In a child with hydrocephalus the following signs are found?
a. Macewen sign
b. Kernig's sign
c. Sunset eyes
d. Increased head circumference

1. A

   A, C, and D only

2. B

   A, B, and C only

3. C

   A, B, C, and D

4. D

   B, C, and D only

Appeared in: MNS 2024

Explanation

• Macewen sign, also known as the 'cracked pot' sound, indicates separation of the cranial sutures due to increased intracranial pressure (ICP), a key feature of hydrocephalus in infants.
• Sunset eyes, or the 'setting-sun sign,' is a downward deviation of the eyes caused by pressure from the enlarged ventricles on the brainstem tectum, which controls upward gaze.
• Increased head circumference is a hallmark sign of hydrocephalus in infants because their cranial sutures are not yet fused, allowing the skull to expand in response to the accumulating cerebrospinal fluid (CSF).

Why Other Options Were Wrong

• Option B: This option is incorrect because it includes Kernig's sign (B). Kernig's sign is a classic indicator of meningeal irritation, primarily associated with meningitis, not a direct sign of hydrocephalus.
• Option C: This option incorrectly includes Kernig's sign (B). While signs A, C, and D are all characteristic of hydrocephalus, Kernig's sign points to a different pathology (meningeal irritation).
• Option D: This option is incorrect because it includes Kernig's sign (B) and omits Macewen sign (A), which is a valid sign of hydrocephalus caused by sutural separation.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of hydrocephalus in children as background academic context rather than a clinical decision trigger.
• Nurses play a crucial role in the early detection of hydrocephalus by performing serial measurements of head circumference and assessing for signs of increased ICP during routine check-ups.
• Early recognition and reporting of these signs are critical for timely neurosurgical intervention, such as the placement of a ventriculoperitoneal (VP) shunt, to prevent irreversible brain damage and developmental delays.
• Post-operatively, nurses must monitor for shunt malfunction or infection, with signs including a return of hydrocephalus symptoms (e.g., bulging fontanelle, vomiting, lethargy) or signs of infection (fever, redness along the shunt track).

How to Approach the Question

• First, identify the core concept of the question, which is recognizing the clinical signs of hydrocephalus in a child.
• Evaluate each listed sign (a, b, c, d) individually to determine its association with hydrocephalus.
• Recall that Macewen sign (a), sunset eyes (c), and increased head circumference (d) are all direct results of increased intracranial pressure on the developing skull and brain of an infant.
• Recognize that Kernig's sign (b) is a specific test for meningeal irritation, a hallmark of meningitis, not hydrocephalus itself.
• Eliminate all answer options that incorrectly include Kernig's sign (B).
• Select the option that contains only the correct signs associated with hydrocephalus, which is the combination of A, C, and D.

Concept Tested & Keywords

• Concept Tested: Clinical manifestations of hydrocephalus in children
• Stem keywords: hydrocephalus, child, signs
• Lead-in keywords: are found
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
• Negative lead-in flag: false

Question ID

QFfaRpmYv27cozm4TI4ngD

Copy ID

Reference Book

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

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 589-591