Positive Kernig's sign indicates?

AIIMS Delhi NO - 2017

Medical Surgical Nursing

Easy

Appeared in: AIIMS Delhi NO - 2017

Explanation

A positive Kernig's sign is a classic clinical finding that indicates meningism, or irritation of the meninges.
Meningitis, the inflammation of the meninges, is the most common cause of meningism.
The sign is elicited by flexing the hip and knee to 90 degrees and then attempting to extend the knee. Pain or resistance during this maneuver is due to the stretching of inflamed spinal nerve roots.
The provided image correctly illustrates the procedure for testing Kernig's sign (A) as a diagnostic tool for meningitis.

Option B: Guillain-Barré Syndrome (GBS) is a disorder of the peripheral nervous system, primarily causing ascending muscle weakness and areflexia. It does not typically present with signs of meningeal irritation like Kernig's sign.
Option C: Hydrocephalus is the accumulation of cerebrospinal fluid (CSF), leading to increased intracranial pressure. While it can be a complication of meningitis, its classic signs are headache, vomiting, and altered consciousness, not a positive Kernig's sign.
Option D: Rheumatic fever is an inflammatory condition that follows a streptococcal infection and primarily affects the heart, joints, skin, and brain (Sydenham's chorea). It does not cause meningeal irritation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of Meningeal Irritation Signs as background academic context rather than a clinical decision trigger.
Recognizing Kernig's sign and other signs of meningeal irritation is a critical nursing skill. Prompt identification can lead to early diagnosis and treatment of meningitis, which is a medical emergency.
A nurse observing a positive Kernig's sign must immediately report the finding to the physician and prepare for a potential lumbar puncture and initiation of antibiotic therapy.
What if the patient is an infant under 12 months? In this population, classic signs like Kernig's and Brudzinski's may be absent or unreliable. The nurse should be vigilant for other signs like fever, irritability, poor feeding, a bulging fontanelle, and lethargy.

How to Approach the Question

First, identify the key term in the question: 'Positive Kernig's sign'.
Recall the clinical significance of this sign. Access your knowledge of physical assessment findings.
Associate Kernig's sign with meningeal irritation. The pain on knee extension with a flexed hip is caused by stretching inflamed meninges.
Evaluate the options provided. 'Meningitis' is the direct inflammation of the meninges.
Rule out the other options by considering their primary pathophysiology. GBS involves peripheral nerves, hydrocephalus involves CSF volume, and rheumatic fever is a systemic inflammatory response to infection.
Conclude that meningitis is the condition most directly indicated by a positive Kernig's sign.

Concept Tested & Keywords

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