When the neck of the child is flexed passively, the flexion of the knee occurs; this represents?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019

Child Health Nursing (Pediatrics)

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019

Explanation

The sign described in the question is the classic presentation of Brudzinski's sign.
It is elicited by passively flexing the patient's neck forward while they are in a supine position.
A positive sign is the involuntary flexion of the patient's hips and knees, which occurs as a reflex to relieve the tension on the inflamed meninges.
This sign is a strong indicator of meningeal irritation, most commonly seen in meningitis.

Option A: Kernig's sign is tested differently. It involves flexing the patient's hip and knee to a 90-degree angle and then attempting to straighten the leg. A positive sign is resistance or pain on extension.
Option C: Stallworthy's sign is an obstetric sign. It refers to fetal bradycardia that occurs when the fetal head is pressed into the pelvis, suggesting posterior placental implantation (placenta previa). It is unrelated to neurological assessment.
Option D: The Lamba sign, also known as the 'twin peak sign,' is a finding on an ultrasound of a twin pregnancy. It indicates a dichorionic diamniotic gestation. It has no relevance to a neurological examination.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of meningeal irritation signs (Brudzinski's sign) as background academic context rather than a clinical decision trigger.
Prompt recognition of Brudzinski's and Kernig's signs is a critical nursing skill for the early suspicion of meningitis, which is a medical emergency requiring immediate intervention.
A nurse's assessment findings of these signs are crucial triggers for escalating care, leading to urgent diagnostic workups like a lumbar puncture and the initiation of empirical antibiotic therapy.
What if? If a patient has a fever and headache but both Brudzinski's and Kernig's signs are negative, meningitis cannot be completely ruled out. These signs can be absent, especially in infants and the elderly. The nurse must continue to monitor for other signs of neurological decline, such as altered mental status or seizures, and report all findings.

How to Approach the Question

First, carefully read the clinical scenario described in the question stem. Identify the specific action performed ('neck...flexed passively') and the patient's resulting reaction ('flexion of the knee occurs').
Recognize that this is a knowledge-based question asking you to identify a named clinical sign.
Access your memory of key physical assessment findings, particularly those related to neurological and infectious diseases.
Differentiate between the two primary signs of meningeal irritation: Brudzinski's sign and Kernig's sign. Remember that Brudzinski's involves the neck ('B' for brain/neck connection), while Kernig's involves the knee ('K' for knee).
Match the action-reaction pair from the question to the correct definition. Passive neck flexion causing knee/hip flexion is the definition of Brudzinski's sign.
Evaluate the other options to confirm your choice. Kernig's sign has a different procedure. Stallworthy's and Lamba signs are from different medical specialties (obstetrics) and are therefore incorrect.

Concept Tested & Keywords

Concept Tested: Identification of meningeal irritation signs (Brudzinski's sign)
Stem keywords: neck, flexed passively, flexion of the knee
Lead-in keywords: represents
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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

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