A patient with a sore throat and fever had a throat smear stained with Gram's method, revealing Gram-positive cocci in chains. What is the most likely causative agent?

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pyogenes. This bacterium is known to cause sore throat and fever, commonly referred to as strep throat. Gram's stain showing Gram-positive cocci in chains is characteristic of Streptococcus species. Streptococcus pyogenes is a beta-hemolytic bacterium that forms chains and is a common cause of bacterial pharyngitis. Staphylococcus aureus (B) is a Gram-positive cocci that forms clusters, not chains. Neisseria gonorrhoeae (C) is a Gram-negative diplococcus and is not associated with sore throat. Enterococcus faecalis (D) is a Gram-positive cocci that can cause infections but is not typically associated with sore throat.

Correct Answer: B

Rationale: The correct answer is B: Salmonella enteritidis. In this case, the presence of Gram-negative rods producing gas in the blood culture indicates a likelihood of Salmonella infection, as it is a common cause of severe abdominal pain, vomiting, and gas production. Salmonella enteritidis is a known pathogen that can cause gastroenteritis and systemic infections. Escherichia coli (choice A) can also cause similar symptoms, but it is less likely to produce gas in blood culture. Clostridium perfringens (choice C) typically causes food poisoning with rapid onset and less likely to be isolated from blood cultures. Campylobacter jejuni (choice D) is associated with gastroenteritis but is less likely to cause systemic infections with gas-producing Gram-negative rods in blood culture.

Correct Answer: A

Rationale: The correct answer is A: Entamoeba histolytica. This is because the presence of cysts with four nuclei is characteristic of Entamoeba histolytica, a protozoan parasite that causes amoebic dysentery. Entamoeba histolytica cysts contain four nuclei, distinguishing them from other pathogens. Giardia lamblia and Trichomonas vaginalis are not associated with cysts containing four nuclei. Balantidium coli is a ciliated protozoan that does not typically form cysts with multiple nuclei. In summary, the unique feature of four nuclei in the cysts points towards Entamoeba histolytica as the most likely causative agent of the diarrhea in this patient.

Correct Answer: C

Rationale: Rationale: 1. Vibrio cholerae produces cholera toxin causing severe diarrhea. 2. Clostridium tetani causes tetanus, not diarrhea. 3. Clostridium botulinum causes botulism, not diarrhea. 4. Shigella dysenteriae causes dysentery, not typical diarrhea. Summary: A: Incorrect, causes tetanus. B: Incorrect, causes botulism. C: Correct, produces cholera toxin causing severe diarrhea. D: Incorrect, causes dysentery.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pneumoniae. This bacterium is the most likely causative agent based on the description of Gram-positive cocci in pairs with a capsule. S. pneumoniae is known for its characteristic morphology and the presence of a capsule, which helps in evading the immune system. It commonly causes pneumonia, especially in patients with a productive cough and fever. Incorrect choices: B: Klebsiella pneumoniae typically presents with a mucoid capsule and is associated with pneumonia in immunocompromised individuals. C: Neisseria meningitidis is a Gram-negative diplococcus and is more commonly associated with meningitis and septicemia. D: Staphylococcus aureus is a Gram-positive cocci, but it does not typically present in pairs with a capsule and is more commonly associated with skin and soft tissue infections.