Young man is hospitalized in pulmonology with complaints of dry cough, fatigue and suffocations. The anamnesis and the lab tests lead to pneumocystis pneumonia. The CD4+ cells are less than 200/mm3. What test you will order:

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.

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: C

Rationale: The correct answer is C: Salmonella. This bacterium should be handled in a Biosafety Level 2 facility due to its potential to cause disease in humans. Salmonella is a pathogenic bacterium that can cause foodborne illnesses and infections. Handling it in a Biosafety Level 2 facility ensures proper containment and protection of personnel. A: Micrococcus luteus and B: Bacillus subtilis are common environmental bacteria that do not pose significant risks to human health, so they can be safely handled in lower biosafety levels. D: Staphylococcus epidermidis is a common skin commensal bacterium that is generally not considered highly pathogenic, so it does not require Biosafety Level 2 containment.

Correct Answer: A

Rationale: Step-by-step rationale for choice A being correct: 1. Parvovirus B19 is a single-stranded DNA (ssDNA) virus. 2. The prefix "parvo-" indicates small size, characteristic of ssDNA viruses. 3. ssDNA viruses replicate in the host cell by converting their ssDNA genome into double-stranded DNA (dsDNA). 4. Therefore, the correct answer is A: Its genome consists of dsDNA. Summary of why other choices are incorrect: B: Parvovirus B19 is a non-enveloped virus, making choice B incorrect. C: Parvovirus B19 has a linear ssDNA genome, not segmented, making choice C incorrect. D: Parvovirus B19 has two structural proteins - VP1 and VP2, making choice D incorrect.

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: C

Rationale: The correct answer is C: orphan drugs. Orphan drugs are medications developed to treat rare diseases affecting fewer than 200,000 patients. These diseases often lack attention from pharmaceutical companies due to the high cost and limited market potential. Orphan drugs receive special incentives and regulatory support to encourage their development. A: Secondary drugs do not specifically refer to medications for rare diseases. B: Minor drugs is not a recognized term in the context of rare disease medications. D: Specialty drugs typically refer to high-cost medications used to treat complex or chronic conditions, but not necessarily rare diseases.

Correct Answer: D

Rationale: The correct answer is D: five. Escherichia coli can cause enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enterohemorrhagic E. coli (EHEC), enteroaggregative E. coli (EAEC), and diffusely adherent E. coli (DAEC). Each form has distinct characteristics and pathogenesis. Therefore, the other choices (A, B, C) are incorrect because they do not accurately represent the number of known forms of gastroenteritis caused by Escherichia coli.

Correct Answer: A

Rationale: The correct answer is A: Streptococcus pneumoniae. This bacterium is the most likely causative agent based on the description of Gram-positive cocci in pairs with a capsule. S. pneumoniae is known for its characteristic morphology and the presence of a capsule, which helps in evading the immune system. It commonly causes pneumonia, especially in patients with a productive cough and fever. Incorrect choices: B: Klebsiella pneumoniae typically presents with a mucoid capsule and is associated with pneumonia in immunocompromised individuals. C: Neisseria meningitidis is a Gram-negative diplococcus and is more commonly associated with meningitis and septicemia. D: Staphylococcus aureus is a Gram-positive cocci, but it does not typically present in pairs with a capsule and is more commonly associated with skin and soft tissue infections.

Correct Answer: A

Rationale: The correct answer is A: germination. In the lytic life cycle of phages, germination is not a stage. The lytic cycle involves adsorption, penetration, replication, assembly, and lysis. Germination is typically associated with the lysogenic cycle, where the phage DNA integrates into the host genome. Therefore, A is the correct answer. Choices B, C, and D are incorrect because they are all stages of the lytic cycle. Penetration refers to the injection of phage DNA into the host cell, adsorption is the attachment of the phage to the host cell, and lysis is the final stage where the host cell bursts, releasing new phages.