Which ones of the following symptoms are NOT typical for botulism

Correct Answer: C

Rationale: The correct answer is C because chills, fever, and loss of consciousness are not typical symptoms of botulism. Botulism is characterized by descending, flaccid paralysis (choice A), dry mouth, difficulty swallowing, and speaking (choice B), and blurred vision, diplopia (choice D). These symptoms result from the neurotoxin produced by Clostridium botulinum, leading to muscle weakness and paralysis. Chills, fever, and loss of consciousness are more commonly associated with infections or other conditions, not botulism.

Correct Answer: D

Rationale: The correct answer is D: Clindamycin. Clindamycin is a lincosamide antibiotic that is safe to use in patients with a history of anaphylaxis to beta-lactam antibiotics like cefaclor. Clindamycin is effective against streptococcus pyogenes and is a suitable alternative in this case. Amoxicillin (choice A) is a beta-lactam antibiotic similar to cefaclor and may cause a cross-reactive allergic reaction. Meropenem (choice B) is a carbapenem antibiotic and not typically used for acute pharyngitis. Cephalexin (choice C) is a cephalosporin antibiotic and may also cause cross-reactivity in patients with a history of anaphylaxis to cefaclor.

Correct Answer: A

Rationale: Cell-mediated immunity plays a crucial role in combating infections with intracellular pathogens by activating T cells to directly kill infected cells. Facultative and obligate intracellular pathogens, such as viruses and some bacteria, require cell-mediated immunity for effective clearance. Option A is correct due to the specificity of this immune response. Choices B, C, and D are incorrect as they are primarily associated with humoral immunity involving antibodies and not T cell responses against intracellular pathogens.

Correct Answer: A

Rationale: The correct answer is A: Balantidium coli. This large ciliated protozoa with a kidney-shaped macronucleus is characteristic of Balantidium coli, an intestinal parasite known to cause foul-smelling diarrhea in humans. Balantidium coli is the only option among the choices that fits this specific description. Entamoeba histolytica causes amoebic dysentery, Giardia lamblia causes giardiasis, and Trichomonas hominis is a non-pathogenic protozoa found in the intestinal tract. Therefore, based on the morphology described in the question, Balantidium coli is the correct causative agent.

Correct Answer: C

Rationale: The correct answer is C: Chronic atrophic rhinitis. This infection is typical for the upper respiratory tract as it affects the nasal mucosa and sinuses. It is characterized by inflammation and atrophy of the nasal mucosa. Psittacosis (A) is a zoonotic infection transmitted from birds, affecting the lungs. Mycoplasma bronchitis (B) is a lower respiratory tract infection caused by Mycoplasma pneumoniae. Legionnaires disease (D) is a severe form of pneumonia caused by Legionella bacteria. Therefore, C is the correct answer as it specifically pertains to the upper respiratory tract.

Correct Answer: D

Rationale: The thin microorganisms described with 12-14 equal ringlets and pale-pink sharp points are characteristic of Borrelia spirochetes, the causative agent of relapsing fever. The ringlet appearance corresponds to the characteristic coiled structure of Borrelia spirochetes. The length of 10-13 mkm falls within the typical size range of Borrelia spirochetes. This pathogen is commonly identified in Romanovsky-Giemsa stained samples from patients with relapsing fever. Summary of other choices: A: Leishmaniasis - Leishmania parasites are larger and do not have the described ringlets or pale-pink sharp points. B: Leptospirosis - Leptospira bacteria are not described as having ringlets or pale-pink sharp points. C: Surra - Surra is caused by Trypanosoma evansi, and the description does not match the characteristics of this parasite.

Correct Answer: D

Rationale: The correct answer is D because all three bacteria listed (Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa) can produce endotoxins that can lead to septic shock. Endotoxins are lipopolysaccharides found in the outer membrane of Gram-negative bacteria like E. coli and P. aeruginosa. Staphylococcus aureus, a Gram-positive bacterium, can also produce endotoxins called superantigens that can trigger a massive immune response leading to septic shock. Therefore, all of the above choices are correct. Choices A, B, and C alone are incorrect because they do not account for the fact that all three bacteria listed produce endotoxins that can cause septic shock.

Correct Answer: D

Rationale: The correct answer is D because a fourfold increase in titer in the second serum sample indicates a significant rise in specific antibodies, which is crucial for diagnosing viral infections accurately. This increase is considered significant in serologic reactions as it shows a strong antibody response to the virus. A: A threshold increase may not be substantial enough to confirm a diagnostic antibody response. B: Dismissing the increase in titer would overlook important diagnostic information. C: A twofold increase may not be as indicative of a strong antibody response compared to a fourfold increase.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pyogenes. Rationale: 1. Gram-positive cocci in pairs suggest Streptococcus species. 2. Catalase-negative rules out Staphylococcus. 3. Beta-hemolytic indicates Streptococcus pyogenes due to its beta-hemolytic properties. Summary: B: Streptococcus pneumoniae is catalase-negative but not beta-hemolytic. C: Enterococcus faecalis is not typically beta-hemolytic. D: Staphylococcus aureus is catalase-positive and not typically in pairs.