A site for medical students - Practical,Theory,Osce Notes

Ocular myoclonus clinical significance

Rapid involuntary conjugate saccadic movement of eyes
It is described as rapid, involuntary, multivectorial (horizontal and vertical), unpredictable, conjugate fast eye movements without intersaccadic [quick rotation of the eyes] intervals)
Ocular myoclonus associations
  • Opsoclonus Myoclonus Syndrome (OMS) is also called as Opsoclonus-Myoclonus-Ataxia (OMA), is a rare neurological disorder  which appears to be the result of an autoimmune process involving the nervous system
  • Seen in Postencephalitic syndrome 
  • Neuroblastoma
  • It may be seen associated with  viral infection ,perhaps St. Louis encephalitis, Epstein-Barr, Coxsackie B, enterovirus, or just a flu
  • OPM-palatal myoclonus when associated with abnormal eye movements,it is called "oculopalatal myoclonus", or OPM.   A clicking sound is commonly heard in this symptom

Ocular dipping

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.

What is Dyspepsia?

Dyspepsia is a term to denote a variety of alimentary symptoms arising form upper gastrointestinal tract.
Symptoms  includes 
  • Upper abdominal pain ± related to food
  • Heart burn, regurgitation, water brash
  • Anorexia, nausea, vomiting
  • Early repletion and satiety after meals
  • Flatulence, belching and bloating.
Causes of dyspepsia
Organic dyspepsia
Functional dyspepsia
Organic causes of dyspepsia
  • Peptic oesophagitis
  • Peptic ulcer
  • Upper GI malignancy
  • Hepatobiliary disease
  • C/c pancreatitis
  • Other system disorders - CRF, CHF etc.
  • Drugs - NSAID, corticosteroids
  • Alcoholism, pregnancy
Functional dyspepsia [nonulcer dyspepsiaI
It is due to motor dysfunction of upper gastrointestinal tract mediated by neurohumoral mechanism
What are the Alarm features in Dyspepsia
  • Weight loss
  • Anemia
  • Vomiting
  • Hematemesis
  • Melaena
  • Dysphagia
  • Palpable abdominal mass.

Importance of past history in GIT

Past history is very important in gastrointestinal system

  • History of Jaundice indicate viral hepatitis
  • Drug intake - history of drug intake such as rifampicin. INH. anabolic steroids pills are risk factors for jaundice .NSAID intake for melena  or history of any herbal remedies
  • Blood transfusion or transfusion of any blood products (viral hepatitis C. D and G).
  • Recent tattooing or acupuncture: Drug rule out viral hepatitis
  • Alcohol consumption predispose to cirrhosis
  • Tuberculosis can cause ascites due to tuberculous peritonitis.
  • Haematemesis or melena (peptic ulcer, ruptured oesophageal varices, gastric malignancy)-
  • Fever seen in tuberculosis, hepatocellular failure
  • Haematochczia occur due to lower G. 1. malignancy. haemorrhoid

Points to note in a renal lump :

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.

How to elicit Tenderness over the renal angle?

Patient is asked to sit and the angle formed by the 12th rib and lateral border of erector spinae muscle is pressed by the ball of the thumb—"Murphys kidney punch". This  test is done on both sides.
Renal  angle is tender in the following conditions
  • Acute pyelonephritis
  • Perinephric abscess
  • Nephrolithiasis, 
  • Tuberculosis of kidney

How to do palpation of kidney?

  • Lower Pole of right kidney is normally palpable.
  • Left kidney is usually not palpable unless either low in position or enlarged 
  • Though kidney is retroperitoneally situated, it moves with respiration as it is related to the crus of the diaphragm posteriorly, the movement of the diaphragm is reflected to kidney producing restricted movement during respiration.
  • Use bimanual technique to palpate the kidneys.
How to palpate the kidneys?
  • The lower pole of right kidney is commonly palpable in thin patients for obvious reasons. Previously it was told that left kidney is palpated best from left side but nowadays no such dogma is present.
  • Both the kidneys are palpated from right side of the patient. The method of palpation goes like this :
  • Preliminary preparations of the patient are the same as done during palpation of liver. Always sit on a stool for palpation of kidneys.
  • To palpate the right kidney, place the right hand horizontally in the right lumbar region anteriorly and the left hand is placed posteriorly in the right loin region (bimanual palpation)
  • Push the right hand in a backward, upward and inward direction, and ask the patient to take deep inspiration. A firm mass may be felt in between the two hands (if kidney is enlarged).
  • Next, a sharp tap is given by the left hand placed in the loin region. The anteriorly placed right hand now feels the kidney and the kidney then falls back (by gravity) on the posterior abdominal wall which is felt by the left hand. This is ballottement. Firm pressure is exerted by both hands at the height of inspiration to trap the palpable kidney between the two hands, otherwise it will prevent the descend of kidney by the diaphragm
  • The left kidney is then palpated by placing the right hand anteriorly and the left hand posterior- the left loin.