A patient with a sore throat had a throat culture revealing Gram-positive cocci in chains. The bacteria were catalase-negative and beta-hemolytic on blood agar. What is the most likely causative agent?

Correct Answer: A

Rationale: Step 1: Gram-positive cocci in chains suggest Streptococcus species. Step 2: Catalase-negative eliminates Staphylococcus aureus. Step 3: Beta-hemolytic on blood agar matches Streptococcus pyogenes. Step 4: Streptococcus pyogenes is a common cause of sore throat (pharyngitis). Summary: A: Streptococcus pyogenes - Correct due to Gram-positive cocci in chains, catalase-negative, beta-hemolytic, and common cause of sore throat. B: Staphylococcus aureus - Incorrect due to catalase-positive. C: Streptococcus pneumoniae - Incorrect due to alpha-hemolytic. D: Enterococcus faecalis - Incorrect due to not being beta-hemolytic.

Correct Answer: B

Rationale: The correct answer is B: Staphylococcus aureus. This bacterium is commonly found in hospital environments due to its ability to colonize human skin and mucous membranes. It is a leading cause of hospital-acquired infections. Borrelia burgdorferi is mainly associated with Lyme disease transmitted by ticks, not commonly found in hospitals. Bacillus cereus is a foodborne pathogen, not typically prevalent in hospital settings. Staphylococcus haemolyticus is a coagulase-negative staphylococcus species, less pathogenic and less common in hospitals compared to Staphylococcus aureus.

Correct Answer: B

Rationale: Step-by-step rationale for why choice B (Tuberculin is introduced) is correct: 1. Tuberculin test helps identify individuals with latent TB infection. 2. Negative skin-allergic samples suggest absence of active TB. 3. Introducing tuberculin can help confirm latent TB infection. 4. Antibiotics are not prescribed for negative skin-allergic samples. 5. Vaccines are not administered for TB diagnosis. Summary: - Choice A is incorrect as antibiotics are not prescribed for negative skin-allergic samples. - Choice C is incorrect as vaccines are not used for TB diagnosis. - Choice D is incorrect as introducing tuberculin is the appropriate step in this scenario.

Correct Answer: B

Rationale: The correct answer is B: Alpha-hemolytic streptococci. Streptococcus pneumoniae are classified as alpha-hemolytic streptococci based on their ability to partially break down red blood cells, causing a greenish discoloration on blood agar plates. This distinguishes them from beta-hemolytic streptococci, which completely break down red blood cells. Streptococcus pneumoniae are not resistant to bile (choice A), as they are bile soluble. They are not stained by the Ziehl-Neelsen staining method (choice C), which is used for acid-fast bacteria such as Mycobacterium tuberculosis. They are sensitive to optochin (choice D), which is a key differentiating factor in identifying them from other alpha-hemolytic streptococci.

Correct Answer: B

Rationale: The correct answer is B: Clostridium botulinum. This bacterium belongs to the Clostridium genus, known for its ability to produce endospores. Endospores are dormant, resistant structures that help bacteria survive harsh conditions. Staphylococcus aureus (A), Escherichia coli (C), and Neisseria gonorrhoeae (D) do not produce endospores. Staphylococcus aureus is a gram-positive bacterium known for causing various infections, but it does not form endospores. Escherichia coli is a gram-negative bacterium commonly found in the intestines of humans and animals, but it does not produce endospores. Neisseria gonorrhoeae is a gram-negative bacterium that causes the sexually transmitted infection gonorrhea, but it also does not form endospores.

Correct Answer: A

Rationale: The correct answer is A: Vibrios. Vibrios are gram-negative curved bacteria that are motile and do not form spores or capsules. The description of the bacteria in the question fits the characteristics of Vibrios. Vibrios are commonly found in aquatic environments and some species can cause gastrointestinal infections in humans. B: Spirochetes are also gram-negative curved bacteria, but they are spiral-shaped and have unique axial filaments for motility. The description in the question does not match the characteristics of spirochetes. C: Clostridia are gram-positive, spore-forming bacteria. The question specifically states that the bacteria are gram-negative and do not form spores, ruling out Clostridia. D: Corynebacteria are gram-positive, non-spore-forming bacteria. The description in the question does not match the characteristics of Corynebacteria.

Correct Answer: B

Rationale: The correct answer is B: Precipitins. When a granular sediment forms at the bottom of the test-tubes, it indicates the formation of antigen-antibody complexes that are insoluble and precipitate out of the solution. Precipitins are antibodies that specifically react with antigens to form insoluble complexes. Agglutinins cause clumping of cells, opsonins enhance phagocytosis, and bacteriolysins lyse bacteria. These processes do not result in the formation of a granular sediment, making them incorrect choices in this context.

Correct Answer: D

Rationale: Step 1: Formic acid is produced during fermentation by Actinomyces. Step 2: Actinomyces are known to produce organic acids like formic acid through fermentation. Step 3: Other choices like Streptococcus, Klebsiella, and Clostridium are not typically associated with formic acid production. Step 4: Actinomyces is the most likely candidate based on its fermentation capabilities. Summary: Actinomyces is the correct answer because it is known to produce formic acid during fermentation, while the other choices lack this specific metabolic function.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pneumoniae. The description of Gram-positive cocci in pairs with pointed ends and capsules matches the morphology of S. pneumoniae. This bacterium is known to cause pneumonia, especially in individuals with underlying conditions like COPD. Staphylococcus aureus (B) typically appears in clusters, not pairs. Klebsiella pneumoniae (C) is a Gram-negative rod, not a cocci. Neisseria meningitidis (D) is a Gram-negative diplococcus, not a cocci. Hence, based on the morphology and clinical context, Streptococcus pneumoniae is the likely microorganism causing pneumonia in this patient.