidity and spasms characteristic of tetanus. 3. Clostridium perfringens is associated with gas gangrene, not tetanus. 4. Neisseria gonorrhoeae causes gonorrhea, not tetanus. 5. Bacillus anthracis causes anthrax, not tetanus. In summary, Clostridium tetani is the correct answer as it is specifically associated with causing tetanus, while the other choices are associated with different diseases.

Correct Answer: A

Rationale: The correct answer is A: IgG. Anti-tetanus gamma globulin is produced by hyperimmunization, leading to a high concentration of specific antibodies, predominantly IgG. IgG is the most abundant immunoglobulin in the blood and provides long-term immunity against tetanus. IgA is mainly found in mucosal areas, not in gamma globulin preparations. IgM is the first antibody produced in response to an infection and is not the prevailing class in this preparation. IgE is associated with allergic reactions and parasitic infections, not with anti-tetanus immunity.