Cracked pot sound elicited while skull percussion indicative of increased intracranial tension is known as?

JODHPUR AIIMS SNO-2018

Medical Surgical Nursing

Easy

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Macewen's sign is the specific term for the 'cracked pot' sound produced by percussing the skull.
This sound indicates increased intracranial pressure (ICP), which has caused the separation of cranial sutures.
It is most commonly observed in infants and young children with conditions like hydrocephalus, as their cranial sutures are not yet fully fused.
The separated sutures allow the skull bones to resonate upon percussion, similar to a cracked pot.

Option A: Homans' sign is related to the circulatory system in the lower extremities, not the neurological system or the head.
Option B: Romberg sign assesses balance and proprioception, which involves the sensory pathways of the spinal cord and cerebellum, not intracranial pressure.
Option C: Peroneal sign indicates neuromuscular hyperexcitability (tetany), usually due to an electrolyte imbalance like hypocalcemia. It is elicited on the leg, not the head.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of increased intracranial pressure as background academic context rather than a clinical decision trigger.
In pediatric nursing, routine head circumference measurement and assessment for signs like Macewen's, a bulging fontanelle, and sunsetting eyes are critical for early detection of hydrocephalus or other causes of increased ICP.
A positive Macewen's sign is a red flag that requires immediate reporting to the physician and preparation for diagnostic imaging like a cranial ultrasound or CT scan.
What if? If the patient were an adult, a 'cracked pot' sound on percussion would be an extremely rare and ominous finding, as adult sutures are fused. In an adult, signs of increased ICP include headache, vomiting, papilledema (swelling of the optic disc), and changes in consciousness.

How to Approach the Question

First, identify the key phrases in the question: 'cracked pot sound', 'skull percussion', and 'increased intracranial tension'.
Recognize that the question is asking for the specific name of a clinical sign that links these three elements.
Evaluate each option based on your knowledge of common medical signs.
Eliminate options that are clearly unrelated to the head or intracranial pressure. Homans' sign (leg/DVT) and Peroneal sign (leg/tetany) can be quickly ruled out.
Differentiate between the remaining neurological signs. Romberg sign tests balance/proprioception, not ICP.
Conclude that Macewen's sign is the correct term that specifically describes the auditory finding on skull percussion related to increased ICP.

Concept Tested & Keywords

Concept Tested: Clinical signs of increased intracranial pressure
Stem keywords: Cracked pot sound, skull percussion, increased intracranial tension
Lead-in keywords: known as
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1386-1388