tremor disorders W2

Question 1

things to consider

when assessing tremor

Answer 1

position (which body parts affected?)
frequency(at rest, during movements etc)
amplitude (high, low, variable?)
character
other exacerbating factors

Question 2

common causes of tremor?

Answer 2

physiological
parkinsonism
essential tremor
dystonic
functional

Question 3

what is physiological tremor mediated by

Answer 3

sympathetic nervous system

Question 4

what can physiological tremor be exacerbated by

Answer 4

anxiety
emotion
drugs/toxin

Question 5

features of physiological tremor? what is it sometimes associated with?

Answer 5

small fine tremor
associated with palpitations and sweating

Question 6

parkinsons disease tremor features?

Answer 6

asymmetric
at rest
low amplitude
moderate
‘pill rolling’ characteristic with thumb and index

Question 7

essential tremor features?

Answer 7

affects head, can affect both arms
high frequency
family history
respond to treatment with alcohol

Question 8

dystonic tremor features?

Answer 8

head, arms, legs
postural component
variable features

Question 9

functional disorder tremor features?

Answer 9

any part of body
any frequency
variable
distractable

Question 10

definition of tremor?

Answer 10

involuntary oscillatory movement about a joint or group of joints resulting from alternating contraction and relaxation of muscles

Question 11

other abnormal movements similar to tremor?

Answer 11

chorea - smooth flowing movements involving multiple muscle groups
myoclonus - individual jerks in a body region
dystonia - involuntary sustained contraction in a region leading to contorted postures (often of neck and arm)

Question 12

ways to classify tremor?

Answer 12

region affected (multiple? bilateral?)
when is it present? (rest? posture? movement?)
amplitude (fine (low) or coarse (high))
frequency

Question 13

clinical examination of tremor?

Answer 13

hands resting in lap, supinated, is there tremor? (rest tremor)
hands outstretched? (postural tremor)
during actions eg draw spiral, write sentence, mime
finger nose testing (intention tremor as approaching targets)
during walking

Question 14

intention tremor and past pointing in finger nose testing characteristic of what?

Answer 14

a cerebellar syndrome

Question 15

physiological tremor appearance

Answer 15

fine (low amplitude)
fast (high frequency)
symmetrical, upper limbs

Question 16

physiological tremor treatment?

Answer 16

treat underlying cause
anxiety?
reduce caffeine
treat hyperthyroidism
beta blockers

Question 17

essential tremor appearance?

Answer 17

bilateral symmetrical arm tremor typically with movement
variable amplitude and frequency
also develop head and vocal tremor

Question 18

treatment for essential tremor?

Answer 18

beta blockers
primodone
deep brain stimulation surgery
supportive measures

Question 19

appearance of parkinsons tremor?

Answer 19

slow coarse pill rolling
prominent at rest
present during walking
asymmetrical
associated with cogwheeling (rigidity)

Question 20

drugs which induce tremor?

Answer 20

beta agonists (eg salbutamol)
theophylline
sodium valproate
thyroxine
lithium
tricyclic antidepressants
recreational drugs (amphetamines)
alcohol
caffeine

Question 21

metabolic/endocrine causes of tremor?

Answer 21

hyperthyroidism
hypoglycaemia
alcohol withdrawal
advanced renal failure
advanced hepatic failure
hyperparathyroidism

Question 22

intention tremor features?

Answer 22

absent at rest
appears during movement when approaching a target
increasingly coarse amplitude when nearing target
more pronounced if arm fully outstretched
dysmetria (past pointing, missing target)