What are the signs and symptoms of tetanus?

Appeared in: UPRVUNL - 2021

Explanation

Tetanus is a disease caused by a neurotoxin (tetanospasmin) from Clostridium tetani that blocks inhibitory nerve signals, leading to unopposed muscle contraction and spasm.
The correct option accurately describes the classic neuromuscular manifestations of this process.
Stiff neck, difficulty chewing (trismus or lockjaw), and spasms of facial muscles (risus sardonicus) are hallmark early signs.
Severe, generalized spasms can cause the back to arch backward in a characteristic posture known as opisthotonus, which is described as 'bending of the back in the shape of a bow'.

Option A: These symptoms, particularly the combination of fever with a relatively low pulse (relative bradycardia or Faget's sign), are characteristic of Typhoid fever, not tetanus.
Option B: This cluster of symptoms—chronic cough, low-grade fever, chest pain, and coughing up blood (hemoptysis)—are the classic signs of pulmonary tuberculosis (TB).
Option C: The presence of a 'red strawberry tongue' is a pathognomonic sign of Scarlet Fever, an infection caused by Group A Streptococcus.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical presentation of Tetanus as background academic context rather than a clinical decision trigger.
The primary nursing priority in a patient with tetanus is maintaining a patent airway, as laryngeal spasms can be sudden and fatal.
Nurses play a crucial role in preventing tetanus through patient education on wound care and ensuring adherence to the tetanus vaccination schedule (boosters every 10 years).
What if? If a patient presents with a deep, contaminated wound but is asymptomatic, the priority is not to wait for symptoms but to provide post-exposure prophylaxis, which includes wound debridement, a tetanus toxoid booster, and possibly Tetanus Immune Globulin (TIG) based on their vaccination history.

How to Approach the Question

First, identify the core concept of the question, which is the clinical presentation of a specific disease: Tetanus.
Recall the fundamental pathophysiology of tetanus. It is caused by a neurotoxin that results in severe, uncontrolled muscle spasms.
Evaluate each option based on this core knowledge. Look for descriptions of muscle rigidity and spasms.
Option A (low pulse with fever), Option B (respiratory symptoms), and Option C (strawberry tongue) describe signs of other distinct infectious diseases.
Recognize that Option D's description of stiff neck, lockjaw, arched back, and facial spasms directly corresponds to the classic neuromuscular symptoms of tetanus (trismus, opisthotonus, and risus sardonicus).

Concept Tested & Keywords

QDy8ukS2a5AymRHrrLYint

E6 Medicine Davidson Principles Practice 24e p. 1146-1148

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1826-1828

E6 Medicine Harrison 22e Part 1 p. 1272-1274

Practise the full UPRVUNL - 2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.