An adult patient with type 2 diabetes attends the emergency room. He reported that two days ago he was accidentally injured in the left leg, but he did not seek medical care. At the time of examination, an infected wound was found, surrounded by a large area of inflammation with characteristic tissue crepitation on palpation and with foul odor. Blood (for hemoculture) and wound secretions were taken for microbiological testing. The microscopic examination reveals large Gram-positive bacteria, with centrally located spores. These bacteria were unable to grow in vitro at presence of oxygen. The most likely cause of this disease is:

Correct Answer: B

Rationale: The correct answer is B: Clostridium perfringens. In this case, the patient's presentation of infected wound with tissue crepitation, foul odor, and Gram-positive bacteria with centrally located spores that cannot grow in the presence of oxygen is indicative of gas gangrene caused by Clostridium perfringens. This anaerobic bacterium produces various toxins that lead to tissue destruction and gas production in the affected area. Clostridium tetani (choice A) causes tetanus, characterized by muscle stiffness and spasms. Clostridium botulinum (choice C) causes botulism, leading to muscle paralysis. Clostridium difficile (choice D) is associated with antibiotic-associated diarrhea. These choices are incorrect as they do not match the clinical presentation described in the question.

Correct Answer: A

Rationale: The correct answer is A: Neisseria gonorrhoeae. This bacterium is a gram-negative diplococci commonly associated with gonorrhea, which presents with symptoms like painful urination. Neisseria gonorrhoeae is known to infect the urethra in males. Escherichia coli, Proteus vulgaris, and Klebsiella pneumoniae are all gram-negative bacteria, but they are not typically associated with urethral discharge or gonorrhea. E. coli is commonly associated with urinary tract infections, Proteus vulgaris with wound infections, and Klebsiella pneumoniae with pneumonia and other respiratory infections. Therefore, based on the patient's symptoms and the characteristics of the bacteria, Neisseria gonorrhoeae is the most appropriate causative agent in this case.

Correct Answer: A

Rationale: The correct answer is A: Neisseria meningitidis. This bacterium is a Gram-negative diplococcus commonly associated with meningitis. Neisseria meningitidis is a leading cause of bacterial meningitis in young adults and adolescents. It is known for causing fever, headache, and neck stiffness. The other choices, Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae, are not typically Gram-negative diplococci and are not commonly associated with the symptoms described. Streptococcus pneumoniae is a Gram-positive coccus, Haemophilus influenzae is a Gram-negative coccobacillus, and Klebsiella pneumoniae is a Gram-negative rod. Therefore, Neisseria meningitidis is the most likely causative agent in this scenario.

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 Gram stain process involves staining bacterial cells with crystal violet and iodine, followed by decolorization and counterstaining. The primary differentiation is based on the cell wall structure, distinguishing bacteria into Gram-positive (retain purple color) and Gram-negative (lose purple color). This classification is crucial in microbiology for treatment decisions as it correlates with different antibiotic susceptibilities. Choices A, B, and D are incorrect because the Gram stain process does not primarily focus on flagella, shape, or motility of bacteria.

Correct Answer: B

Rationale: The correct answer is B: Vibrio cholerae. Cholera is caused by this specific bacterium. Vibrio cholerae produces a toxin that leads to severe diarrhea and dehydration. Salmonella typhi causes typhoid fever, Escherichia coli can cause various infections but not cholera, and Shigella dysenteriae causes dysentery, not cholera. Therefore, the correct choice is B.

Correct Answer: C

Rationale: The correct answer is C: Nucleic acid and proteins. Viruses contain genetic material in the form of nucleic acids (DNA or RNA) surrounded by a protein coat. This genetic material carries instructions for viral replication. Proteins are also essential components of viruses, serving various functions like facilitating viral entry into host cells. Option A is incorrect as lipids are not main components of viruses. Option B is incorrect as lipids are not typically found in the main structure of viruses. Option D is incorrect as lipids are not primary components of viruses, and glycoproteins are not always present in the main structure of viruses.

Correct Answer: B

Rationale: The correct answer is B: RG2. RG2 is appropriate for agents associated with human disease that pose a moderate health risk. These agents may cause disease of varying severity, but generally do not result in serious health consequences. Other choices are incorrect because: A: RG1 is for agents not associated with disease in healthy adults, C: RG3 is for agents associated with serious or lethal human disease, and D: RG4 is for agents that pose a high risk of life-threatening disease and for which there are no treatments.

Correct Answer: D

Rationale: The correct answer is D: it is a live attenuated vaccine. This is true because the mumps vaccine is indeed a live attenuated vaccine, meaning it contains a weakened form of the virus to stimulate an immune response without causing the disease. This type of vaccine provides long-lasting immunity. A, B, and C are incorrect: A: the vaccine is recommended, not obligatory - this is incorrect because the mumps vaccine is typically recommended for all individuals to prevent the spread of the disease. B: the vaccine is not given in combination with other vaccines - this is incorrect as the mumps vaccine is often given in combination with measles and rubella vaccines as the MMR vaccine. C: the vaccine is administered orally - this is incorrect because the mumps vaccine is usually administered via injection, not orally.