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individual to search for evidence of a rheumatic disease or the myopathy that may accompany hypothyroidism, hyperparathyroidism and renal tubular acidosis, hypophosphatemia, hypoglycemia, and the intrinsic phosphorylase or phosphofructokinase defect Patients with these latter diseases often complain of soreness, stiffness, and lameness after strenuous muscular effort According to Mills and Edwards, the most valuable screening tests are the sedimentation rate and serum CK concentration Other patients probably have an obscure metabolic myopathy, presently undiagnosable In every reported series, such as that of Serratrice and coworkers, about half of the cases with diffuse myalgia are undiagnosable This coincides with our own experience

Most neurologists would agree that sensory testing is the most dif cult part of the neurologic examination For one thing, test procedures are relatively crude and inadequate and are unlike those natural modes of stimulation with which the patient is familiar It is also fair to say that few diagnoses are made solely on the basis of the sensory examination; more often the exercise serves simply to complement the motor examination Quite often, no objective sensory loss can be demonstrated despite symptoms that suggest the presence of such an abnormality Only rarely does the opposite pertain, ie, one discovers a sensory de cit when there has been no complaint of sensory symptoms In the former instance, sensory symptoms in the nature of paresthesias or dysesthesias may be generated along axons of nerves not suf ciently diseased to impair or reduce sensory function; in the latter instance, loss of function may have been so mild and gradual as to pass unnoticed Always there is some dif culty in evaluating the response to sensory stimuli, since it depends on the patient s interpretation of sensory experiences This, in turn, will depend on the patient s general awareness and responsiveness and ability to cooperate as well as his intelligence, education, and suggestibility At times, children and relatively uneducated persons, by virtue of their simple and direct responses, are better witnesses than more sophisticated individuals, who are likely to analyze their feelings minutely and report small and insigni cant differences in stimulus intensity

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Command-line interface (CLI) Using the CLI, you can interface with ILOM to perform operations that otherwise would be accomplished using the web browser interface The CLI will allow you to script out your actions, which you can schedule to run without user intervention The CLI is based on industry-standard Distributed Management Task Force Specification Intelligent Platform Management Interface (IPMI) IPMI is an industry-standard interface that will allow you to manage server hardware Using IPMI, you can perform management and reporting of the servers, perform system monitoring, trigger alerts on exceptions, and recover systems by performing power resets You can use the IPMITool utility to interface with ILOM and retrieve information about the server platform from the service processor hardware The IPMITool is available on the host operating system of the server platform, or you can install it on a remote system and access the ILOM remotely SNMP interface SNMP is an industry-standard systems management protocol that is used to manage systems and devices connected over a network SNMP consists of managed devices that will send SNMP messages via the network to the central management station ILOM acts like a managed device and will forward SNMP messages to central management stations such as the Oracle Enterprise Manager Ops Center, and also to third-party monitoring software

Before proceeding to sensory testing, the physician should question patients about their symptoms, and this too poses special problems

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Figure 9-4 The sensory homunculus, or cortical representation of sensation in the postcentral gyrus; compare this to the distribution of body areas in the motor cortex (see also Fig 3-4) (Reproduced with permission from Kandel ER, Schwartz JH, Jessel TM: Principle of Neural Science, 4th ed New York, McGraw-Hill, 2000)

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