Pain in the lower back and resistance to straighten the leg at the knee in meningeal irritation is suggestive of positive?

Appeared in: NVS Staff Nurse - 2019

Explanation

The question describes the exact maneuver used to elicit Kernig's sign, a critical indicator of meningeal irritation.
The pathophysiology involves stretching the inflamed meninges and spinal nerve roots when the leg is extended, which causes pain and a protective hamstring muscle spasm.
This sign is commonly associated with conditions that cause inflammation of the meninges, such as bacterial or viral meningitis and subarachnoid hemorrhage.
The image provided visually demonstrates the correct procedure for testing for Kernig's sign.

Option B: Chvostek's sign is unrelated to meningeal irritation. It tests for neuromuscular excitability caused by low calcium levels.
Option C: Asterixis is a motor disorder, not a sign of meningeal irritation. It is a characteristic "flapping tremor" of the hands.
Option D: Although Brudzinski's sign also indicates meningeal irritation, it is elicited by a different maneuver (passive neck flexion). The question specifically describes the leg extension maneuver of Kernig's sign.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of meningeal irritation as background academic context rather than a clinical decision trigger.
A positive Kernig's or Brudzinski's sign is a red flag for meningitis, a medical emergency. The nurse must act quickly to report the finding and initiate appropriate protocols.
Priority nursing interventions for suspected meningitis include placing the patient on droplet precautions, performing frequent neurological assessments (Glasgow Coma Scale, pupillary response), establishing IV access, and preparing for a lumbar puncture (spinal tap).
What if? If the patient is an infant under 18 months old, classic signs like Kernig's and Brudzinski's are often absent. The nurse should instead assess for a bulging fontanelle, a high-pitched cry, irritability, and poor feeding as more reliable indicators of meningitis in this age group.

How to Approach the Question

First, carefully read the description of the clinical maneuver in the question stem: a patient's hip and knee are flexed, and then the leg is straightened at the knee.
Next, identify the patient's response to this maneuver: pain and resistance.
Recall the definitions of the four named signs provided in the options.
Match the described maneuver and patient response to the correct definition. The procedure described is the test for Kernig's sign.
Differentiate this from the other signs. Brudzinski's involves neck flexion, Chvostek's involves tapping the facial nerve, and Asterixis is a hand tremor. This confirms Kernig's sign is the only match.

Concept Tested & Keywords

Concept Tested: Clinical signs of meningeal irritation
Stem keywords: pain in the lower back, resistance to straighten the leg, meningeal irritation
Lead-in keywords: suggestive of positive

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1568-1570

Practise the full NVS Staff Nurse - 2019

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