A patient with foul-smelling diarrhea had a stool sample showing large ciliated protozoa with a kidney-shaped macronucleus. What is the diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Balantidiasis. The large ciliated protozoa with a kidney-shaped macronucleus described in the stool sample is consistent with Balantidium coli, the causative agent of balantidiasis. Balantidium coli is the only ciliated protozoan parasite that infects humans and presents with these specific characteristics. Giardiasis (B) is caused by Giardia intestinalis, which is flagellated, not ciliated. Amoebiasis (C) is caused by Entamoeba histolytica, which has an amoeboid shape, not ciliated. Trichomoniasis (D) is caused by Trichomonas vaginalis, which is a flagellated protozoan and does not have a kidney-shaped macronucleus. Hence, the correct diagnosis in this case is Balantidiasis.

Correct Answer: D

Rationale: Step-by-step rationale for why answer D is correct: 1. Tetanus exotoxins are produced by Clostridium tetani bacteria. 2. Once formed, the exotoxins can spread through the bloodstream. 3. Retrograde axonal transport allows the exotoxins to travel to the central nervous system (CNS). 4. In the CNS, the exotoxins can cause the symptoms of tetanus. 5. Options A, B, and C are incorrect as tetanus exotoxins do not follow those pathways. In summary, option D is correct as tetanus exotoxins can spread through the blood and reach the CNS via retrograde axonal transport, while the other options do not align with the known pathophysiology of tetanus.

Correct Answer: A

Rationale: The correct answer is A: Pseudomonas aeruginosa. Pseudomonas aeruginosa is known to produce green colonies on Endo agar due to its pyoverdin pigment. It is also a Gram-negative rod. P. aeruginosa commonly causes respiratory infections in immunocompromised patients. Escherichia coli (B) typically produces pink colonies on Endo agar and is more associated with gastrointestinal infections. Salmonella typhi (C) and Shigella dysenteriae (D) are both Enterobacteriaceae that usually do not produce green colonies on Endo agar and are more associated with gastrointestinal infections as well.

Correct Answer: A

Rationale: The correct answer is A: Neisseria meningitidis. This bacterium is a Gram-negative diplococcus, oxidase-positive, and fermentative. Neisseria meningitidis is known to cause respiratory infections and is commonly found in sputum cultures of patients with such infections. Neisseria gonorrhoeae (B) is also a Gram-negative diplococcus but is not fermentative. Moraxella catarrhalis (C) is oxidase-positive but not fermentative. Haemophilus influenzae (D) is not a diplococcus and is not fermentative. Therefore, Neisseria meningitidis is the most likely causative agent based on the given characteristics.

Correct Answer: A

Rationale: The correct answer is A: spleen. The spleen is not a component of the gastrointestinal tract; it is part of the lymphatic system. The pharynx, esophagus, and stomach are all part of the gastrointestinal tract responsible for digestion and absorption of food. The spleen's main functions include filtering blood, storing blood cells, and supporting the immune system, making it unrelated to the digestive process.

Correct Answer: A

Rationale: The correct answer is A: Trichomonads. Trichomonads are pear-shaped protozoa, typically 6-13 micrometers long, with one nucleus, undulating membrane, and four flagella at the front. These characteristics match the description provided in the question. Trichomonads are commonly found in oral cavities and can cause gum infections like periodontosis. Summary: - B: Leishmania - Leishmania is a flagellated protozoan responsible for Leishmaniasis, not typically found in the oral cavity. - C: Amoebae - Amoebae are not pear-shaped and do not have the specific characteristics described in the question. - D: Balantidia - Balantidia are ciliated protozoa, not flagellated like trichomonads, and are not typically associated with gum infections.

Correct Answer: B

Rationale: The correct answer is B: Aminoglycosides. Aminoglycosides are antibiotics that act by binding to the 30S ribosomal subunit, disrupting protein synthesis in bacteria. This interaction affects the ribosomes directly, leading to inhibition of bacterial protein production. Penicillins (A) work by inhibiting cell wall synthesis, Sulfonamides (C) target folic acid synthesis, and Quinolones (D) inhibit DNA gyrase. These mechanisms do not directly affect the ribosomes, making them incorrect choices in this context.

Correct Answer: B

Rationale: The correct answer is B: Trichomonas vaginalis. Trichomonas vaginalis is a protozoan parasite that can survive and grow in low moisture conditions. It does not require a host cell and can thrive in moist environments, making it able to grow on substances with very low moisture content. Giardia lamblia (A), Balantidium coli (C), and Entamoeba histolytica (D) are all parasites that require a host to survive and reproduce, making them unable to grow on substances with very low moisture content. Trichomonas vaginalis is the only organism among the choices that fits the criteria of being able to grow on low moisture substances.

Correct Answer: A

Rationale: The correct answer is A: Ciprofloxacin. Pseudomonas aeruginosa is commonly resistant to Ampicillin, Cefazolinum, and Azithromycin. Ciprofloxacin is a fluoroquinolone antibiotic known for its efficacy against Pseudomonas aeruginosa. Its broad spectrum and ability to penetrate tissues make it the most advisable choice for treating secondary obstructive pyelonephritis caused by this pathogen.