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Ms. Johnson is a 61-year-old woman presenting today with a chief complaint of a hand tremor that has worsened over the past three years. The tremor occurs when she uses her hands for activities such as slicing vegetables, sewing, putting on her lipstick, or typing at her computer.Her handwriting has become messy and sprawling and very difficult to read. She has worked for 23 years as an executive assistant; as a result of her tremor and the associated difficulties, she is considering retirement. She notes that on the rare occasion that she consumes alcohol, the tremor is somewhat improved.Family history is positive for two grandparents who also “had the shakes” later in life. She assumes that they both had Parkinson’s disease and is afraid “that’s what’s wrong with me, too.” Medications include an antihypertensive, a statin, and an estrogen patch. Today her BP is 120/62. Height is 5’6”, weight 139 lbs. On physical examination, mental status, cranial nerves, sensation, muscle strength, tone, and deep tendon reflexes are all normal. There is a mild tremor bilaterally in both hands as she writes her name. No tremor at rest. There is no bradykinesia or rigidity noted. Voice is somewhat tremulous. There is a slight involuntary back- and-forth horizontal rotation of the head.Lab data, including lipids, TSH and FBS are all within normal limits.
Answers:
- Diagnosis Name
- Ms. Johnson most likely acquired the disorder called "Essential Tremor".
- Explanation
- According to my research, Parkinson's disease has not been linked to any genetic traces that
- Causes/Risk Factors
- Some of the factors that place Ms. Johnson at risk for her condition is her age. It is most
- I would ask the patient if she has ever suffered from a head injury? This study source was downloaded by 100000829426687 from CourseHero.com on 07-28-2021 01:43:56 GMT -05:00
What is the name of the disease/disorder?
What are the reasons for your diagnosis?
can affect any other family member on the family tree. As a result, I began to look at at the symptoms that Ms. Johnson presents. Her main complaint was tremors on her hand that gradually worsened over three years. She also suffers from having tremors attack while she writes, chops vegetables, and typing on her computer. These are to name a few that resembles symptoms synonymous to those of essential tremors. The patient experiences essential shakiness when they use their hands.
What are some of the factors that put this patient at risk for the disease?
common for patients aged 40 and over to acquire essential tremors. Another factor that places her at risk is the fact that she had two grandparents who also "had the shakes" later in life.What other questions might you have for the patient that would provide you with more data?
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- Clinical Manifestation
- Diagnostic Procedures
- Treatment
Describe the clinical features of the disease that are present in the individual.Ms. Johnson presents a bilaterally slight tremor in both hands as she wrote her name. No signs of shaking while she was at rest. There were also no bradykinesia nor rigidity noted. As she spoke, there was a presence of tremble. Lastly, she presents an involuntary head nod with a horizontal rotation.
What types of procedures were done on the patient and what were the results?Ms. Johnson underwent a physical examination which consisted of mental status, cranial nerves, sensation, muscle strength, tone, and deep tendon reflexes, all of which are within reasonable limits. She also got lab tests which consisted of lipids, TSH, and FBS, which all resulted normal.Are there other diagnostic procedures that you would like to have performed? If so, which ones and why?-I would try to request a Dopamine Transporter Scan to help determine if Ms. Johnson has essential tremor or Parkinson’s Disease (PD). This scan shows if the levels of dopamine in the brain is sufficient or low, which can indicate the rise of either essential tumor or PD.-I would also request for a Positron Emission Tomography (PET) Scan in order to observe the functionality of the patient’s brain, more particularly how the brain metabolizes glucose. Because when blood glucose levels hits rock bottom (hypoglycemia), the patient suffers from tremors.
Describe the treatment plan that you would prescribe for this patient.I would prescribe my patient with medicaments. One is propranolol, which is typically an antihypertensive pill that is a beta blocker. Another medicament I can prescribe her is gabapentin and topiramate pills which are anti-seizure medications.Additionally, I would highly suggest physical and/or occupational therapy. The doctors of physical therapy aim to help patients develop control, strength, and coordination. They can suggest for you to use heavier utensils, use weighted wristbands, and use of wide grip writing tools, to name a few.Lastly, worse case scenario, a patient may have to undergo deep brain stimulation surgery.Deep brain surgery involves an electrical tube that strikes the thalamus and a wire connected to your chest that sends painless impulses that aims to disrupt the signals from thalamus that can This study source was downloaded by 100000829426687 from CourseHero.com on 07-28-2021 01:43:56 GMT -05:00
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be causing your tremors.
References:
NINDS essential tremor information page. National Institute of Neurological Disorders and Stroke.https://www.ninds.nih.gov/Disorders/All-Disorders/Essential-Tremor-Information-Page. Accessed Jan 26, 2019.National Library of Medicine. What is essential tremor? Genetics Home Reference. http://ghr.nlm.nih.gov/condition/essential- tremor/. Accessed Jan 26, 2019.https://parkinson.org/blog/whats-hot/update-DAT-scanning This study source was downloaded by 100000829426687 from CourseHero.com on 07-28-2021 01:43:56 GMT -05:00
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