Signs of meningeal irritation include all the following, EXCEPT?

Appeared in: KPSC Staff Nurse - 2016

Explanation

Kehr's sign is the correct answer as it is not a sign of meningeal irritation.
It is defined as acute pain referred to the left shoulder, indicating irritation of the diaphragm.
This sign is classically associated with a ruptured spleen, where blood accumulates under the diaphragm.
The phrenic nerve, which innervates the diaphragm, shares the same cervical nerve roots (C3-C5) as the supraclavicular nerves that supply sensation to the shoulder area, causing this referred pain.

Option A: Neck stiffness, or nuchal rigidity, is a hallmark sign of meningeal irritation. It is caused by inflammation of the meninges, leading to spasms of the neck muscles.
Option B: Brudzinski's sign is a classic and specific indicator of meningeal irritation. The maneuver and its positive result are directly related to meningeal inflammation.
Option C: Kernig's sign is another cardinal sign of meningeal irritation. The pain on knee extension with a flexed hip is due to stretching the inflamed meninges and nerve roots.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment for signs of meningeal irritation as background academic context rather than a clinical decision trigger.
Recognizing the signs of meningeal irritation is a critical nursing skill for the early detection of life-threatening conditions like bacterial meningitis and subarachnoid hemorrhage.
Prompt identification allows for immediate initiation of diagnostic procedures (like lumbar puncture) and empirical antibiotic therapy, which significantly improves patient outcomes.
What if? If the patient is an infant under 12-18 months, classic signs like Kernig's and Brudzinski's may be absent. A nurse must instead assess for a bulging fontanelle, high-pitched cry, irritability, lethargy, and poor feeding as primary indicators of meningitis.

How to Approach the Question

First, read the question carefully and note the keyword 'EXCEPT'. This means you are looking for the option that does not belong with the others.
Identify the common theme among the options. The question stem mentions 'meningeal irritation'.
Analyze each option to see if it fits the theme. 'Neck stiffness', 'Brudzinski's sign', and 'Kernig's sign' are all well-known signs of meningeal irritation.
The option that does not fit the theme is 'Kehr's sign'.
Recall or deduce the meaning of the outlier option. Kehr's sign is related to abdominal trauma (specifically splenic rupture) and referred shoulder pain.
Therefore, Kehr's sign is the correct answer because it is the exception.

Concept Tested & Keywords

QyHhlrCJlbT3hmZ_j6WbPp

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

E6 Medicine Harrison 22e Part 1 p. 1161-1163

Practise the full KPSC Staff Nurse - 2016

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