What are the signs and symptoms of tetanus?

Appeared in: UPRVUNL - 2021

Explanation

Tetanus is caused by a potent neurotoxin produced by the bacterium Clostridium tetani.
The toxin blocks inhibitory nerve signals in the spinal cord, leading to unopposed muscle contraction and rigidity.
The most common initial sign is trismus (lockjaw), which is a spasm of the jaw muscles, making chewing difficult.
This progresses to stiffness in the neck (stiff neck), difficulty swallowing (dysphagia), and spasms of the facial muscles, causing a characteristic grinning expression known as risus sardonicus.
In severe cases, powerful spasms of the back muscles cause the body to arch dramatically, a condition called opisthotonos.

Option A: This combination of symptoms, especially fever accompanied by a relatively low pulse rate (relative bradycardia), is a classic presentation of Typhoid fever, not tetanus.
Option B: These symptoms describe a chronic respiratory infection. Chronic cough, low-grade fever, and hemoptysis (coughing up blood) are hallmark signs of pulmonary Tuberculosis.
Option C: The key sign in this option is the 'strawberry tongue,' where the tongue is initially white-coated and then peels to a bright red, bumpy appearance. This is a pathognomonic sign of Scarlet Fever.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of Tetanus as background academic context rather than a clinical decision trigger.
Nurses must recognize early signs like trismus and dysphagia for prompt intervention, as airway compromise from laryngeal spasms is a life-threatening complication.
Management involves wound debridement, administering tetanus immune globulin (TIG) and antibiotics (like metronidazole), and controlling spasms with sedatives in a quiet, low-stimulus environment.
Tetanus is almost entirely preventable through vaccination. A key nursing role is educating patients on maintaining up-to-date immunizations, including booster shots every 10 years.

How to Approach the Question

First, identify the core concept of the question, which is to recognize the specific signs and symptoms of Tetanus.
Recall the fundamental pathophysiology of tetanus: it's a disease caused by a neurotoxin that leads to severe, unopposed muscle spasms and rigidity.
Systematically evaluate each option against this core knowledge.
Eliminate Option A by recognizing that fever with a low pulse points towards Typhoid fever.
Eliminate Option B by identifying the chronic respiratory symptoms as characteristic of Tuberculosis.
Eliminate Option C by associating the unique 'strawberry tongue' with Scarlet Fever.

Concept Tested & Keywords

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

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

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

Practise the full UPRVUNL - 2021

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