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A 45-year-old man comes to your office for evaluation of tremor. He started to notice the tremor recently, when he began building model airplanes with his son and had difficulty doing the fine motor tasks required for this hobby. His son has been making jokes about the shaking to his mother, who was concerned about this new tremor and scheduled an appointment for her husband to see you.
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- What additional questions should you ask to gather more details regarding his tremor?
- How do you classify tremors?
- What warning symptoms can help you determine if this is indicative of a concerning disease or something more benign?
- How do you determine the cause of his tremor through the history?
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Tremor is the most common movement disorder of adult life.1 In most cases, it is secondary to either essential tremor or Parkinson's disease. Patients often seek medical attention due to concern about possible Parkinson's disease or another serious illness. The most common etiology is essential tremor, although there are many other causes of tremor in adults.
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Although the physical examination is important in the evaluation of tremor, the history alone can provide the necessary clues to a correct diagnosis. The initial approach is to first determine whether it occurs primarily with rest, holding a posture, or action. This will narrow the differential diagnosis and allow for a more directed history. Although a few alarm symptoms indicate the need for urgent assessment of tremor, the evaluation usually occurs in the outpatient setting.
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