A 60-Year-Old Man Comes to the Physician Complaining of Shaking

question 405

Multiple Choice

A 60-year-old man comes to the physician complaining of shaking of his right hand.  This problem began several months ago and has progressed over time.  He says it is worse while watching TV, but that he frequently forgets about it while working or doing his regular daily activities.  He is an accountant who works at a bank.  His past medical history is significant for left hip osteoarthritis for which he occasionally takes naproxen to relieve the pain.  His mother has diabetes mellitus.  His father died of a heart attack at age 60.  His blood pressure is 125/68 mm Hg in both arms and heart rate is 72/min.  His BMI is 27 kg/m².  Physical examination shows a right hand tremor that diminishes with movement, and involuntary resistance to flexion of the right wrist and right arm.  No sensory abnormalities are present.  Muscle strength is preserved on both sides.  Plantar reflexes are flexor bilaterally.
Which of the following is the most accurate tool that can be used to diagnose this patient's disease?

• A)Autonomic testing
• B)Electroencephalography
• C)Lumbar puncture
• D)MRI of the brain
• E)Physical examination

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Definitions:

Aptitude Tests

Standardized tests designed to measure an individual's potential to develop skills or knowledge in a specific area.

Divergent Thinking

The process of generating creative ideas by exploring many possible solutions, often leading to novel or unconventional solutions.

Verbal Abilities

The capacity to use language effectively, encompassing both spoken and written communication skills.

Knowledge

Information, understanding, or skill that one gets through experience or education.