A patient with pneumonia had sputum stained by the Gram method. The smear revealed 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. This bacterium is a common cause of pneumonia and is known to appear as Gram-positive cocci in pairs with a capsule. The presence of a capsule is a key characteristic of S. pneumoniae. Staphylococcus aureus (B) is a Gram-positive cocci but typically does not have a capsule. Neisseria meningitidis (C) is a Gram-negative diplococcus, not a Gram-positive cocci. Klebsiella pneumoniae (D) is a Gram-negative rod, not a Gram-positive cocci. Therefore, based on the staining pattern and the presence of a capsule, Streptococcus pneumoniae is the most likely causative agent in this case.

Correct Answer: A

Rationale: The correct answer is A: Clostridium tetani. Clostridium tetani is responsible for causing tetanus due to its production of tetanospasmin toxin. This neurotoxin leads to muscle stiffness and spasms characteristic of tetanus. Clostridium perfringens is associated with gas gangrene, not tetanus. Streptococcus pyogenes causes strep throat and skin infections, not tetanus. Escherichia coli is a common gut bacteria and is not responsible for tetanus. Therefore, choice A is the correct answer for causing tetanus.

Correct Answer: D

Rationale: The correct answer is D because the flu vaccine mainly stimulates systemic immunity, not local immunity. Systemic immunity refers to the immune response throughout the body, while local immunity is specific to a certain area. Choice A is incorrect because the flu vaccine is indeed recommended. Choice B is incorrect as the flu vaccine can be a subunit vaccine, containing only specific antigens. Choice C is incorrect as the flu vaccine is typically administered parenterally, meaning through injection, nasal spray, or oral routes.

Correct Answer: D

Rationale: The correct answer is D: Pulmonary tuberculosis. The presence of red bacilli stained with Ziehl-Nielsen method indicates acid-fast bacteria, which are characteristic of Mycobacterium tuberculosis, the causative agent of tuberculosis. The size and appearance of the bacilli described match those of M. tuberculosis. Chronic pneumonia, along with the specific staining pattern, strongly suggests tuberculosis as the likely diagnosis. Explanation for other choices: A: Pneumococcal pneumonia is caused by Streptococcus pneumoniae, which would not show red bacilli on Ziehl-Nielsen staining. B: Pulmonary actinomycosis is caused by Actinomyces species, not acid-fast bacteria like M. tuberculosis. C: Pulmonary candidiasis is caused by Candida species, which are fungi and do not appear as red bacilli on staining.

Correct Answer: C

Rationale: The correct answer is C: Bacillus subtilis. Bacillus subtilis is known for its spore-forming ability, which is a survival mechanism to withstand harsh conditions. Spore formation allows the bacteria to become dormant and resistant to heat, chemicals, and radiation. Escherichia coli (A) is not known for spore formation. Staphylococcus aureus (B) does not form spores either. Listeria monocytogenes (D) is a pathogenic bacterium but does not typically form spores.

Correct Answer: C

Rationale: The correct answer is C because bacterial enzymes like amylase and protease catalyze biochemical reactions like digestion. Amylase breaks down carbohydrates, while protease breaks down proteins. This process is essential for bacterial metabolism and nutrient acquisition. Choice A (Break down toxins) is incorrect because bacterial enzymes are primarily involved in nutrient breakdown, not toxin degradation. Choice B (Facilitate movement) is incorrect as enzymes are not directly involved in bacterial movement. Choice D (Promote spore formation) is incorrect because enzymes like amylase and protease are not directly involved in spore formation.

Correct Answer: A

Rationale: The correct answer is A: Propionibacterium shermanii. This bacterium is used in the production of certain types of cheese, such as Swiss cheese, to create the characteristic holes and flavor. Propionibacterium produces carbon dioxide gas during fermentation, forming the holes in the cheese. Acetobacter aceti (B) is used in vinegar production. Giardia (C) is a parasite that causes gastrointestinal issues, not used in cheese production. Fusobacterium (D) is a type of bacteria associated with infections in humans, not used in cheese production.

Correct Answer: B

Rationale: The correct answer is B: Clostridium botulinum. This bacterium produces the botulinum toxin, which causes botulism by blocking nerve functions. Clostridium tetani causes tetanus, not botulism. Staphylococcus aureus produces toxins that cause food poisoning, not botulism. Bacillus anthracis causes anthrax, not botulism. Therefore, the correct choice is Clostridium botulinum because it is the specific bacterium responsible for producing the toxin that leads to botulism.

Correct Answer: D

Rationale: The correct answer is D: Gram-negative coccobacillus. Francisella tularensis is a Gram-negative coccobacillus because it has a unique shape that is between a coccus (spherical) and a bacillus (rod-shaped) and it stains pink/red in the Gram staining process. It is important to note that it is not a coccus (choice B) or a Gram-positive bacterium (choice A). Choice C is too general and does not specify the coccobacillus shape of F. tularensis. So, the correct answer is D due to its specific characteristics as a Gram-negative coccobacillus.