SGPGI Nursing Officer-2023
Medical & Surgical Nursing
Medium
Identify the disease sign which denotes in the following image? 
Appeared in: SGPGI Nursing Officer-2023
Explanation
- The image clearly depicts carpal spasm (flexion of the wrist and adduction of the thumb) induced by the inflation of a blood pressure cuff.
- This specific clinical finding is the definition of a positive Trousseau's sign.
- Trousseau's sign is a classic indicator of latent tetany caused by hypocalcemia (a serum calcium level below 8.6 mg/dL).
- The ischemia from the cuff increases the excitability of the ulnar nerve, triggering the spasm in susceptible individuals.
Why Other Options Were Wrong
- Option B: Chvostek's sign involves the facial muscles, not the hand. It is elicited by tapping the facial nerve, not by using a blood pressure cuff.
- Option C: Rose sign, also known as rose spots, refers to a faint pink or salmon-colored skin rash, typically seen on the trunk in diseases like typhoid fever. It is not a neuromuscular sign.
- Option D: There is no universally recognized 'DVT sign.' The most commonly associated (though unreliable) sign for Deep Vein Thrombosis (DVT) is Homans' sign, which involves calf pain upon dorsiflexion of the foot. This is completely unrelated to the hand spasm shown.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Identification of clinical signs associated with electrolyte imbalances, specifically hypocalcemia to guide bedside assessment, documentation, and the next nursing action.
- Recognizing Trousseau's sign is a critical nursing skill for the early detection of hypocalcemia, which can lead to life-threatening complications like laryngospasm and seizures if untreated.
- Nurses should be particularly vigilant for this sign in at-risk patients, such as those who have had thyroid or parathyroid surgery, patients with pancreatitis, or those with chronic kidney disease.
- If a positive Trousseau's sign is observed, the nurse's priority is to ensure patient safety (e.g., seizure precautions), notify the provider immediately, and prepare for the potential administration of IV calcium gluconate.
How to Approach the Question
- First, carefully analyze the image to identify the key components and actions. Observe the presence of a blood pressure cuff on the upper arm and the specific posture of the hand (flexed wrist, adducted thumb).
- Recognize this specific hand posture as carpal spasm.
- Connect the stimulus (inflated BP cuff) with the response (carpal spasm).
- Review the definitions of the clinical signs provided in the options.
- Match your observation from the image to the correct definition. Trousseau's sign is defined as carpal spasm induced by ischemia from a BP cuff.
- Eliminate the other options by recalling their definitions: Chvostek's sign (facial twitch), Rose sign (skin rash), and DVT signs (leg-related).
Concept Tested & Keywords
- Concept Tested: Identification of clinical signs associated with electrolyte imbalances, specifically hypocalcemia.
- Stem keywords: disease sign, image
- Lead-in keywords: Identify
- Clinical cues: The image shows a blood pressure cuff and a resulting hand spasm, which is a key diagnostic clue.
Question ID
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Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 30-32
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 154-156
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1096-1098
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