Microscopical examination of an infiltrate removed from the submandibular skin area of a 30 y.o. man revealed foci of purulent fluxing surrounded by maturing granulations and mature connective tissue, the pus contains druses consisting of multiple short rod-like elements with one end attached to the homogenous centre. What disease is it?

Correct Answer: A

Rationale: The correct answer is A: Actinomycosis. This is supported by the presence of purulent foci with druses consisting of short rod-like elements attached to a homogenous center, which is characteristic of Actinomyces species. Actinomycosis commonly presents with granulation tissue and connective tissue formation. B: Tuberculosis does not typically present with druses containing short rod-like elements. C: Syphilis does not typically present with purulent foci or druses. D: Candidosis does not typically present with the described features of purulent fluxing and druses with short rod-like elements.

Correct Answer: C

Rationale: The correct answer is C: Respiratory tract. The respiratory tract is likely the most frequently used portal of entry for pathogens because it is constantly exposed to the external environment and has a large surface area lined with mucous membranes that can trap and facilitate the entry of pathogens. Additionally, the respiratory tract serves as a direct pathway for pathogens to reach the bloodstream and other organs. Skin (choice A) is a physical barrier that can prevent pathogen entry, while the gastrointestinal tract (choice B) has acidic pH and enzymes that can kill many pathogens. Conjunctiva (choice D) is a less common portal of entry compared to the respiratory tract due to its smaller surface area and protective mechanisms such as tears.

Correct Answer: D

Rationale: The correct answer is D: All of the above. Clostridium tetani, Staphylococcus aureus, and Escherichia coli are all capable of producing exotoxins. Exotoxins are proteins released by bacteria that can cause damage to the host. Clostridium tetani produces tetanospasmin, causing tetanus. Staphylococcus aureus produces toxins like enterotoxin and toxic shock syndrome toxin-1. Escherichia coli can produce Shiga toxin and heat-labile toxin. Therefore, all three bacteria listed can produce exotoxins, making choice D the correct answer. Choices A, B, and C are incorrect as they do not encompass all the bacteria capable of producing exotoxins.

Correct Answer: B

Rationale: The correct answer is B: intravenous administration. This route bypasses the first-pass metabolism, allowing the drug to directly enter the bloodstream for immediate distribution. In contrast, on the skin (A) and sublingual (D) routes have slower absorption rates due to barriers like skin layers or mucous membranes. Intramuscular (C) absorption is slower than intravenous due to slower perfusion rates in muscle tissues. Overall, intravenous administration provides the fastest and most direct route for drug absorption, making it the most rapid method.

Correct Answer: A

Rationale: Step 1: Large, oval protozoa with a single nucleus and four flagella indicate Giardia lamblia. Step 2: Giardia lamblia is a flagellated protozoan causing diarrhea. Step 3: It has a distinct appearance under microscopy. Step 4: Entamoeba histolytica causes dysentery with no flagella. Step 5: Balantidium coli is a ciliated protozoan with a larger size. Step 6: Trichomonas vaginalis lacks a cyst stage and causes genitourinary infections.

Correct Answer: A

Rationale: The correct answer is A: T-lymphocytes. In skin mycosis, a disorder of cellular immunity indicates a deficiency in T-lymphocytes, which play a crucial role in cell-mediated immunity. T-lymphocytes are responsible for recognizing and destroying infected cells. Reduction in T-lymphocytes impairs the body's ability to fight fungal infections. Incorrect choices: B: Immunoglobulin G - Immunoglobulin G is involved in humoral immunity, not cellular immunity. C: Immunoglobulin E - Immunoglobulin E is typically associated with allergic responses, not cellular immunity. D: B-lymphocytes - B-lymphocytes are responsible for producing antibodies in humoral immunity, not directly involved in cell-mediated immunity.

Correct Answer: B

Rationale: The correct answer is B: Klebsiella pneumoniae. This bacterium is gram-negative, capsulated, and forms lactose-positive colonies. It was first isolated in pneumonia but is more commonly associated with urinary infections, otitis, meningitides, sepsis, and nosocomial infections. Klebsiella pneumoniae fits all the characteristics mentioned in the question, making it the correct choice. Incorrect choices: A: Staphylococcus aureus is gram-positive and does not have a capsule. C: Streptococcus pneumoniae is also gram-positive and does not fit the description given. D: Mycobacterium tuberculosis is an acid-fast bacterium associated with tuberculosis, but it is neither gram-negative nor lactose-positive.

Correct Answer: A

Rationale: The correct answer is A: Artificial food media. Treponema pallidum is a fastidious bacterium that cannot be cultivated on artificial food media due to its complex nutritional requirements. It can be cultivated on cell lines and intratesticular in rabbits. Therefore, option A is incorrect. Option B and C are correct.

Correct Answer: A

Rationale: The correct answer is A: Yersinia pestis. Y. pestis is the causative agent of plague, characterized by fever, enlarged lymph nodes, and bacteremia. The bipolar-staining, Gram-negative rods seen on Gram stain are typical of Y. pestis. Incorrect choices: B: Francisella tularensis causes tularemia, not plague. C: Brucella abortus causes brucellosis, not plague. D: Clostridium botulinum causes botulism, not plague. In summary, the key features of the patient's presentation and the Gram stain findings align with Yersinia pestis as the correct causative agent of plague.