Having trouble remembering all the important questions to ask during your patient encounter? Then try this Tremor Mnemonic for USMLE Step 2 CS.
- Neurologic exam: Mini-Mental Status Exam, Cranial nerves (2-12), Muscle strength exam, Sensory exam, DTRs, Cerebellar, Gait.
- CV exam: Auscultation
- Pulmonary exam: Auscultation
- Parkinson’s disease (resting tremor)
- Essential tremor (postural tremor “tremor on outstretched arms”, action tremor)
- Physiologic tremor (postural tremor, action tremor) [eg, anxiety, caffeine, hypoglycemia…]
- Hyperthyroidism (fine tremor + classic signs of hyperthyroidism)
- Drug induced tremor [eg, Beta-agonist, nicotine, lithium, metoclopramide…]
- Wilson’s disease (resting tremor, similar to Parkinson’s tremor)
- Midbrain lesion
- TSH and Free T4
- Heavy metal screens (eg, Arsenic or Mercury)
- Brain MRI
- Slit lamp for Kayser-Fleischer ring, Serum Ceruloplasmin, AST/ALT, Liver biopsy (Wilson’s disease work up)
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