Sustained pressure for 15 seconds is sufficient to elicit the sign. A positive test consists of an increase in the height of the jugular pulses of 3 cm or more. In order to demonstrate the test the patient needs to be positioned so that the jugular venous pulse can be seen and that there is at least a 3 cm distance between the pulse and the angle of the jaw. A probable Katz hand pattern has the classic distribution combined with palmar symptoms unless the symptoms are confined solely to the ulnar nerve distribution. Clinical breast examination combined with mammography reduces breast cancer mortality in women with annual examinations.
Fever is the most sensitive finding followed by a stiff neck.
Kernigs sign is performed with the patient supine and the hip flexed at 90 degrees. A positive sign consists of pain in the lower back or posterior thigh with extension of the knee in this position. A positive Brudzinskis sign consists of the patient spontaneously flexing the hips and knees when the neck is passively flexed in a supine position. A positive sign consists of worsening of a baseline headache. Both Kernigs and Brudzinskis signs appear to have a low sensitivity and high specificity, but they have not been well studies.