The patient has developed pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is marked, the tongue is coated by white coating. The pulse is frequent. The painful lymphatic nodules are determined in the axillary area. The skin is erythematous and glistering over the lymphatic nodules. What is the most probable diagnosis?

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Question 1 of 5

The patient has developed pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is marked, the tongue is coated by white coating. The pulse is frequent. The painful lymphatic nodules are determined in the axillary area. The skin is erythematous and glistering over the lymphatic nodules. What is the most probable diagnosis?

Correct Answer: D

Rationale: The most probable diagnosis is D: Tularemia. Tularemia is a bacterial infection caused by Francisella tularensis. The symptoms described align with tularemia, such as pain in axillary area, fever, shaky gait, coated tongue, frequent pulse, painful lymphatic nodules, and erythematous skin over nodules. The key features pointing towards tularemia are the presence of lymphadenitis in the axillary area and the erythematous, glistering skin over the nodules, which are characteristic of ulceroglandular tularemia. Bubonic plague (A) presents with painful, swollen lymph nodes called buboes but typically lacks the erythematous skin findings. Acute purulent lymphadenitis (B) usually presents with pus-filled lymph nodes but does not typically cause shaky gait or coated tongue. Lymphogranulomatosis (C) is a term for Hodgkin's lymphoma, which does not

Question 2 of 5

A 45-year-old patient complains of body temperature rise up to 40oC, general weakness, headache, painfulness and spastic muscle contractions around the wound in the shin. He received this wound 5 days ago when working in his garden. He requested no medical care back then. What wound infection can be suspected?

Correct Answer: A

Rationale: The correct answer is A: Tetanus. The patient's symptoms of muscle contractions, fever, and wound history suggest tetanus, caused by Clostridium tetani bacteria commonly found in soil. The spastic muscle contractions around the wound are classic for tetanus due to the neurotoxin produced by the bacteria. General weakness and headache are also common symptoms. B: Anthrax is unlikely as it presents with different symptoms such as skin lesions, respiratory symptoms, and gastrointestinal symptoms. C: Erysipelas is characterized by red, swollen patches on the skin, not consistent with the symptoms described. D: Gram-positive is not a specific diagnosis but a broad category of bacteria. Tetanus is caused by Clostridium tetani, which is a Gram-positive bacterium, but this choice does not provide a specific infection diagnosis.

Question 3 of 5

The patient 25 y.o. was admitted on the 1st day of the disease with complaints of double vision in the eyes, heavy breathing. The day before the patient ate homemade mushrooms. On objective examination: paleness, widened pupils, disorder of swallowing, bradycardia, constipation are marked. What is the diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Botulism. Botulism is a rare but serious illness caused by a toxin produced by the bacterium Clostridium botulinum. In this case, the patient's symptoms align with botulism due to the ingestion of homemade mushrooms. The symptoms of double vision, heavy breathing, paleness, widened pupils, swallowing difficulties, bradycardia, and constipation are all classic signs of botulism poisoning. The toxin affects the nervous system and can lead to paralysis. The other choices (B: Yersiniosis, C: Leptospirosis, D: Salmonellosis) do not match the patient's symptoms and history of consuming mushrooms, making them incorrect.

Question 4 of 5

A 37-year-old male was admitted to a hospital complaining of abdominal pain, difficulty in swallowing and breathing, constipation, and nausea. He developed respiratory failure and required endotracheal intubation and ventilation. Two days before, the patient consumed dried salted fish bought from an artisanal producer. Laboratory investigation for infectious pathogen was performed using Kitt-Tarozzi's method. Observation under a bright field microscopy revealed the presence of typical microorganisms with tennis racket appearance. Which of the following is the most likely diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Botulism. Botulism is caused by the toxin produced by Clostridium botulinum bacteria found in improperly preserved or canned foods. The symptoms described align with botulism, such as difficulty swallowing and breathing due to muscle paralysis. The tennis racket appearance seen under microscopy corresponds to the characteristic appearance of Clostridium botulinum spores. The other choices can be ruled out based on the clinical presentation and microscopy findings. Cholera typically presents with severe watery diarrhea, Nontyphoidal Salmonella infection with fever and gastrointestinal symptoms, and Typhoid fever with high fever and abdominal pain. Therefore, the most likely diagnosis in this case is botulism.

Question 5 of 5

A 19 year old woman suffers from primary syphilis. Doctor administered her complex therapy that includes benzylpenicillin sodium salt. What is the mechanism of action of this drug?

Correct Answer: A

Rationale: The correct answer is A. Benzylpenicillin sodium salt, also known as penicillin G, works by blocking the synthesis of peptidoglycan in the microbial cell wall. Peptidoglycan is crucial for the structural integrity of bacterial cell walls. By inhibiting its synthesis, penicillin disrupts the cell wall formation, leading to cell lysis and bacterial death. Choices B, C, and D are incorrect because penicillin does not target cytoplasm proteins, thiol enzymes, or RNA synthesis. Penicillin's primary mode of action is specifically related to interfering with bacterial cell wall synthesis.

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