In the morning a patient had nausea, abdominal discomfort, single vomiting, dry mouth. In the evening, the patient presented with the increasing general weakness, double vision, difficult swallowing of solid food. Objectively: ptosis, mydriasis, anisocoria, absence of gag and pharyngeal reflex, dry mucous membranes. The previous evening the patient had dinner with canned food and alcohol. What is the presumptive diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Botulism. The symptoms described, such as ptosis, mydriasis, anisocoria, dry mouth, and absent gag reflex, are classic signs of botulism. Botulism is caused by the bacterium Clostridium botulinum, commonly found in improperly preserved canned foods. The progression from gastrointestinal symptoms to neurological symptoms, like double vision and difficulty swallowing, is characteristic of botulism due to the toxin's effect on neuromuscular transmission. Poliomyelitis primarily affects the motor neurons and presents with different symptoms. Food toxicoinfection typically involves gastrointestinal symptoms and does not manifest with the neurological findings seen in this case. Acute ischemic stroke presents with sudden onset neurological deficits due to impaired blood flow to the brain, which is not consistent with the gradual progression of symptoms in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Staphylococcus aureus. This bacterium is commonly associated with hospital-acquired infections due to its ability to cause a wide range of infections and its resistance to multiple antibiotics. Staphylococcus aureus can cause skin infections, pneumonia, bloodstream infections, and surgical site infections, making it a significant threat in healthcare settings. Escherichia coli (choice A) is more commonly associated with foodborne illnesses. Clostridium difficile (choice B) is known for causing antibiotic-associated diarrhea. Bacillus anthracis (choice D) is primarily associated with anthrax infections, which are not typically acquired in hospital settings.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pneumoniae. The presence of Gram-positive diplococci with a capsule is characteristic of S. pneumoniae. This bacterium is a common cause of pneumonia, especially in patients with fever and cough. It is also known for causing infections such as otitis media and sinusitis. Staphylococcus aureus (B) is a Gram-positive cocci but does not typically form diplococci or have a capsule. Neisseria meningitidis (C) is a Gram-negative diplococcus commonly associated with meningitis, not pneumonia. Klebsiella pneumoniae (D) is a Gram-negative rod, not a diplococcus, and is more commonly associated with pneumonia in immunocompromised patients.

Correct Answer: C

Rationale: The correct answer is C: acetyl-CoA. Acetyl-CoA is the compound that combines with oxaloacetic acid at the beginning of the Krebs cycle to form citric acid. This step is essential for the cycle to proceed, making acetyl-CoA the correct choice. A: Citric acid is formed after acetyl-CoA combines with oxaloacetic acid, so it is a product of the reaction, not the compound that enters the cycle. B: Pyruvic acid is converted to acetyl-CoA in a separate process before entering the Krebs cycle. D: Phosphoglyceraldehyde is not involved in the Krebs cycle; it is a compound in glycolysis.

Correct Answer: C

Rationale: The correct answer is C because there is no obligatory vaccine for Neisseria meningitidis in Bulgaria. The rationale for this is that while vaccines are available for meningococcal disease, they are not mandatory in Bulgaria. Therefore, this statement is incorrect. A: This statement is correct as Waterhouse-Friderichsen syndrome can occur during meningococcemia due to rapid progression of the infection leading to adrenal gland failure. B: This statement is incorrect as Neisseria meningitidis is most common in infants, children, and adolescents, with a second peak in young adults. D: This statement is correct as Neisseria meningitidis is transmitted through respiratory secretions, such as coughing or kissing, especially in close contacts like household members or roommates.