A 60year old man came to hospital with complaints of tremors in right hand
A 60year old male agricultural worker by occupation came to hospital with complaints of tremors in right hand
Chief complaints
Patient complaints of tremors in right forearm and hand
History of presenting illness
Patient was apparently asymptomatic 2years back
He then developed shivering of right hand and arm which was
- Insidious on onset and gradually progressive
- Initally shivering was localised to fingers only, later radiated to Palm.
- numbness present
- Decreased power in right hand
- inability to hold things,unable to eat food, unable to work.
- pain in right thigh
- Shivering of right hand aggravated due to stress, anxiety fear, present for sometime during sleep.
- Shivering is present throughant the day Intensity increases and decreases.
History of past illness
Not a known case of
- Diabetes
- Hypertension
- Epilepsy
- Asthma
- Tuberculosis
No history of trauma in the past
Personal history
- Sleep:adequate
- Diet: mixed
- Bowel and bladder movements: normal
- Addictions:
- Alcohol since 25yrs occasional drinker (stopped 3 years back)
- Cigarettes since 25 years(stopped 6years back)
- No allergies
Family history
No significant family history
General examination
- Patient was conscious coherent well and oriented to time space and person
- Patient was examined in a well ventilated room after taking his consent
- Moderately built and well nourished
- No pallor
- No icterus
- No cyanosis
- No lymphadenopathy
- No pedal oedema
- No clubbing of fingers
Vitals
- Temperature:afebrile
- Pulse:84 beats per minute
- Bp:110/80mm Hg
- Respiratory movements: 16 cycles minute
SYSTEMIC EXAMINATION
Cardiovascular system
- No thrills
- No cardiac murmurs
- Cardiac sounds: S1 and S2
Respiratory system
- dyspnea absent
- No wheezing
- No Vesicular breath sounds .
- Position of trachea - central
Abdomen
- Abdomen is scaphoid
- No tenderness
- No Palpable mass
- Bowel sounds anew present
- No bruits
- No free fluids
Central nervous system
Patient was conscious and coherent well oriented to time, space and person
- Speech is normal
- Cranial nerves normal
- Motor system normal
- Sensory system normal
- Glasgow scale normal
REFLEXES
Right. Left
Biceps ++ ++
Triceps ++ ++
Supinator ++ ++
Knee ++ ++
Ankle ++ ++
CEREBELLAR SIGNS
finger nose in coordination
Knee heal in coordination
GAIT
Normal.
Provisional diagnosis
Essential tremors
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