On examination of a 6-year-old child the doctor noticed greyish film on the child's tonsils. Microscopy of the smear stained by Neisser method detected there Corynebacterium diphtheria. What morphologic feature was the most indicative for determining the type of the agent?

Correct Answer: C

Rationale: The correct answer is C: Polar placement of volutin granules. This feature is indicative of Corynebacterium diphtheria. Volutin granules are metachromatic granules found in the polar region of the bacterial cell, which is characteristic of this species. This feature helps differentiate it from other bacteria. Explanation: A: Fence-like position of the agent's cells is not a specific morphologic feature of Corynebacterium diphtheria. B: Spores that exceed cells in diameter is not a characteristic feature of Corynebacterium diphtheria. D: Presence of the capsule is not a distinguishing morphologic feature of Corynebacterium diphtheria. In summary, the polar placement of volutin granules is the most indicative feature for determining the type of agent as Corynebacterium diphtheria, making it the correct choice.

Correct Answer: A

Rationale: The correct answer is A: Neisseria meningitidis. This bacterium is a Gram-negative diplococcus commonly associated with meningitis. The patient's symptoms of fever, headache, and neck stiffness are classic signs of meningococcal meningitis. Neisseria meningitidis is known to cause outbreaks in crowded settings. Streptococcus pneumoniae (Choice B) is a common cause of bacterial meningitis but typically appears as Gram-positive cocci. Haemophilus influenzae (Choice C) can also cause meningitis but is more commonly seen in unvaccinated children. Klebsiella pneumoniae (Choice D) is a Gram-negative bacterium but is not a typical causative agent of meningitis.

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: A

Rationale: The correct answer is A: Treponema pallidum. This bacterium is responsible for causing syphilis due to its unique spiral shape and ability to penetrate mucous membranes. It is transmitted through sexual contact or from mother to fetus. Neisseria gonorrhoeae causes gonorrhea, Chlamydia trachomatis causes chlamydia, and Escherichia coli is a common bacterium in the gastrointestinal tract. Syphilis is distinct due to its characteristic symptoms and stages, making Treponema pallidum the correct choice.

Correct Answer: A

Rationale: The correct answer is A: Alexander Fleming. He discovered the antibiotic properties of Penicillium in 1928. Fleming observed that a mold called Penicillium notatum inhibited the growth of bacteria, leading to the discovery of penicillin. Louis Pasteur is known for his work on pasteurization and microbiology, not penicillin. Joseph Lister is known for pioneering antiseptic surgery techniques. Edward Jenner is known for developing the smallpox vaccine, not penicillin. Fleming's discovery revolutionized medicine by introducing the first antibiotic, penicillin, which has saved countless lives.

Correct Answer: A

Rationale: The most probable diagnosis is Dermatotropic leishmaniasis. The roundish ulcers, lymph node enlargement, and presence of unicellular aflagellar organisms in discharge are characteristic of this parasitic infection transmitted by sandfly bites. Leishmania parasites cause skin lesions and lymphadenopathy. Toxoplasmosis (B) presents with flu-like symptoms, not ulcers. Scabies (C) causes intense itching and burrows, not ulcers. Trypanosomiasis (D) presents with fever, not ulcers. In this case, the symptoms align closely with Dermatotropic leishmaniasis, making it the most likely diagnosis.

Correct Answer: B

Rationale: The correct answer is B: Malaria. Fever developing 2 weeks post-blood transfusion is characteristic of malaria due to the incubation period of the parasite. Trypanosomiasis presents earlier, amebiasis usually causes GI symptoms, and toxoplasmosis typically manifests with flu-like symptoms. Malaria is the most likely cause based on the timing and clinical presentation.

Correct Answer: B

Rationale: The correct answer is B: Sporadic disease. When an infection occurs in several persons without any epidemiological link, it is considered sporadic. This term is used to describe isolated cases that do not form a specific pattern or cluster. It indicates random occurrences and lack of connection between the affected individuals. A: Epidemic refers to a sudden increase in the number of cases of a disease within a specific population or region, usually linked by a common source or exposure. C: Endemic signifies the constant presence of a disease within a specific population or region, with cases occurring at a relatively stable rate. D: Pandemic indicates a global outbreak of a disease affecting a large number of people across multiple countries or continents.

Correct Answer: D

Rationale: The correct answer is D because all of the symptoms mentioned (short period of depression, nausea, restlessness) can be early signs of rabies. Rabies typically presents with a variety of non-specific symptoms in the early stages, including behavioral changes such as depression and restlessness, as well as gastrointestinal symptoms like nausea. Therefore, it is important to consider the combination of these symptoms collectively rather than individually when suspecting rabies. Choices A, B, and C alone may not definitively indicate rabies, but when seen together, they should raise suspicion and prompt further evaluation and testing for rabies.