Munchkin Clowns - Rules of Play says:

Clowns bring joy and laughter to people everywhere with their happy antics. For many circus-goers, the clowns are the best part of the show. They've never met these clowns. Munchkin Clowns is a mini-expansion for Munchkin that invites you to wear your Big Red Shoes and Big Red Nose for big bonuses! Fight Poundfoolish with Pound Cake. If you fail, that's it...you're dead!