FrontalCortex, Inc. is a non-profit corporation dedicated to neurology education.

Tremor 01

Topic: Behavior

Created on Saturday, December 30 2006 by jdmiles

Last modified on Sunday, November 16 2008.

A very old man is seen in clinic by his Neurologist. He complains of more than 2 years of worsening tremor.
The tremor is worse in the right hand. It improves slightly when he uses the hand to perform a task. He has no cognitive symptoms.
He drinks 5 40-oz beers every night. When he does, he notices no change in the tremor.
There is no significant family history.
He is currently on medications for plantar warts, genital herpes, and acid reflux.
Significant findings on physical exam are shown in the image above.
Of the following options, which medication would make the best choice as empiric treatment for this tremor?

A) Primidone

B) Refecoxib

C) Pramipexole

D) Edrophonium

E) Flunarizine

	= Go back to the top of the page.
	= Reload a different version of this question ().
	= Load a random question from the database.
	= Use this question as a template to create a totally NEW question.
	= Enter detailed rating for this question!
	= How users like you have rated this question.

This question was created on December 30, 2006 by jdmiles.
This question was last modified on November 16, 2008.

ANSWERS AND EXPLANATIONS

A) primidone

This answer is incorrect.

By history and exam, this patient's tremor appears Parkinsonian: it is worse at rest, it is asymmetrical, has a pill-rolling quality, and does not improve with ethanol intake. Primidone is not indicated in the treatment of Parkinsonsim. Primidone is an antiepileptic drug, and is indicated in the treatment of epilepsy or essential tremor. (See References)


Please log in if you want to rate questions.

B) refecoxib

This answer is incorrect.

By history and exam, this patient's tremor appears Parkinsonian: it is worse at rest, it is asymmetrical, has a pill-rolling quality, and does not improve with ethanol intake. Refecoxib is not indicated in the treatment of Parkinsonsim. Refecoxib is an NSAID, and is indicated in the treatment of pain. (See References)


Please log in if you want to rate questions.

C) pramipexole

This answer is correct.

By history and exam, this patient's tremor appears Parkinsonian: it is worse at rest, it is asymmetrical, has a pill-rolling quality, and does not improve with ethanol intake. Pramipexole is indicated in the treatment of Parkinson disease. Pramipexole is a dopaminergic agent, and is effective against a broad spectrum of Parkinsonian symptoms. (See References)


Please log in if you want to rate questions.

D) edrophonium

This answer is incorrect.

By history and exam, this patient's tremor appears Parkinsonian: it is worse at rest, it is asymmetrical, has a pill-rolling quality, and does not improve with ethanol intake. Edrophonium is not indicated in the treatment of Parkinsonsim. Edrophonium is a cholinergic agent, and is indicated in the of evaluation of myasthenia gravis. (See References)


Please log in if you want to rate questions.

E) flunarizine

This answer is incorrect.

By history and exam, this patient's tremor appears Parkinsonian: it is worse at rest, it is asymmetrical, has a pill-rolling quality, and does not improve with ethanol intake. Flunarizine is not indicated in the treatment of Parkinsonsim. Flunarizine is an antimigraine agent, and is indicated in the treatment of migraine. (See References)


Please log in if you want to rate questions.

References:

1. Rao, G., Fisch, L., Srinivasan, S., D\'Amico, F., Okada, T., Eaton, C., and Robbins, C. (2003). Does this patient have Parkinson disease? JAMA, 289(3):347-353. (PMID:12525236)
2. Shannon, K.M. (2004). Movement Disorders. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, 4th Edition. Butterworth Heinemann, Philadelphia. Pp. 2131-2140. (ISBN:0750674695)	Advertising:
3. Fahn, S., and Przedborski, S. (2000). Parkinsonism. In Rowland, L.P. (Ed), Merritt\'s Neurology, 10th Edition. Lippincott Williams & Wilkins, Philadelphia. Pp. 679-693. (ISBN:0683304747)	Advertising:
4. Cochran, E.J. (2005). Neurodegenerative Diseases. In Prayson, R.A., and Goldblum, J.R. (Eds.). Neuropathology. Elsevier Churchill Livingstone, Philadelphia. Pp. 232-243. (ISBN:0443066582)	Advertising:
5. Aminoff, M.J. (2001). Parkinson\'s Disease and Other Extrapyramidal Disorders. In Braunwald, E., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., and Jameson, J.L. (Eds.). Harrison\'s Principles of Internal Medicine, 15th Edition. McGraw Hill. New York. (ISBN:0070072728)	Advertising:
6. Victor, M., and Ropper, A.H. (2001). Adams and Victor\'s Principles of Neurology, 7th Edition. McGraw-Hill, New York. Pp. 1128-1137. (ISBN:0070674973)	Advertising:
7. Pierantozzi, M., Pietroiusti, A., Brusa, L., Galati, S., Stefani, A., Lunardi, G., Fedele, E., Sancesario, G., Bernardi, G., Bergamaschi, A., Magrini, A., Stanzione, P., and Galante, A. (2006). Helicobacter pylori eradication and L-dopa absorption in patients with PD and motor fluctuations. Neurology, 66(12): 1824-1829. (PMID:16801644)


Please log in if you want to rate questions.

FrontalCortex.com -- Neurology Review Questions -- Neurology Boards -- Board Review -- Residency Inservice Training Exam -- RITE Exam Review
behavior
Tremor 01
Question ID: 12300600
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 12/30/2006
Modified: 11/16/2008
Estimated Permutations: 0