During physical examination, a patient experiences pain and resistance on extension of the knee while the hip is flexed This finding is positive for which of the following signs?

1. A

   Brudzinski's sign

2. B

   Babinski's sign

3. C

   Kernig's sign

4. D

   Romberg's sign

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

• Kernig's sign is a classic physical examination finding used to assess for meningeal irritation, a hallmark of meningitis.
• The test is performed by having the patient lie supine, then flexing their hip and knee to a 90-degree angle.
• A positive sign occurs when attempting to extend the knee causes pain in the hamstrings and resistance to the movement, which exactly matches the scenario described in the question.

Why Other Options Were Wrong

• Option A: Brudzinski's sign is tested by flexing the patient's neck, not by manipulating the leg. A positive sign is the involuntary flexion of the hips and knees in response to neck flexion.
• Option B: Babinski's sign involves stroking the sole of the foot to check for an upper motor neuron lesion. The maneuver and the clinical indication are completely different from what is described.
• Option D: Romberg's sign is a test of balance and proprioception, performed by having the patient stand with their eyes closed. It does not involve any leg manipulation in a supine position.

Related Visual

• Visual 1: Diagram - An illustration clearly showing the two steps of the Kernig's sign test: first, flexing the hip and knee, and second, attempting to extend the knee, with an indicator for pain.
• Visual 2: Diagram - An illustration of the Brudzinski's sign test, showing passive neck flexion leading to involuntary hip and knee flexion, to provide a clear contrast.
• Visual 3: Table - A summary table comparing the procedure, positive finding, and indication for Kernig's, Brudzinski's, Babinski's, and Romberg's signs.

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.
• Early recognition of signs of meningeal irritation, like Kernig's sign, is a critical nursing responsibility. It allows for the prompt suspicion of meningitis, which is a medical emergency.
• A positive Kernig's sign must be documented and reported to the healthcare provider immediately to facilitate timely diagnostic procedures, such as a lumbar puncture, and the initiation of life-saving antibiotic therapy.
• What if the patient was an infant younger than 18 months? In this population, Kernig's and Brudzinski's signs are often absent or unreliable. A nurse would need to rely on other signs of meningitis, such as a bulging fontanelle, high-pitched cry, irritability, poor feeding, or fever, to raise suspicion.

How to Approach the Question

• First, carefully read the question to break down the physical maneuver being described: the patient is supine, the hip is flexed, and then the knee is extended.
• Next, identify the patient's reaction to this maneuver: pain and resistance.
• Systematically review the four options provided and recall the procedure for each clinical sign.
• Compare the maneuver from the question to the definition of each sign. Brudzinski's involves the neck, Babinski's involves the sole of the foot, and Romberg's involves standing balance.
• Recognize that the description of flexing the hip and then encountering pain upon knee extension is the exact definition of a positive Kernig's sign.
• Select Kernig's sign as the correct answer because it is the only option that matches the described clinical finding.

Concept Tested & Keywords

• Concept Tested: Identification of neurological signs for meningeal irritation
• Stem keywords: physical examination, pain and resistance, extension of the knee, hip flexed
• Lead-in keywords: positive for which of the following signs
• Negative lead-in flag: false

Question ID

Q3rK7WWxq5D3-wKwt9Erim

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