Essential tremor: The Daily PANCE Blueprint

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Essential tremor: The Daily PANCE Blueprint

A 65-year-old man presents with a bilateral hand tremor that worsens when writing or drinking from a cup but improves at rest. His symptoms have gradually worsened over the past two years. He reports that having a glass of wine in the evening often reduces the shakiness. There is a family history of similar tremors. On exam, the tremor is most noticeable when he extends his arms or holds a posture. Which of the following is most likely to temporarily improve his symptoms?

A. Alcohol consumption
B. Anticholinergic medication
C. Dopamine agonists
D. Physical exercise
E. High-protein meals

Answer and topic summary

The answer is A. Alcohol consumption

Essential tremor is a benign movement disorder that typically improves transiently with alcohol consumption. The tremor is classically bilateral, postural, and most noticeable with voluntary movements like writing or drinking. It often has a familial component and worsens with stress or fatigue. Alcohol’s exact mechanism in improving the tremor is unclear, but it is believed to modulate GABAergic activity in the cerebellum. First-line treatment for essential tremor includes propranolol or primidone. Alcohol is not used therapeutically but is a known diagnostic clue.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Neurology ⇒ Movement Disorders ⇒ Essential tremor

Also covered as part of the Family Medicine and Internal Medicine PAEA EOR topic list

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