Kernig's sign | |
---|---|
Positive Kernig's sign in cerebrospinal meningitis | |
Differential diagnosis | subarachnoid hemorrhage or meningitis |
Kernig's sign is a test used in physical examination to look for evidence of irritation of the meninges. The test involves flexing the thighs at the hip, and the knees, at 90 degree angles, and assessing whether subsequent extension of the knee is painful (leading to resistance), in which case it is deemed positive. [1] This may indicate subarachnoid haemorrhage or meningitis. [2] Patients may also show opisthotonus—spasm of the whole body that leads to legs and head being bent back and body bowed forward. [3]
Karl et al. noted much of the literature on Kernig's sign is old and they could find no randomised trials of it. They also noted low sensitivity of 5% meaning absence of Kernig's sign does not rule out meningitis, specificity however is 95% so if positive then meningitis is very likely. Kernig's should not be relied on when meningitis is suspected and a lumbar puncture should be performed. [4]
The test is named after Woldemar Kernig (1840–1917), a Russian neurologist.
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. The person may experience respiratory and circulatory problems due to the body's inability to maintain normal bodily functions. People in a coma often require extensive medical care to maintain their health and prevent complications such as pneumonia or blood clots. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural causes, or can be medically induced.
Urethritis is the inflammation of the urethra. The most common symptoms include painful or difficult urination and urethral discharge. It is a commonly treatable condition usually caused by infection with bacteria. This bacterial infection is often sexually transmitted, but not in every instance; it can be idiopathic, for example. Some incidence of urethritis can appear asymptomatic as well.
The brachiocephalic artery, brachiocephalic trunk, or innominate artery is an artery of the mediastinum that supplies blood to the right arm, head, and neck.
Cyanosis is the change of body tissue color to a bluish-purple hue, as a result of decrease in the amount of oxygen bound to the hemoglobin in the red blood cells of the capillary bed. Cyanosis is apparent usually in the body tissues covered with thin skin, including the mucous membranes, lips, nail beds, and ear lobes. Some medications may cause discoloration such as medications containing amiodarone or silver. Furthermore, mongolian spots, large birthmarks, and the consumption of food products with blue or purple dyes can also result in the bluish skin tissue discoloration and may be mistaken for cyanosis. Appropriate physical examination and history taking is a crucial part to diagnose cyanosis. Management of cyanosis involves treating the main cause, as cyanosis isn’t a disease, it is a symptom.
The somatic nervous system (SNS) is made up of nerves that link the brain and spinal cord to voluntary or skeletal muscles that are under conscious control as well as to skin sensory receptors. Specialized nerve fiber ends called sensory receptors are responsible for detecting information within and outside of the body.
A cardiac stress test is a cardiological examination that evaluates the cardiovascular system's response to external stress within a controlled clinical setting. This stress response can be induced through physical exercise or intravenous pharmacological stimulation of heart rate.
Monoarthritis, or monoarticular arthritis, is inflammation (arthritis) of one joint at a time. It is usually caused by trauma, infection, or crystalline arthritis.
Meningism is a set of symptoms similar to those of meningitis but not caused by meningitis. Whereas meningitis is inflammation of the meninges, meningism is caused by nonmeningitic irritation of the meninges, usually associated with acute febrile illness, especially in children and adolescents. Meningism involves the triad of nuchal rigidity, photophobia and headache. It therefore requires differentiating from other CNS problems with similar symptoms, including meningitis and some types of intracranial hemorrhage. Related clinical signs include Kernig's sign and three signs all named Brudzinski's sign.
The Edinger–Westphal nucleus is one of two nuclei of the oculomotor nerve and is located in the midbrain. It receives afferents from both pretectal nuclei. It contains parasympathetic pre-ganglionic neuron cell bodies that synapse in the ciliary ganglion. It contributes the autonomic, parasympathetic component to the oculomotor nerve, ultimately providing innervation to the iris sphincter muscle and ciliary muscle to mediate the pupillary light reflex and accommodation, respectively.
A chignon is a temporary swelling caused by a build-up of bloody fluid left on an infant's head after they have been delivered by vacuum extraction. A vacuum extraction is a type of assistance used during vaginal delivery by an obstetrician or midwife when the second stage of labor, where the cervix is fully dilated allowing for fetus delivery, is stalled. It anatomically resembles regular caput succedaneum, one of two most frequently occurring birth injuries to the head, the other being cephalohematoma, a usually harmless condition where blood accumulates under the newborn's scalp after vaginal delivery.
Trendelenburg gait, named after Friedrich Trendelenburg, is an abnormal human gait. It is caused by weakness or ineffective action of the gluteus medius muscle and the gluteus minimus muscle.
End organ damage is severe impairment of major body organs due to high blood pressure or states of low blood pressure or low blood volume. This can present as a heart attack or heart failure, pulmonary edema, neurologic deficits including a stroke, or acute kidney failure.
The Spurling test is a medical maneuver used to assess nerve root pain. The patient rotates their head to the affected side and extends their neck, while the examiners applies downward pressure to the top of the patient's head. A positive Spurling's sign is when the pain arising in the neck radiates in the direction of the corresponding dermatome ipsilaterally. It is a type of cervical compression test.
Intraocular hemorrhage is bleeding inside the eye. Bleeding can occur from any structure of the eye where there is vasculature or blood flow, including the anterior chamber, vitreous cavity, retina, choroid, suprachoroidal space, or optic disc.
Obstructive shock is one of the four types of shock, caused by a physical obstruction in the flow of blood. Obstruction can occur at the level of the great vessels or the heart itself. Causes include pulmonary embolism, cardiac tamponade, and tension pneumothorax. These are all life-threatening. Symptoms may include shortness of breath, weakness, or altered mental status. Low blood pressure and tachycardia are often seen in shock. Other symptoms depend on the underlying cause.
Acquired C1 esterase inhibitor deficiency, also referred to as acquired angioedema (AAE), is a rare medical condition that presents as body swelling that can be life-threatening and manifests due to another underlying medical condition. The acquired form of this disease can occur from a deficiency or abnormal function of the enzyme C1 esterase inhibitor (C1-INH). This disease is also abbreviated in medical literature as C1INH-AAE. This form of angioedema is considered acquired due to its association with lymphatic malignancies, immune system disorders, or infections. Typically, acquired angioedema presents later in adulthood, in contrast to hereditary angioedema which usually presents from early childhood and with similar symptoms.
Streptococcal intertrigo is a skin condition that is secondary to a streptococcal bacterial infection. It is often seen in infants and young children and can be characterized by a fiery-red color of the skin, foul odor with an absence of satellite lesions, and skin softening in the neck, armpits or folds of the groin. Newborn children and infants commonly develop intertrigo because of physical features such as deep skin folds, short neck, and flexed posture. Prompt diagnosis by a medical professional and treatment with topical and/or oral antibiotics can effectively relieve symptoms.
The Thomas test is a physical examination test, named after the Welsh orthopaedic surgeon, Hugh Owen Thomas (1834–1891), to rule out hip flexion contracture and psoas syndrome.
Anorectal disorders include conditions involving the anorectal junction as seen in the image. They are painful but common conditions like hemorrhoids, tears, fistulas, or abscesses that affect the anal region. Most people experience some form of anorectal disorder during their lifetime. Primary care physicians can treat most of these disorders, however, high-risk individuals include those with HIV, roughly half of whom need surgery to remedy the disorders. Likelihood of malignancy should also be considered in high risk individuals. This is why it is important to perform a full history and physical exam on each patient. Because these disorders affect the rectum, people are often embarrassed or afraid to confer with a medical professional.
Spleen pain is a pain felt from the left upper quadrant of the abdomen or epigastrium where the human spleen is located or neighboring.