Essential tremor: The Daily PANCE Blueprint
A 70-year-old man presents with a 5-year history of tremors in both hands, worsening with stress and caffeine intake. He denies any recent head trauma, medications besides aspirin for occasional headaches, or alcohol abuse. On examination, there is a postural and kinetic tremor involving both hands, most prominent when attempting to fingerpoint or pour water. Resting tremor is minimal. What is the MOST likely diagnosis in this patient?
A. Parkinson's disease
B. Dystonia
C. Essential tremor
D. Cerebellar ataxia
E. Wilson's disease
Answer and topic summary
The answer is C. Essential tremor
Essential tremor is the most common movement disorder, characterized by a postural and kinetic tremor typically affecting the hands and arms. The presentation in this case, with prominent tremor worsening with activity and minimal resting tremor, is classic for essential tremor.
Incorrect Answers with Explanations:
- A. Parkinson’s disease: Parkinson’s disease can cause tremor, but it’s typically a resting tremor, meaning it’s most prominent at rest and improves with activity. Other Parkinsonian features like bradykinesia (slowness of movement) and rigidity are usually absent in essential tremor.
- B. Dystonia: Dystonia causes sustained muscle contractions leading to abnormal postures or twisting movements. Tremor is not a prominent feature of dystonia.
- C. Cerebellar ataxia: Cerebellar ataxia causes incoordination and gait disturbances, not the postural and kinetic tremor seen in essential tremor.
- E. Wilson’s disease: Wilson’s disease is a genetic disorder causing copper buildup in the body. It can present with tremor, but it often involves other neurological features like dystonia, slurred speech, and cognitive decline.
Key Points:
- Essential Tremor Presentation: Postural and kinetic tremor worsening with activity and minimal resting tremor are characteristic of essential tremor.
- Differential Diagnosis: Essential tremor needs to be distinguished from other movement disorders like Parkinson’s disease, dystonia, and cerebellar ataxia based on the specific tremor characteristics and accompanying features.
- Considering Age: Essential tremor is more common in older adults compared to some other movement disorders.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Neurology ⇒ ⇒
Also covered as part of the Family Medicine and Internal Medicine PAEA EOR topic list
