Essential Tremor Flashcards

1
Q

An essential tremor is a movement disorder involving a tremor (unwanted and uncontrolled shaking). Are essential tremors typically unilateral or bilateral?

A
  • bilaterally
  • essentially it is symmetrical throughout the body
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2
Q

An essential tremor is a movement disorder involving a tremor (unwanted and uncontrolled shaking). All of the following can be affected, but which is most common?

1 - hands
2 - legs
3 - head
4 - voice
5 - torso

A

1 - hands

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3
Q

Are essential tremors more prominent at rest or during voluntary movement?

A
  • voluntary movement
  • a tremor at rest is called a resting tremor
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4
Q

In an essential tremor, which occurs when patients perform voluntary movements, does the tremor get worse at the start of the movement or when they are trying to complete movements?

A
  • complete movements
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5
Q

The exact cause of an essential tremor is unknown, but which of the following have been linked with causing essential tremors?

1 - family history
2 - ageing
3 - lifestyle (lack of sleep caffeine)
4 - all of the above

A

4 - all of the above

  • typically there is thought to be alterations in the cerebello-thalamo-cortical circuit
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6
Q

Does the risk of developing an essential tremor increase or decrease with age?

A
  • increases with age
  • equally affects men and women
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7
Q

What is the estimated prevalence of an essential tremor?

1 - 0.3 – 0.9% general population
2 - 3 – 9% general population
3 - 30 – 90% general population
4 - none of the above

A

4 - none of the above

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8
Q

In patients with an essential tremor, they can typically present with symptoms in the following:

  • hands, legs, head, torso and voice

If patients develop other symptoms such as muscle stiffness and memory issues, is this still classed as an essential tremor?

A
  • no
  • if other symptoms are present then it is unlikely to be an essential tremor
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9
Q

To be diagnosed with an essential tremor, how long do patients need to have had the symptoms for?

1 - >12 weeks
2 - >1 year
3 - >3 years
4 - >6 years

A

3 - >3 years

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10
Q

Which of the following can improve an essential tremor?

1 - alcohol
2 - caffeine
3 - lack of sleep
4 - medications

A

1 - alcohol
- 50-75% improve with alcohol
- acts as a suppressant so reduces tremor

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11
Q

All of the following can make essential tremors worse, EXCEPT which one?

1 - alcohol
2 - caffeine
3 - lack of sleep
4 - medications

A

1 - alcohol

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12
Q

Do essential tremors and Parkinsons disease always occur in isolation?

A
  • no
  • can occur together
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13
Q

In addition to an essential tremor, there is essential tremor plus. What is the distinguishing feature between essential tremor vs. essential tremor plus?

1 - duration of tremor
2 - age at onset of tremor
3 - additional neurological symptoms of uncertain significance
4 - all of the above

A

3 - additional neurological symptoms of uncertain significance

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14
Q

Differentiating between essential tremor (ET) and Parkinsonism can be difficult. Does ES or Parkinsonism present with unilateral symptoms?

A
  • Parkinsonism
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15
Q

Is hypophonia (soft speech) present in essential tremor or Parkinsonism?

A
  • Parkinsonism
  • caused by a poor coordination in the vocal musculature
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16
Q

Is a lack of facial expression and a reduced blink rate present in essential tremor or Parkinsonism?

A
  • Parkinsonism
17
Q

Is a vocal tremor present in essential tremor or Parkinsonism?

A

essential tremor

18
Q

Is a resting tremor present in essential tremor or Parkinsonism?

A
  • Parkinsonism
  • may also present with Cogwheel rigidity, reduced arm swing on walking and en bloc turning
19
Q

In a patient with an essential tremor, we would need to perform imaging to help diagnose the patient and try to rule out Parkinsons disease. What imaging should be used to distinguish between Parkinsons disease and an essential tremor?

1 - DAT-SPECT
2 - F-FDG PET/CT
3 - standard MRI
4 - standard CT

A

1 - DAT-SPECT
- I123-ioflupane

20
Q

Which of the following is NOT a differential for an essential tremor?

1 - Parkinson’s disease
2 - Alzheimer’s
3 - Multiple sclerosis
4 - Huntington’s Chorea
5 - Hyperthyroidism
6 - Fever

A

2 - Alzheimer’s

21
Q

When treating a patient with an essential tremor, all of the following should be used in conservative management, EXCEPT which one?

1 - reassure the patient
2 - removal of medications
3 - reduction in caffeine
4 - weighted cups / instruments / bracelets
5 - increased alcohol intake

A

5 - increased alcohol intake
- although it can reduce the tremor, it would not be recommended

22
Q

Which of the following is NOT a medication used to treat patients with an essential tremor?

1 - Propranolol
2 - Primidone
3 - Topiramate
4 - Haloperidol
5 - Botulinum therapy

A

4 - Haloperidol
- typical anti-psychotic, which would most probably make the patients symptoms worse

23
Q

Which 2 of the following are used to treat patients with an essential tremor?

1 - Deep brain stimulation
2 - Transcranial MRI-guided focused ultrasound thalamotomy
3 - cerebral surgery
4 - lobectomy

A

1 - Deep brain stimulation
2 - Transcranial MRI-guided focused ultrasound thalamotomy