Microscopy of a smear from a patient with foul-smelling diarrhea revealed large ciliated protozoa with a kidney-shaped macronucleus. What is the diagnosis?

Correct Answer: A

Rationale: The correct diagnosis is A: Balantidiasis. The presence of large ciliated protozoa with a kidney-shaped macronucleus is characteristic of Balantidium coli, the causative agent of balantidiasis. The ciliated trophozoites of Balantidium coli are unique compared to the other choices. Giardiasis is caused by Giardia lamblia, which has flagella and not cilia. Amoebiasis is caused by Entamoeba histolytica, which lacks cilia. Trichomoniasis is caused by Trichomonas vaginalis, which also lacks cilia. Therefore, based on the specific morphology described, the correct diagnosis is Balantidiasis.

Correct Answer: A

Rationale: The correct answer is A: Pseudomonas aeruginosa. P. aeruginosa is a Gram-negative rod that is a lactose non-fermenter commonly associated with deep tissue infections. It is an opportunistic pathogen known for its ability to cause infections in immunocompromised individuals. P. aeruginosa is often resistant to multiple antibiotics and can form biofilms, making it difficult to treat. Summary of why other choices are incorrect: B: Escherichia coli is a Gram-negative rod that ferments lactose and is commonly found in the gastrointestinal tract. It is not typically associated with deep tissue infections. C: Salmonella typhi is a Gram-negative rod that causes typhoid fever, primarily affecting the gastrointestinal system, not deep tissue infections. D: Shigella dysenteriae is a Gram-negative rod that causes bacillary dysentery, which primarily affects the gastrointestinal tract and does not typically cause deep tissue infections.

Correct Answer: A

Rationale: The correct answer is A: Helicobacter pylori. This bacterium is the most likely causative agent of gastric ulcers. Here's the rationale: 1. Helicobacter pylori is commonly associated with gastric ulcers. 2. It is a gram-negative bacterium that grows on chocolate agar and is oxide reductase-positive. 3. The slow growth on the fifth day is characteristic of H. pylori. 4. Campylobacter jejuni and Campylobacter fetus are not typically associated with gastric ulcers. 5. Mycoplasma hominis is a bacterium that lacks a cell wall and is not commonly found in gastric ulcers.

Correct Answer: A

Rationale: The correct answer is A: Clostridium botulinum. Clostridium botulinum produces the botulinum toxin, which causes botulism. This bacteria thrives in anaerobic environments and can contaminate improperly canned foods. Clostridium tetani causes tetanus, not botulism. Staphylococcus aureus produces enterotoxins causing food poisoning, not botulism. Escherichia coli can cause food poisoning through various toxins, but not botulism. Therefore, the correct choice is Clostridium botulinum as it specifically produces the botulinum toxin responsible for botulism.

Correct Answer: A

Rationale: The correct answer is A: Pseudomonas aeruginosa. This is because Pseudomonas is a Gram-negative rod, oxidase-positive, and non-lactose fermenter. These characteristics are typical of Pseudomonas species. B: Escherichia coli is a Gram-negative rod but is lactose fermenter and usually oxidase-negative. C: Klebsiella pneumoniae is a Gram-negative rod, non-lactose fermenter, but is usually oxidase-negative. D: Shigella dysenteriae is a Gram-negative rod, non-lactose fermenter, but is usually oxidase-negative and is more associated with causing shigellosis rather than deep tissue infections.

Correct Answer: A

Rationale: The correct answer is A: Entamoeba histolytica. This is because the presence of cysts with four nuclei is characteristic of Entamoeba histolytica, a protozoan parasite that causes amoebic dysentery. Entamoeba histolytica cysts contain four nuclei, distinguishing them from other pathogens. Giardia lamblia and Trichomonas vaginalis are not associated with cysts containing four nuclei. Balantidium coli is a ciliated protozoan that does not typically form cysts with multiple nuclei. In summary, the unique feature of four nuclei in the cysts points towards Entamoeba histolytica as the most likely causative agent of the diarrhea in this patient.

Correct Answer: A

Rationale: The correct answer is A: yeast and molds. Yeast and molds can resist acidic pH due to their ability to maintain a stable internal pH through various mechanisms such as ion transport and cell wall composition. Bacteria, including E. coli, are generally more sensitive to acidic conditions. Choice D is incorrect as yeast and molds are known to thrive in acidic environments.

Correct Answer: A

Rationale: The correct answer is A because the cytoplasmic membrane in bacteria is primarily composed of phospholipids, glycerol, and glycolipids. Phospholipids form the basic structure of the membrane, with glycerol serving as the backbone and glycolipids present on the outer surface. Lipopolysaccharides (choice B) are primarily found in the outer membrane of Gram-negative bacteria, not the cytoplasmic membrane. Choice C is incorrect because peptidoglycan is a component of the bacterial cell wall, not the cytoplasmic membrane. Choice D is incorrect as the cytoplasmic membrane in bacteria is indeed composed of phospholipids, glycerol, and glycolipids.

Correct Answer: B

Rationale: The correct answer is B: For HIV. Pneumocystis pneumonia in a young man with CD4+ cells less than 200/mm3 is highly suggestive of HIV infection. HIV weakens the immune system, leading to opportunistic infections like pneumocystis pneumonia. Testing for HIV is crucial for diagnosis and appropriate management. Explanation for other choices: A: Testing for ureaplasma urealyticum is not indicated in this case as the symptoms and CD4+ cell count point towards an HIV-related infection. C: Testing for Treponema pallidum (syphilis) is not relevant in the context of a young man with pneumocystis pneumonia and low CD4+ cell count. D: Testing for Neisseria gonorrhoea is not appropriate in this scenario as the symptoms and CD4+ cell count suggest an underlying HIV infection rather than a bacterial sexually transmitted infection.