In hydrocephalus, a cracked pot sound is heard when tapping the head. What is this sign called?

Appeared in: Haryana CHO - 2022

Explanation

Macewen's sign is the term for the 'cracked pot' sound heard upon percussion of an infant's skull.
This sign is indicative of separated cranial sutures, which is a direct result of increased intracranial pressure (ICP).
Hydrocephalus is a common cause of increased ICP in infants, leading to the accumulation of cerebrospinal fluid and expansion of the skull.
The sound is generated because the separated, unfused cranial bones resonate when tapped, similar to a cracked piece of pottery.

Option A: Chadwick's sign is related to obstetrics, not neurology. It is an early sign of pregnancy.
Option B: Homan's sign is used in the assessment of the peripheral vascular system, specifically to screen for Deep Vein Thrombosis (DVT).
Option C: Kernig's sign is a sign of meningeal irritation, which is characteristic of meningitis, not hydrocephalus itself.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of clinical signs in pediatric and neurological disorders as background academic context rather than a clinical decision trigger.
Early detection of increased intracranial pressure (ICP) in infants is a critical nursing responsibility to prevent irreversible brain damage and cognitive impairment.
Macewen's sign, along with a bulging fontanelle, rapid increase in head circumference, and the 'setting-sun' eye sign, are key indicators of hydrocephalus that require immediate reporting and intervention.
What if? If the patient were an adult with increased ICP, Macewen's sign would be absent because their cranial sutures are fused. Instead, a nurse would look for signs like severe headache, papilledema (swelling of the optic disc), vomiting, and altered level of consciousness.

How to Approach the Question

This is a factual recall question that tests knowledge of specific clinical signs.
First, break down the question stem to identify the key elements: the condition (hydrocephalus) and the specific finding ('cracked pot sound' on head percussion).
Next, review the four options, which are all named clinical signs.
Systematically recall or deduce the medical condition associated with each sign.
Chadwick's sign is related to pregnancy. Homan's sign is for DVT. Kernig's sign is for meningitis.
Macewen's sign is specifically associated with increased intracranial pressure and separated sutures, as seen in hydrocephalus.

Concept Tested & Keywords

Concept Tested: Assessment of clinical signs in pediatric and neurological disorders.
Stem keywords: hydrocephalus, cracked pot sound, tapping the head
Lead-in keywords: What is this sign called

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

Practise the full Haryana CHO - 2022

Attempt every question from this paper in a timed mock, then review the full solution for each one.