Cox & Roper: Clinical Skills

Chapter 09 - Hands

Instructions: Each group of extended matching questions consists of lettered options followed by a list of numbered problems/questions. For each numbered problem/question select the one lettered option that most closely answers the question. You can use the lettered options once, more than once, or not at all.

Options:

1. Anxiety
2. Beta 2 agonist
3. Hyperthyroidism
4. Parkinson's disease
5. Drug induced Parkinsonism
6. Cerebellar Syndrome
7. Flapping tremor secondary to type 2 respiratory failure
8. Flapping tremor liver disease
9. Hypoglycaemia
10. Benign essential tremor
11. Alcoholism

Choose from the list of causes of tremor, the one that matches the clinical scenarios below

1

Scenario 1 a) A 36 year old woman visits her GP. She has is an asthmatic and has a ventolin and a becotide inhalers. She is concerned because she has developed a coarse shaking of her hands. Choose... Anxiety Beta 2 agonist Hyperthyroidism Parkinson's disease Drug induced Parkinsonism Cerebellar Syndrome Flapping tremor secondary to type 2 respiratory failure Flapping tremor liver disease Hypoglycaemia Benign essential tremor Alcoholism Correct. Page reference 228Incorrect. Page reference 228Your answer has been saved.

2

Scenario 2 a) A 43 year old man is referred to the neurology clinic because he has slowed down.and has developed a tremor of his right hand. The tremor is pill-rolling in nature and the neurologist notes that there is poverty of facial expression. Choose... Anxiety Beta 2 agonist Hyperthyroidism Parkinson's disease Drug induced Parkinsonism Cerebellar Syndrome Flapping tremor secondary to type 2 respiratory failure Flapping tremor liver disease Hypoglycaemia Benign essential tremor Alcoholism Correct. Page reference: 219, 400-401Incorrect. Page reference: 219, 400-401Your answer has been saved.

3

Scenario 3 a) A 81 year old man is on a medical ward. He has been falling recently and the physicians suspect a stroke. The consultant decides to test his coordination. He demonstrates an intention tremor and frequently misses the target finger and his nose with his left finger. Choose... Anxiety Beta 2 agonist Hyperthyroidism Parkinson's disease Drug induced Parkinsonism Cerebellar Syndrome Flapping tremor secondary to type 2 respiratory failure Flapping tremor liver disease Hypoglycaemia Benign essential tremor Alcoholism Correct. Page reference: 228, 296-298Incorrect. Page reference: 228, 296-298Your answer has been saved.

4

Scenario 4 a) A 72 year old woman with chronic obstructive pulmonary disease (COPD) continues to smoke. Her breathing has become steadily worse and no longer responds to her nebuliser. She was sent by ambulance to A&E and on the way she was given high flow rates of oxygen. On arrival at A&E she is semi-conscious. The doctor in attendance gets her to cock her wrists back and her hands start to jerk downwards in a flapping manner. Choose... Anxiety Beta 2 agonist Hyperthyroidism Parkinson's disease Drug induced Parkinsonism Cerebellar Syndrome Flapping tremor secondary to type 2 respiratory failure Flapping tremor liver disease Hypoglycaemia Benign essential tremor Alcoholism Correct. The patient is demonstrating a flapping tremor and it is likely that the high flow rates of oxygen has led to respiratory depression and hypercapnia. Page reference: 88, 228Incorrect. Page reference: 88, 228Your answer has been saved.

5

Scenario 5 a) A 17 year old man is a diabetic. He took his normal insulin at breakfast time but skipped lunch so he could play football with his friends. In the afternoon, he complained of a headache, was sweaty and belligerent. In fact some of his friends thought he had been drinking. He exhibited a coarse tremor of his hands. Choose... Anxiety Beta 2 agonist Hyperthyroidism Parkinson's disease Drug induced Parkinsonism Cerebellar Syndrome Flapping tremor secondary to type 2 respiratory failure Flapping tremor liver disease Hypoglycaemia Benign essential tremor Alcoholism Correct. Knowing the patient is diabetic gives a clue. His lifestyle choices that day have led to him becoming hypoglycaemic. The headache, sweating and tremor are typical. Personality change can be seen with aggression often featuring. If sugar is not administered the patient will become unconscious and can die. Page reference 228Incorrect. Page reference 228Your answer has been saved.

(c) Oxford University Press, 2007