Watch the video version of this episode on YouTube - https://youtu.be/oVobgOqAKiA

A physical therapist working in a high school setting has an athlete come into the treatment room complaining of a headache, fever, and a painful neck. The therapist positions the athlete in supine and flexes the hip to 90 degrees. When the therapist attempts to extend the knee in this position, the patient complains of significant pain. Which finding is MOST consistent with this scenario? 

1. Positive Kernig’s sign
2. Negative Kernig’s sign
3. Positive Brudzinski’s sign
4. Negative Brudzinski’s sign

Transcript

Welcome back to the Scorebuilders’ Q and A Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist working in a high school setting has an athlete come into the treatment room complaining of a headache, fever, and a painful neck. The therapist positions the athlete in supine and flexes the hip to 90 degrees. When the therapist attempts to extend the knee in this position, the patient complains of significant pain. Which finding is MOST consistent with this scenario? 

1. Positive Kernig’s sign
2. Negative Kernig’s sign
3. Positive Brudzinski’s sign
4. Negative Brudzinski’s sign

The athlete is presenting with signs and symptoms of meningitis, which can be fatal if not diagnosed immediately.

Let’s explore meningitis as a medical condition.

Meningitis
Meningitis refers to the inflammation of the meninges of the brain and spinal cord and can occur through viral or bacterial forms.

Diagnosing Meningitis

• Lumbar puncture
• Blood tests
• Kernig's and Brudzinski's sign

Diagnosing Meningitis
A lumbar puncture (spinal tap) is the most definitive test for diagnosing meningitis since it allows for the analysis of cerebrospinal fluid. Blood tests can also be useful to identify the presence of infection and differentiate between bacterial and viral meningitis. Physical examination procedures such as Kernig's and Brudzinski's signs can be used to assess for meningeal irritation.

Let’s explore each of the options

Option 1 - Positive Kernig’s sign

Kernig’s sign
A positive Kernig’s sign is characterized by pain that is present when a patient is positioned in supine and cannot tolerate a combination of passive hip flexion and knee extension. This description is consistent with the information presented in the question. The pain results from inflammation of the meninges within the spinal cord. Kernig’s sign is a common screening tool used when meningitis is suspected. 

Option 2 - Negative Kernig’s sign

Kernig’s sign
A negative Kernig’s sign is characterized by the absence of pain when positioned in supine with a combination of passive hip flexion and knee extension. Regardless of the presence or absence of Kernig’s sign, the therapist should contact the physician given the patient’s current clinical presentation.

Option 3 - Positive Brudzinski’s sign

Brudzinski’s sign
A positive Brudzinski’s sign occurs when a patient placed in supine experiences pain with passive flexion of the neck. Passive neck flexion will also produce hip and knee flexion since the patient attempts to decrease neural tension caused by the progression of inflammation within the meninges. Brudzinski’s sign is a common screening tool used when meningitis is suspected.

Option 4 - Negative Brudzinski’s sign

Brudzinski’s sign
A negative Brudzinski’s sign occurs when a patient does not feel any pain or does not exhibit hip and knee flexion with passive flexion of the neck while positioned in supine. Regardless of the presence or absence of Brudzinski’s sign, the therapist should contact the physician given the patient’s current clinical presentation.

The correct answer is Option 1

Let’s explore the all student data:

58% of students selected Option 1, Positive Kernig’s sign - the correct response
2% of students selected Option 2, Negative Kernig’s sign
38% of students selected Option 3, Positive Brudzinski’s sign
2% of students selected Option 4, Negative Brudzinski’s sign

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!