A nurse posted in the pediatric ward observed a cracked pot sound on percussion of the skull in a newborn baby with hydrocephalus. The nurse recorded this sign as:

1. A

   Macewen's sign

2. B

   Brudzinski's sign

3. C

   Flag sign

4. D

   Kernig's sign

Appeared in: PGICH Noida NO-2025

Explanation

• Macewen's sign is the specific medical term for the 'cracked pot' sound elicited by percussing the skull.
• This sound is a direct result of the separation of cranial sutures in an infant's skull.
• Suture separation is caused by persistently increased intracranial pressure (ICP), a hallmark of conditions like hydrocephalus.
• The presence of this sign in a newborn with hydrocephalus is a classic and expected clinical finding.

Why Other Options Were Wrong

• Option B: Brudzinski's sign is a test for meningeal irritation, not increased ICP from hydrocephalus. It involves flexing the patient's neck and observing for involuntary flexion of the hips and knees.
• Option C: Flag sign is a nutritional indicator, not a neurological sign. It refers to alternating bands of depigmented and normal-colored hair, seen in children with severe protein malnutrition (Kwashiorkor).
• Option D: Kernig's sign, like Brudzinski's sign, is a test for meningeal irritation. It is positive if there is pain or resistance when attempting to extend a knee after the hip has been flexed to 90 degrees.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Clinical signs of hydrocephalus in infants helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Recognizing Macewen's sign is a critical nursing skill in pediatrics, as it provides a non-invasive clue to potentially life-threatening increased intracranial pressure.
• Early identification of signs like Macewen's, a bulging fontanelle, and rapidly increasing head circumference allows for prompt intervention (e.g., neurosurgical consultation for shunting) to prevent brain damage.
• What if? If the patient were a 10-year-old instead of a newborn, Macewen's sign would be absent because the cranial sutures are fused. In an older child, signs of increased ICP would include headache, vomiting, and papilledema, as the skull is a rigid box.

How to Approach the Question

• First, identify the key clinical finding described in the question stem: a 'cracked pot sound' on skull percussion.
• Next, note the patient's condition: a newborn with hydrocephalus. This context is crucial.
• Connect the finding to the condition. Hydrocephalus causes increased intracranial pressure, which in an infant leads to the separation of cranial sutures.
• Review the options and recall or deduce the correct medical term for this specific sign.
• Eliminate the options related to other conditions. Brudzinski's and Kernig's signs are for meningitis, and Flag sign is for malnutrition.

Concept Tested & Keywords

• Concept Tested: Clinical signs of hydrocephalus in infants
• Stem keywords: pediatric ward, newborn, hydrocephalus, cracked pot sound, percussion of the skull
• Lead-in keywords: recorded this sign as
• Clinical cues: The combination of 'newborn', 'hydrocephalus', and 'cracked pot sound' points directly to a specific sign of increased intracranial pressure in infants.

Question ID

QO_ltr76Cr-eA54hp1iGdv

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1386-1388, 1568-1570