A patient with fever and diarrhea had a stool sample that revealed Gram-negative rods that fermented lactose. What is the most likely causative agent?

Correct Answer: A

Rationale: The correct answer is A: Escherichia coli. E. coli is a Gram-negative rod that ferments lactose. It is a common cause of gastroenteritis presenting with fever and diarrhea. Salmonella typhi does not ferment lactose and causes typhoid fever. Shigella dysenteriae causes dysentery and does not ferment lactose. Proteus vulgaris does not typically cause gastroenteritis and is not known for lactose fermentation.

Correct Answer: C

Rationale: The correct answer is C: S.aureus. Stomatitis is commonly caused by S.aureus due to its ability to form clusters of oval polymorphous Gram-positive microorganisms. S.aureus is known to colonize the oral mucous membrane and can cause infections, especially after prolonged antibiotic use. Explanation for other choices: A: С.albicans - Candida albicans is a fungus commonly associated with oral thrush, not typically causing stomatitis. B: C.perfringens - Clostridium perfringens is a bacterium associated with food poisoning and gas gangrene, not commonly causing stomatitis. D: S.pyogenes - Streptococcus pyogenes is known to cause strep throat and skin infections, but not typically associated with stomatitis.

Correct Answer: B

Rationale: The correct answer is B: dermis. The papillary layer is located in the dermis, specifically at the junction with the epidermis. It contains capillaries, lymphatics, and sensory receptors, contributing to the skin's strength and elasticity. The epidermis (choice A) is the outermost layer of the skin, while the hypodermis (choice C) and subcutaneous layer (choice D) are deeper layers beneath the dermis, primarily composed of fat cells and connective tissue. Therefore, the papillary layer is part of the dermis, making choice B the correct answer.

Correct Answer: D

Rationale: The thin microorganisms described with 12-14 equal ringlets and pale-pink sharp points are characteristic of Borrelia spirochetes, the causative agent of relapsing fever. The ringlet appearance corresponds to the characteristic coiled structure of Borrelia spirochetes. The length of 10-13 mkm falls within the typical size range of Borrelia spirochetes. This pathogen is commonly identified in Romanovsky-Giemsa stained samples from patients with relapsing fever. Summary of other choices: A: Leishmaniasis - Leishmania parasites are larger and do not have the described ringlets or pale-pink sharp points. B: Leptospirosis - Leptospira bacteria are not described as having ringlets or pale-pink sharp points. C: Surra - Surra is caused by Trypanosoma evansi, and the description does not match the characteristics of this parasite.

Correct Answer: C

Rationale: Step 1: Escherichia coli is known to produce a toxin called colibactin that targets cholesterol. Step 2: Colibactin disrupts cholesterol metabolism in host cells. Step 3: This disruption can lead to various health issues. Step 4: Streptococcus pyogenes produces different toxins, not specifically targeting cholesterol. Step 5: Corynebacterium diphtheriae produces diphtheria toxin, not targeting cholesterol. Step 6: Aeromonas hydrophila produces various toxins, but not known for targeting cholesterol. Summary: Escherichia coli produces toxins that specifically target cholesterol, making it the correct choice over the other options.