Which sign of meningeal irritation occurs in a child diagnosed with bacterial meningitis?

HPSSC - 2015

Child Health Nursing (Pediatrics)

Medium

Appeared in: HPSSC - 2015

Explanation

Meningitis causes inflammation of the meninges, leading to increased intracranial pressure (ICP) and neurological sensitivity.
In children, especially infants, this manifests as marked or extreme irritability, a high-pitched cry, and sensitivity to being touched or moved.
This is a classic early sign, often preceding more specific signs like nuchal rigidity, which may be absent in very young children.

Option A: This is a sign of increased intracranial pressure (ICP), which can occur in meningitis, but it's not a direct sign of meningeal irritation itself and is less specific.
Option B: A depressed fontanel is a classic sign of dehydration. Meningitis typically causes a bulging fontanel due to increased ICP.
Option D: This is related to the molding of the infant's skull during birth or can be a sign of craniosynostosis. It is not associated with meningitis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of bacterial meningitis in children as background academic context rather than a clinical decision trigger.
Early recognition of irritability as a sign of meningitis is critical for prompt diagnosis and treatment, which can prevent severe neurological damage or death.
A nurse's initial assessment of a febrile, irritable infant must always include meningitis as a differential diagnosis, triggering escalation and preparation for a lumbar puncture.
What if?: If the child presented with a depressed fontanel and poor skin turgor instead of irritability, the priority would shift from suspected meningitis to managing dehydration with fluid resuscitation.

How to Approach the Question

Identify the core of the question: It asks for a sign of 'meningeal irritation' in a child with 'bacterial meningitis'.
Recall the pathophysiology of meningitis: It's an infection and inflammation of the brain's protective layers (meninges), which increases intracranial pressure (ICP) and irritates the nervous system.
Evaluate each option in the context of meningitis and increased ICP.
Analyze Option A (Prominent scalp vein): This can be from high ICP, but is it a primary sign of irritation? It's more of a secondary pressure sign.
Analyze Option B (Depressed fontanel): This indicates low fluid volume (dehydration). Meningitis causes high pressure, which would lead to a bulging fontanel. This is the opposite of what's expected.
Analyze Option C (Marked irritability): Inflammation of the meninges makes the nervous system highly sensitive. Light, sound, and touch are painful, leading to extreme irritability. This is a classic and direct sign.

Concept Tested & Keywords

Concept Tested: Clinical signs of bacterial meningitis in children
Stem keywords: meningeal irritation, child, bacterial meningitis
Lead-in keywords: Which sign
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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