Macewen's sign is found in which disease?

Appeared in: UPPSC-2021

Explanation

Macewen's sign, also known as the 'cracked pot' sound, is a classic clinical sign of hydrocephalus.
It is produced by percussing the skull and indicates separated cranial sutures.
The separation of sutures is caused by increased intracranial pressure (ICP) from the accumulation of cerebrospinal fluid (CSF) within the brain's ventricles.
This sign is most evident in infants and young children whose cranial sutures have not yet fused.

Option B: Meningitis is characterized by signs of meningeal irritation, not separated sutures. The classic signs are Kernig's and Brudzinski's signs, along with nuchal rigidity (stiff neck).
Option C: Appendicitis is an abdominal condition. Its signs, like McBurney's point tenderness, are related to inflammation in the abdomen and have no connection to neurological or cranial findings.
Option D: Cerebral palsy is a non-progressive motor disorder affecting muscle tone, posture, and movement. It does not cause the acute increase in intracranial pressure that leads to Macewen's sign.

Clinical Relevance

Nursing practice connection: Knowing Clinical signs of pediatric neurological disorders helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility in infant care is the regular and accurate measurement of head circumference. A rapid increase is a critical indicator of developing hydrocephalus and must be reported promptly.
Nurses should also assess for other signs of increased ICP in infants, including a tense or bulging fontanelle, irritability, high-pitched cry, poor feeding, and the 'setting-sun' appearance of the eyes.
What if? If a 6-year-old child, whose cranial sutures are fused, presents with signs of increased ICP (like headache and vomiting), Macewen's sign would be absent. Instead, the nurse would look for other signs like papilledema (swelling of the optic disc).

How to Approach the Question

First, identify the key term in the question stem, which is 'Macewen's sign'.
Recognize this as a specific clinical sign that requires factual recall of its associated condition.
Systematically evaluate each option. Think about the primary clinical presentation of each disease.
Recall or deduce that hydrocephalus involves increased fluid and pressure in the head, which could affect the skull bones.
Contrast this with meningitis (inflammation signs), appendicitis (abdominal signs), and cerebral palsy (motor disorder signs) to confirm the correct association.

Concept Tested & Keywords

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

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