WBR0137

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 42-year-old female presents with a one-year history of progressively increasing bilateral hand tremor. The tremor manifests mainly upon executing fine movements and is absent upon rest. The patient notes that the tremor disappears when she drinks alcohol. The patient denies any previous medical conditions and is not taking any medications. Her blood pressure is 150/95, her heart rate is 85 beats per minute and her temperature is 37 degree. What is the most appropriate medication?]]
Answer A	AnswerA::Calcium channel blocker
Answer A Explanation	[[AnswerAExp::Calcium channel blocker is not used in the treatment of essential tremor.]]
Answer B	AnswerB::Diuretic
Answer B Explanation	[[AnswerBExp::Diuretics are not used in the treatment of essential tremor.]]
Answer C	AnswerC::Beta-blocker
Answer C Explanation	[[AnswerCExp::This patient is suffering from essential tremor. The two medications that are prescribed most commonly for control of essential tremor symptoms are the anticonvulsant primidone (mysoline) and the beta-blocker propranolol (inderal).]]
Answer D	AnswerD::ACE inhibitor
Answer D Explanation	[[AnswerDExp::ACE inhibitors are not used in the treatment of essential tremor.]]
Answer E	AnswerE::ARB
Answer E Explanation	[[AnswerEExp::ARBs are not used in the treatment of essential tremor.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::This patient is suffering from essential tremor. Essential tremor is a neurological disorder characterized by shaking of hands. The exact incidence is unknown, but it is presumed to be the most common type of tremor and also the most commonly observed movement disorder. Essential tremor might run in families and can be inherited as an autosomal dominant disease. Other potential sources of tremor (excessive caffeine consumption, recreational drug use, medications, hyperthyroidism) should be excluded if possible. The clues to the diagnosis are the bilateral nature of the tremor, its disappearance upon rest and its attenuation with alcohol use. Educational objective: The two medications that are prescribed most commonly for control of essential tremor symptoms are the anticonvulsant primidone (mysoline) and the beta-blocker propranolol (inderal). Educational Objective: References: ]]
Approved	Approved::No
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