Tremor

Question 1

Differentials for tremor

Answer 1

PD 
Parkinson’s plus syndromes 
BET
Alcohol withdrawal
Anxiety 
Hyperthyroidism 
SOL (tumour)
Cerebellar disease 
Liver disease 
CO2 retention
Salbutamol (asthma/COPD) 
Lithium

Question 2

Timeline

Answer 2

Tell me about it
When did it start
Has it gotten worse
Is it worse at certain times of the day

Question 3

SOCRATES

Answer 3

Site- Is it just your hand/arm, is it unilateral or bilateral, is one arm worse than the other
Onset- did you notice anything that may have triggered it ie. Injury?
Character- worse at rest, when doing something, when holding arms up etc.
Radiation-
Associated features- see next slides
Timeline- already done
Exacerbating and relieving factors- when is it worse or best, impact of alcohol, rest, etc.
Severity- how is it impacting your life

Question 4

Systems review

Answer 4

PD- stiffness, unsteadiness, sense of smell, depression, has anyone commented on facial expressions, falls, dizzy when standing up, libido

NS- weakness, parasthesia, seizures, blackouts, headache, involuntary movements, visual or auditory disturbance

General- FWARJTC, bowels and bladder, abdominal pain (phaeochromocytoma)

Thyroid- heat intolerance, anxiety, palpitations

Anxiety- palpitations, nervous person, phobias, dry mouth

Question 5

Background information

Answer 5

PMH
DH
Surgical history
SH
FH

Question 6

Impact

Answer 6

ICE
Feelings
Do you drive/work (what do you do)