Which of the following findings may be seen in rabies?

PGIMER Sangrur NO - 2023

Medical & Surgical Nursing

Medium

Appeared in: PGIMER Sangrur NO - 2023

Explanation

Rabies virus infection of the brainstem causes the classic signs of hydrophobia (fear of water) and aerophobia (fear of air).
These signs are a direct result of involuntary, painful spasms of the pharyngeal (throat) and laryngeal (voice box) muscles upon attempts to swallow or other stimulation.
The encephalitic ('furious') form of rabies also causes generalized central nervous system hyperexcitability, agitation, and convulsions.
This widespread neurological dysfunction can lead to other involuntary muscle contractions, such as metacarpal spasms, sometimes due to hyperventilation-induced tetany during agitated states.
Because all the listed spasms are plausible clinical findings in rabies, the most complete answer is 'All of the above'.

Option A: This is a correct and classic finding in rabies, but it is an incomplete answer. Pharyngeal spasms and other generalized muscle contractions also occur.
Option B: This is a possible, though less specific, finding in rabies. Selecting this option alone ignores the more definitive and classic signs of pharyngeal and laryngeal spasms.
Option C: This is a correct and classic finding in rabies, but it is an incomplete answer. Laryngeal spasms and other generalized muscle contractions also occur.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical Manifestations of Encephalitic Rabies as background academic context rather than a clinical decision trigger.
Recognizing pharyngeal and laryngeal spasms as hydrophobia is critical for the early suspicion of rabies, especially in a patient with a potential animal exposure history.
Nursing care for a patient with symptomatic rabies is palliative and focuses on comfort. This includes minimizing all stimuli (e.g., keeping the room dark and quiet) to prevent triggering painful spasms.
Strict infection control measures, including contact and droplet precautions (full PPE), are mandatory when caring for a patient with rabies, as the virus is present in saliva and other body fluids.

How to Approach the Question

First, identify the core concept of the question, which is the clinical signs of the disease rabies.
Recall the hallmark symptoms associated with rabies. The most famous sign is 'hydrophobia' (fear of water).
Analyze the physiological basis of hydrophobia. It is caused by intensely painful muscle spasms in the throat when attempting to swallow. This directly links to 'Laryngeal spasm' and 'Pharyngeal Spasm'.
Evaluate the remaining option, 'Metacarpal spasm'. Consider the overall presentation of 'furious' rabies, which includes agitation, hyperactivity, and convulsions. This state of generalized CNS excitement can cause various involuntary muscle spasms, making metacarpal spasm a plausible finding.
Notice the 'All of the above' option. Since you have determined that laryngeal, pharyngeal, and metacarpal spasms are all possible findings, this option is the most comprehensive and correct choice.

Concept Tested & Keywords

QK7cUw0KenhJ3vjJbrBBb5

E6 Medicine Harrison 22e Part 1 p. 1693-1695

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 2088-2090