Painful spasms of the hamstring muscle and resistance to further extension of the leg at the knee while flexing the hip of a recumbent patient is called?

1. A

   Kernig's Sign

2. B

   Brudzinski's Sign

3. C

   Opisthotonus

4. D

   Ankle Clonus

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

• Kernig's sign is defined by pain and resistance in the hamstrings when attempting to extend the knee while the hip is flexed at a 90-degree angle.
• This response is a reflex contraction of the hamstring muscles due to the stretching of inflamed or irritated meninges (the membranes covering the brain and spinal cord).
• The procedure described in the question and shown in the image is the exact method for eliciting Kernig's sign.
• It is a key diagnostic tool used in physical examinations to check for meningitis or subarachnoid hemorrhage.

Why Other Options Were Wrong

• Option B: Brudzinski's sign involves neck flexion, not leg manipulation. It tests for the same condition (meningeal irritation) but through a different maneuver.
• Option C: Opisthotonus is a state of severe, continuous muscle spasm causing the body to arch backward. It is a spontaneous posture, not a sign elicited by a specific test.
• Option D: Ankle clonus is a series of involuntary, rhythmic muscle contractions at the ankle, indicating an upper motor neuron lesion. It is tested by sharply dorsiflexing the foot.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of neurological signs for meningeal irritation to guide bedside assessment, documentation, and the next nursing action.
• A positive Kernig's sign is a red flag for meningitis or subarachnoid hemorrhage, requiring urgent lumbar puncture and further investigation.
• Nurses must be able to perform and recognize this sign to facilitate prompt diagnosis and treatment, which can be lifesaving.
• If a patient with suspected meningitis has a positive Kernig's sign, the nurse should immediately implement droplet precautions (for bacterial meningitis) to prevent transmission, even before the diagnosis is confirmed.

How to Approach the Question

• First, analyze the image to understand the clinical maneuver being performed. Observe the patient's position (supine) and the actions of the examiner (flexing the hip and knee, then extending the knee).
• Next, read the question stem carefully. It describes 'painful spasms of the hamstring' and 'resistance to further extension of the leg' during this specific maneuver.
• Connect the visual information from the image with the textual description in the stem. Both depict the same clinical test.
• Evaluate the options provided. Recall or look up the definitions of each neurological sign.
• Match the described maneuver and patient response to the correct term. The procedure is the classic test for Kernig's sign.
• Differentiate it from the other options. Brudzinski's involves the neck, Opisthotonus is a posture, and Ankle Clonus is a reflex test at the ankle.

Concept Tested & Keywords

• Concept Tested: Identification of neurological signs for meningeal irritation.
• Stem keywords: Painful spasms, hamstring muscle, resistance, extension of the leg, flexing the hip, recumbent patient
• Lead-in keywords: is called
• Clinical cues: The combination of hip flexion followed by attempted knee extension causing pain is the key procedural detail.

Question ID

QBuhA94Ghn3dWqexMdJyT-

Copy ID

Reference Book

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