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Physiology · Spinal reflexes: tetanus
Sample itemA farmer with a puncture wound of the foot develops trismus, risus sardonicus and painful generalised spasms triggered by noise. Which neural mechanism accounts for the spasms?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Blockade of glycine and GABA release from spinal inhibitory interneurons, with disinhibition of motor neurons
Tetanospasmin is carried by retrograde axonal transport to the spinal cord and brainstem, where it cleaves synaptobrevin in inhibitory interneurons. Release of glycine and GABA is blocked, so motor neurons fire unchecked and produce tonic spasm and exaggerated reflexes. Treatment includes human tetanus immunoglobulin, wound care, muscle relaxants and ventilatory support.
Option by option
A. Blockade of acetylcholine release at the neuromuscular junction
Blockade of acetylcholine release is the action of botulinum toxin and produces flaccid paralysis.
B. Destruction of anterior horn cells by viral infection
Anterior horn cell destruction by poliovirus causes flaccid paralysis without spasms.
C. Irreversible inactivation of acetylcholinesterase at the end plate
Cholinesterase inhibition by organophosphates causes fasciculations and cholinergic features, not trismus.
D. Blockade of glycine and GABA release from spinal inhibitory interneurons, with disinhibition of motor neurons (correct)
Loss of inhibitory transmitter release leaves motor neurons unrestrained, giving spasm.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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