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Tremor

  • Common ddx

    • essential tremor, physiologic tremor, drug induced tremor, cerebellar tremor, hyperthyroidism
  • Serious ddx

    • Parkinson disease, hepatic encephalopathy
  • Labs

    • TSH
    • LFTs
    • imaging (CT, MRI) for MS or stroke if cerebellar tremor
    • serum copper, ceruloplasmin if suspect Wilson's
  • Other ddx

    • neuropathic tremor, psychogenic tremor, orthostatic tremor
  • HPI

    • quality of tremor: resting, kinetic, postural, intention, orthostatic
    • acute vs chronic
    • aggravating factors: hunger, anxiety, caffeine, fatigue, drugs/meds
    • alleviating factors: alcohol
    • constant vs comes and goes
  • ROS

    • dementia
    • bradykinesia
    • heat intolerance, weight loss
    • recent psychological stress
  • PMH

    • stroke, MS, brain stem tumor
    • cirrhosis, hepatitis
    • immunocompromised: HIV, transplant
  • FH

    • tremor
  • SH

    • EtOH, smoke, recent emotional stressor
  • Meds

    • new meds, association with tremor
  • Allergies

  • Px

    • vitals
    • mental status
    • test type of tremor: rest, motion, posture
    • intention tremor (finger-to-nose)
    • rapid alternating movement
    • cogwheel rigidity
    • goiter

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