Twitching of facial muscles and spasm of arm muscles are seen in?

NIMHANS Nursing Officer - 2021

Medical & Surgical Nursing

Easy

Appeared in: NIMHANS Nursing Officer - 2021

Explanation

The question describes symptoms that are classic indicators of tetany.
The image visually confirms these signs: Chvostek's sign (facial twitching) and Trousseau's sign (carpopedal spasm).
Tetany is a state of neuromuscular hyperexcitability caused by hypocalcemia (low serum calcium levels).
Low calcium lowers the threshold for nerve and muscle excitation, leading to involuntary contractions, twitching, and spasms.

Option A: Hypercalcemia (high calcium) causes decreased neuromuscular excitability, leading to muscle weakness and lethargy, the opposite of the symptoms presented.
Option B: Rabies presents with generalized spasms, but its hallmark symptoms are hydrophobia, aerophobia, and signs of encephalitis, which are not mentioned.
Option D: Hypothyroidism is characterized by a slowing of metabolic processes. Its symptoms include fatigue, weight gain, cold intolerance, and bradycardia, not neuromuscular hyperexcitability.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of Tetany and Hypocalcemia as background academic context rather than a clinical decision trigger.
A nurse must be able to quickly recognize Chvostek's and Trousseau's signs as indicators of severe hypocalcemia, which is a medical emergency.
Immediate nursing interventions for a patient with tetany include ensuring a patent airway (as laryngospasm can occur), initiating seizure precautions, and preparing for the administration of IV calcium gluconate.
It is also crucial to check the patient's magnesium level, as hypomagnesemia can cause tetany that is resistant to calcium therapy and must be corrected concurrently.

How to Approach the Question

First, analyze the clinical signs presented in the question: 'twitching of facial muscles' and 'spasm of arm muscles'.
Examine the provided image, which gives strong visual cues. Identify the top image as Chvostek's sign and the bottom image as Trousseau's sign.
Recall or deduce that these two specific signs are pathognomonic (highly characteristic) for a particular condition.
Evaluate the options based on this knowledge. Tetany is the medical term for the symptom complex that includes these signs.
Rule out the other options by considering their typical presentations. Hypercalcemia causes opposite symptoms, while Rabies and Hypothyroidism have different and distinct clinical pictures.
Conclude that Tetany is the only option that directly corresponds to the described symptoms and the illustrated clinical signs.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of Tetany and Hypocalcemia
Stem keywords: twitching of facial muscles, spasm of arm muscles
Lead-in keywords: are seen in
Clinical cues: The combination of facial and arm muscle spasms points towards a systemic issue of neuromuscular hyperexcitability.
Negative lead-in flag: false

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