On the 5th day after a surgery for colon injury a patient complains of bursting pain in the postoperative wound, weakness, drowsiness, headache, fever up to 40oC. Objectively: the skin around the wound is swollen, there is gas crepitation. The wound discharges are scarce foul-smelling, of dark-gray color. What is the most likely diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Anaerobic clostridial wound infection. The symptoms and signs described (bursting pain, weakness, drowsiness, fever, swollen skin, gas crepitation, foul-smelling dark-gray discharge) are classic for gas gangrene, caused by Clostridium perfringens. Gas gangrene is an anaerobic infection that thrives in devitalized tissue, such as postoperative wounds. The gas crepitation is due to gas production by the bacteria. Abscess (B) typically presents with localized swelling and fluctuance, not gas crepitation. Postoperative wound infection (C) may present with redness, warmth, and increased wound discharge but not the specific features mentioned. Erysipelas (D) is a superficial bacterial skin infection, typically caused by Streptococcus pyogenes, presenting with well-defined raised borders and redness.

Correct Answer: A

Rationale: The correct answer is A: Vibrio cholerae. This bacterium produces the cholera toxin, an enterotoxin that causes profuse watery diarrhea by disrupting the normal function of the intestines. Vibrio cholerae is specifically known for causing cholera, a severe diarrheal disease. Clostridium botulinum (B) produces botulinum toxin, causing botulism (paralysis, not diarrhea). Escherichia coli (C) can produce enterotoxins, but the question specifies a specific enterotoxin causing diarrhea, which is not a characteristic of all strains of E. coli. Streptococcus pneumoniae (D) is a common cause of respiratory infections but does not produce an enterotoxin causing diarrhea.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Production of auto-antibodies can be due to various factors. Mutant B cell clones can lead to the production of self-reactive antibodies. Antibodies against hidden tissues can also trigger autoimmune responses. Genetic factors play a crucial role in predisposing individuals to autoimmunity. Therefore, the correct answer is D, as all these factors can contribute to the production of auto-antibodies. Choice A is incorrect as it only addresses one possible cause. Choice B is incorrect as it focuses solely on antibodies against hidden tissues. Choice C is incorrect as it overlooks the other potential reasons for auto-antibody production.

Correct Answer: B

Rationale: The correct answer is B: Fimbriae. Fimbriae are hair-like appendages found on the surface of bacteria that enable attachment to host cells. This attachment is crucial for establishing infection. Flagella (A) are used for movement, not attachment. Capsules (C) provide protection and help evade the host immune system, but do not directly facilitate attachment. Endospores (D) are dormant structures for survival, not for attachment to host cells. Fimbriae specifically aid in adherence to host cells, making them the correct choice in this context.

Correct Answer: A

Rationale: The correct answer is A, Anthrax bacillus, because it has the widest infectious spectrum among the options provided. Anthrax bacillus can infect a wide range of hosts, including humans and various animals. It is known for its ability to survive in different environments and cause disease through various routes of exposure. In contrast, choices B, C, and D have more limited infectious spectra. Mumps virus primarily infects humans, the causative agent of gonorrhea mainly affects humans through sexual contact, and the rabies virus typically infects mammals through bites from infected animals. Therefore, Anthrax bacillus is the correct choice due to its broader range of hosts and modes of transmission compared to the other options.

Correct Answer: C

Rationale: Rationale for choice C (Adenovirus) being correct: 1. Adenovirus is a common cause of acute hemorrhagic cystitis. 2. Adenovirus infects the bladder epithelium, leading to inflammation and bleeding. 3. Symptoms include hematuria and bladder pain. 4. Diagnosis is confirmed through viral culture or PCR testing. Summary of why other choices are incorrect: A: Parvovirus B19 - More commonly associated with erythema infectiosum (fifth disease) and aplastic anemia. B: CMV - Known to cause congenital infections, mononucleosis, and retinitis, not typically associated with hemorrhagic cystitis. D: Herpesvirus type 2 - Commonly causes genital herpes, but not typically associated with acute hemorrhagic cystitis.

Correct Answer: A

Rationale: The correct answer is A: Chlamydia. Chlamydia lacks the essential enzymes for ATP synthesis and relies on host cell ATP. Enterococci, Rickettsia, and Staphylococci possess the necessary enzymes for ATP synthesis through cellular respiration. Chlamydia's inability to synthesize ATP makes it dependent on the host cell for energy production, distinguishing it from the other bacteria listed.

Correct Answer: B

Rationale: The correct answer is B: rheumatic fever. Rheumatic fever is an inflammatory disease that can occur as a complication following a group A streptococcal infection. This is known as a post-streptococcal complication. It typically affects the heart, joints, skin, and brain. Endocarditis (choice A) is also a complication of streptococcal infections, but it is an infection of the heart valves, not an inflammatory disease like rheumatic fever. Nephritis (choice C) is inflammation of the kidneys and is not directly related to streptococcal infections. Cytomegalovirus (choice D) is a different viral infection and is not associated with streptococcal infections.