IM 2

Question 1

What are devitalized wounds characterized by?

Answer 1

Low oxygen tension

Devitalized wounds are typically associated with anaerobic infections, such as those caused by Clostridium tetani.

Question 2

What is the incubation period for tetanus?

Answer 2

4-14 days between inoculation and trismus

Trismus is the first symptom of tetanus, commonly known as lockjaw.

Question 3

What binds to the presynaptic membrane at the NM junction in tetanus?

Answer 3

Tetanus neurotoxin

The neurotoxin is internalized and transported to the central nervous system.

Question 4

What does tetanus neurotoxin prevent?

Answer 4

Membrane fusion of small synaptic vesicles

This inhibition blocks neurotransmitter release, leading to muscle spasms.

Question 5

What are the two toxins produced by Clostridium tetani?

Answer 5

• Tetanolysin
• Tetanospasm

Tetanolysin is a hemolysin that prepares the site for infection, while tetanospasm is the pathogenic neurotoxin.

Question 6

What type of bacterium is Clostridium tetani?

Answer 6

Rod-shaped, Gram-positive, non-motile, obligate anaerobe

Clostridium tetani exists in both spore and vegetative forms.

Question 7

What are common risk factors for tetanus?

Answer 7

• Ignorance
• Soil related occupations
• Low socio-economic status
• Poor umbilical cord handling in neonates
• Low immunization coverage
• Religion and culture

These factors contribute to higher incidence rates of tetanus.

Question 8

List some differential diagnoses for tetanus.

Answer 8

• Strychnine poisoning
• Neuroleptic malignant syndrome
• Tardive dyskinesia
• Odontogenic infection

These conditions may present with similar symptoms.

Question 9

What are some complications associated with tetanus?

Answer 9

• Cardiac arrhythmia
• Laryngospasm
• Aspiration pneumonia
• Atelectasis
• Hypoglycemia
• Hyperpyrexia
• DVT
• P.E.

These complications can arise due to severe muscle spasms and autonomic dysfunction.

Question 10

What are common causes of death in tetanus cases?

Answer 10

• Respiratory failure
• Hypoxia
• Aspiration
• Cardiac arrest/exhaustion/dysrhythmia/extremes of BP

These are critical outcomes of severe tetanus infection.

Question 11

What are poor prognostic factors in tetanus?

Answer 11

• Short incubation period
• Short period of onset
• Delay in treatment
• Extremes of ages
• Superimposed infection

These factors can lead to worse outcomes in tetanus patients.

Question 12

What is the vaccination schedule for tetanus prevention?

Answer 12

Vaccination (TT) at 6, 10, 14 weeks of life

The CDC recommends boosters every ten years.

Question 13

What are the clinical features of tetanus?

Answer 13

• Spasms
• Trismus
• Risus sardonicus
• Opisthotonus
• Asphyxia
• Dysphagia
• Urinary retention

These symptoms reflect the effects of muscle spasms and autonomic dysfunction.

Question 14

What are the principles of management for tetanus?

Answer 14

• Stop toxin production
• Prevent binding of released toxin
• Control effects of bonded toxins
• General support/nutrition
• Prevent and rehabilitate

These principles guide the treatment of tetanus.

Question 15

According to the latest WHO data, what percentage of total deaths in Nigeria were attributed to tetanus?

Answer 15

0.56%

This statistic highlights the severity of tetanus as a public health issue.

Question 16

What demographic is most affected by tetanus?

Answer 16

Common among neonates, peasant farmers, woodworkers

Tetanus is especially prevalent in low-resource nations.

Question 17

What is the mortality rate for tetanus?

Answer 17

20-45%

Mortality rates can vary based on access to medical care and treatment.

Question 18

What is a notable characteristic of tetanus spasms?

Answer 18

Spasms commonly commence from the jaw and progress

Spasms can be strong enough to cause bone fractures.

Question 19

What neurotransmitters are blocked by the tetanus toxin?

Answer 19

• GABA
• Glycine

These neurotransmitters are crucial for muscle relaxation and inhibition of motor neuron firing.