Tremor in a 55-year-old WomanTremor and Tremor Differentiation Clinical Pearls of Wisdom Q&A Case
Tremor consists of alternating contractions of agonist and antagonist muscles in an oscillating, rhythmic manner. Tremor may also be characterized based on distribution, frequency, amplitude, and related neurologic dysfunction.
The first step in the evaluation of a patient with tremor is to categorize the tremor based on its activation condition, topographic distribution, and frequency. The diagnosis of tremor is based on clinical information obtained from a thorough history and physical examination.
A 55-year-old woman complains that she has tremor that is embarrassing and more noticeable since it began several years prior. She finds that she cannot paint and draw as well as she used to because of the tremor.
Her father, she recalls, had a tremor as well, and it affected his handwriting. Her tremor started around age fifty.
She feels it is worse when she is stressed, and she has not noted any alleviating factors.
She is a non-drinker, non-smoker who has one cup of coffee a day.
Past medical history includes depression for which she takes sertraline, mild intermittent asthma treated with albuterol and hypertension treated with losartan.
She has not started any new medications in the past year.
Her vital signs are normal, as is the cranial nerve examination.
Speech is fluent with no dysarthria. Her gait is normal with no ataxia.
You ask her to reach out for your pen and note a roughly 8 Hz tremor, symmetrical in both arms.
You ask her to draw a spiral and note a wavy line in drawing. When arms are extended on table, supported, there is no tremor.
Of the following, which medication would be most reasonable to initiate for this patient with tremor?
See the Answer:
About the Author:
About Clinical Pearl of the Month:
Med-Challenger's Clinical Pearl Blog Series is a recurring segment of Med-Challenger's popular Medical Education Blog. Subscribe for more free pearls of wisdom. Opt-out anytime.
Med-Challenger provides online medical education products and services to physicians, nurses, and other medical specialists as well as medical training programs and healthcare groups world-wide via its web-based medical education library and world-class assessment platform at challengercme.com.
More from Med-ChallengerThe Leader in Online Board Review, CME Courses, and Medical Education
Did you like this?
Get more free medical Q&A and informative CME articles.
Subscribe to the Medical Education Blog
More from Med-Challenger's Medical Education Blog
2023 Internal Medicine Boards Survival Guide: How To Best Prepare for IM BoardsNovember 18, 2022
Deadline Approaching – PEMQBook Board Review Course 2023 – 2023 Pediatric Emergency Medicine Live Review Course Begins Dec. 9. Register NOW!November 11, 2022
November 2022 CME Updates, News, and Offers from Med-ChallengerNovember 8, 2022
Board Review & CME Offers
Med-Challenger provides online medical education, top-rated board review courses, annual MOC and CME credit solutions for physicians, nurses, PAs and students. Take advantage of our current offers.
PROCareer Value Bundles
in your specialty.
Useful every year.
Ideal use your CME budget.