2. Ask the patient to fully extend his/her arms and dorsiflex
his/her wrists.
3. His/her fingers are held widely separated.
4. Holds In the same position for a few seconds.
5. Comment as asterlxis present or not.
Alternate Method for
elicitation of flapping tremor
Asterlxis can also be elicited in the legs, head and the
trunk.
Note the following
The patient is elaborately positioned because the flap is
best demonstrated in that position.
Asterlxis Is said to be present if the wrist and fingers Involuntarily
flex abruptly and irregularly: fhe patient compensates by extending the wrist
but the correction is only partial, tlcxion and partial extension occur alternately
so that In the end the wrist comes to a flexed position.
Asterixis occurs because of non-rhythmic, transient loss of
posture In the arms.
This sign is very important for those students who are preparing for USMLE and MRCP
Spider Naevus is a sign of liver cell failure.Sometime seen
in healthy Individuals also.
1. Ask the patient to adequately expose.
2. Examine the- face. neck, arms and chest above the nipples
3. Blanch the spider naevus using the head of a pin or a glass
slide.
4. Release pressure to look for flushing.
5. Comment as present or not.
If present, significant or not significant.
Note the following
Count the naevi above the level of the nipples i.e. in the
drainage area of the superior vena cava.
Less than 7 spider naevi are normal in young persons
More than 7 occur in liver cell failure pregnancy or in persons on oral contraceptive
Spider naevus occurs because of the dilatation of a central
arteriole (the body of the spider) which feeds the vessels radiating from it
(the legs of the spider). If a red naevus does not blanch, it is purpura.
Blanching occurs fully in erythema also and partially in telanglectasias.
These steps are very important for students preparing for USMLE and MRCP exams
1. Avoid offending an unduly modest patient, but this should
never prevent a complete examination.
2. In all the five positions, the patient should be symmetrically
positioned. Otherwise, apparent differences in the breast will result.
3. The nipple, areola and all four quadrants must be examined
In sequence in all the positions.
4. Examine in many positions to detect early changes
The pectoral muscles are relaxed in position (a) contracted in position (b) and stretched along
with the skin in position (c). The breasts are made pendulus In (d). A pillow
under the back in (e) makes the breast more prominent.
5. Since the breast is a frequent site of carcinoma, a general
examination is incomplete unless both the breasts have been Included.
These steps are very important for students preparing for USMLE and MRCP
1 Elicit history of Itching, numbness, course of the lession.
2. Inspect and note: site. size, shape, number, margins (ill
or well-defined).surface (flat or raised), pigmentation,scaling, central
clearing.
3. Examine for sensory loss and regional nerve thickening (if
relevant).
4. Comment on the possible diagnosis.
5. Do one specific test to confirm the diagnosis, e.g.
sensory loss in Hansen's patch.
Note
1. Patch refers to a flat lesion with a colour different
from the surrounding skin. It is large and > 2 cm in diameter. It is called
a macule, it is < 2 cm.
2.. Common causes of patch lesions are dermatophytosis. leprosy
and psoriasis.
Hypertrichosis is a condition where there is excessive
growth of hair in generalized or localized pattern but this is not of male
pattern of distribution.
Congenital hypertrichosis is seen in porphyria cutanea
tarda,
Hurler's syndrome,
Giant pigmented naevus also called as [bathing suit
naevus]
Acquired hypertrichosis is seen in the following conditions
Hypertelorism means the presence of wide spaced eyes. This is diagnosed when the inter inner canthal distance between the two eyes is more than half of the inter pupillary distance Causes of hypertelorism
Hypertelorism is a feature that can have many underlying etiology
This may be due to a mass pushing the two orbits apart
Ocular dipping is an abnormal eye movement consists of cycles of eye movements occurring spontaneously, that are characterized by a slow conjugated downward deviation followed after a delay by a quick return to mid position.
Periodic slow downward movements followed by fast Upward movement to the primary position Slow down-fast up
It is also called as inverse ocular bobbing Causes of ocular dipping
Ocular dipping is only described in unconscious patients, especially those in anoxic coma
Diffuse or multifocal encephalopathies
Diffuse structural brainstem damage.
Creutzfeldt-Jakob disease.
Spontaneous eye movements are useful clinical signs in coma, although they rarely have localizing value. The best-known exception to this rule is ocular bobbing,that is found in pontine lesions.
Once the kidney is palpable examine for the folllowing
Site
Size.
Shape (ovoid normally).
Consistency (resilient or firm in feel).
Margins (rounded).
Surface (normally smooth surface: irregular in polycystic kidney).
Tenderness.
Movement with respiration (normally kidney shows slight movement with respiration).
Whether bimanually palpable and ballottable.
Renal angle tenderness
In case of left sided renal lump—Examine for band of colonic resonance over the lump (by
Remember, a kidney lump is bimanually palpable and ballottable. The kidney is ballottable
Because it is a posterior abdominal organ.
It is heard in perisplenitis or perihepatitis due to microinfarction and inflammation.
Splenic rub is heard in the following conditions:
Chronic myeloid leukaemia
Method of elicitation
Keep a finger on the upper lip and a direct tap on the lips with the examiner's finger lightly over it.
Puckering and protrusion of the lips is seen.
pressure of the knuckle against the center of upper lip provokes con-traction of the orbicularis oris muscle
This is also seen in B/l UMN facial palsy and diffuse cerebral damage.
