Essential vs. Intention tremor

[drmedstudent]

I understand resting tremor occurs at....well....rest. Its common in Parkinson's Disease. But what exactly is the difference between intention and essential tremor? From what I read, both occur while doing something, ie. reaching for a pen, and disappear at rest. So how do u differentiate the two?

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[Captopril]

both occur while doing something, ie. reaching for a pen, and disappear at rest. So how do u differentiate the two?

Not sure if serious

 

[OveractiveBrain]

I understand resting tremor occurs at....well....rest. Its common in Parkinson's Disease. But what exactly is the difference between intention and essential tremor? From what I read, both occur while doing something, ie. reaching for a pen, and disappear at rest. So how do u differentiate the two?

Essential Tremor
Path: Familial
Pt: No resting tremor
....Tremor appears when doing something
....Age <30, look for hammer, tv remote
Dx: Clinical
Tx: Beta-Blockers

Intention Tremor
Path: Cerebellar Lesion (weirnicke's, stroke)
Pt: No resting Tremor
....Tremor appears when reaching for object
....Age >45 (you have to get a stroke of be an alky)
....Tremor gets worse as it approaches the object (as they intend to do something)
Dx: Clinical (MRI/CT?)
Tx: Nothing (Stop Drinking)

The real difference for the test is in the vignette. Its either going to be a young person with a family history of tremors that gets one when he is trying to do something with tools or a TV remote (familial) OR its going to be the stroke patient /alocholic, without family history, who is a bit older, who has a tremor that gets worse as the closer to the object they get (intention)

Not sure if serious

I think you got jokered because, if you have SEEN these tremors, they do not at all look similar. They SOUND similar when you're studying them. But on the Step 2, the diagnosis may not be obvious if all you've done is read about them.

 

[match2011]

Essential Tremor
Path: Familial
Pt: No resting tremor
....Tremor appears when doing something
....Age <30, look for hammer, tv remote
Dx: Clinical
Tx: Beta-Blockers

Intention Tremor
Path: Cerebellar Lesion (weirnicke's, stroke)
Pt: No resting Tremor
....Tremor appears when reaching for object
....Age >45 (you have to get a stroke of be an alky)
....Tremor gets worse as it approaches the object (as they intend to do something)
Dx: Clinical (MRI/CT?)
Tx: Nothing (Stop Drinking)

The real difference for the test is in the vignette. Its either going to be a young person with a family history of tremors that gets one when he is trying to do something with tools or a TV remote (familial) OR its going to be the stroke patient /alocholic, without family history, who is a bit older, who has a tremor that gets worse as the closer to the object they get (intention)



I think you got jokered because, if you have SEEN these tremors, they do not at all look similar. They SOUND similar when you're studying them. But on the Step 2, the diagnosis may not be obvious if all you've done is read about them.

Thanks

 

[drmedstudent]

Essential Tremor
Path: Familial
Pt: No resting tremor
....Tremor appears when doing something
....Age <30, look for hammer, tv remote
Dx: Clinical
Tx: Beta-Blockers

Intention Tremor
Path: Cerebellar Lesion (weirnicke's, stroke)
Pt: No resting Tremor
....Tremor appears when reaching for object
....Age >45 (you have to get a stroke of be an alky)
....Tremor gets worse as it approaches the object (as they intend to do something)
Dx: Clinical (MRI/CT?)
Tx: Nothing (Stop Drinking)

The real difference for the test is in the vignette. Its either going to be a young person with a family history of tremors that gets one when he is trying to do something with tools or a TV remote (familial) OR its going to be the stroke patient /alocholic, without family history, who is a bit older, who has a tremor that gets worse as the closer to the object they get (intention)

thanks!!

but both essential and intention appear when reaching for object right?? its just the history of the pt (ie. age, comorbidities, family hx) that separates the 2 right?

 

[Cooolguy]

The other treatment for essential tremor is primidone

 

[OveractiveBrain]

thanks!!

but both essential and intention appear when reaching for object right?? its just the history of the pt (ie. age, comorbidities, family hx) that separates the 2 right?

So.

Familial: One appears and then does not get worse as an action is going on, then disappears at rest.

Intention: One appears with movement, then gets worse the closer it comes to an object or task, then disappears at rest.

But yes, look at the overall person who is having the tremor (on a Board exam) for risk factors and comorbidities. Step 2 in particular is not going to trip you up by giving you a familial tremor in a 76 year old hypertensive diabetic with a history of CVA...

 

[Cooolguy]

i had an elderly patient with familial tremor for sure. No tremor at rest, tremor on reaching hands out, slight tremor of the head. The answer was a second line drug.

 

[OveractiveBrain]

i had an elderly patient with familial tremor for sure. No tremor at rest, tremor on reaching hands out, slight tremor of the head. The answer was a second line drug.

Good for people going for 270

 

[Cooolguy]

Good for people going for 270

isn't everyone?

if a person has a thyroid nodule, and tsh is low, the next step is a scan right? or an FNA?

 

[drmedstudent]

isn't everyone?

if a person has a thyroid nodule, and tsh is low, the next step is a scan right? or an FNA?

ya i was confused about that as well......uworld says TSH but the other review books i read say FNA. i think TSH makes sense since its much cheaper to do bloodwork than to do a procedure (FNA).

case with the same confusion: 25yr old woman comes with a palpable mass on breast. last period 2 wks ago. what to do next? FNA or tell her to come back in 2 wks?

 

[Captopril]

I understand resting tremor occurs at....well....rest. Its common in Parkinson's Disease. But what exactly is the difference between intention and essential tremor? From what I read, both occur while doing something, ie. reaching for a pen, and disappear at rest. So how do u differentiate the two?

I fail at reading....I skimmed your question and thought you were asking the difference between resting and intention tremor. Hence the douche-y Joker post. I apologize for my misplaced pretentiousness. Godspeed in finding the answer to this most righteous question.

 

[drmedstudent]

I fail at reading....I skimmed your question and thought you were asking the difference between resting and intention tremor. Hence the douche-y Joker post. I apologize for my misplaced pretentiousness. Godspeed in finding the answer to this most righteous question.

haha no worries!!

 

[match2011]

ya i was confused about that as well......uworld says TSH but the other review books i read say FNA. i think TSH makes sense since its much cheaper to do bloodwork than to do a procedure (FNA).

case with the same confusion: 25yr old woman comes with a palpable mass on breast. last period 2 wks ago. what to do next? FNA or tell her to come back in 2 wks?

come back in 2 weeks

 

[drmedstudent]

come back in 2 weeks

thanks match2011 but if they say mass is palpable, movable, nontender (hx strongly suggestive of fibroadenoma) do u still tell em to come back in 2 wks or do the FNA. i know fibrocystic dz isnt ruled out yet and i dont think think u can tell if mass is cystic jus by physical exam

 

[Cooolguy]

wait wait...so going back to the thyroid nodule.

Patient has thyroid nodule-->TSH comes back low--> next step?

a. FNA
b. Thyroid scan

I thought the answer was B, you do a thyroid scan and if its hot, you treat like hyperthyroidism, but if its cold, you do an FNA.

(I know if TSH is normal or high, you go straight to FNA)

I also read in MTB step 3--Thyroid nodule = FNA but this seems like a superficial answer

I had this type of question on my ck...

 

[drmedstudent]

wait wait...so going back to the thyroid nodule.

Patient has thyroid nodule-->TSH comes back low--> next step?

a. FNA
b. Thyroid scan

I thought the answer was B, you do a thyroid scan and if its hot, you treat like hyperthyroidism, but if its cold, you do an FNA.

(I know if TSH is normal or high, you go straight to FNA)

I also read in MTB step 3--Thyroid nodule = FNA but this seems like a superficial answer

I had this type of question on my ck...

ya ur right. according to uworld protocol...1st is to order TSH.
if TSH low ==> do thyroid scan
==>if hyperfunctioning ==> hyperthyroidism
==> if nonfunctioning ==> do ultrasound
if TSH normal/high ==> do ultrasound
==> if it looks benign ==> follow up
==> if concern for malignancy ==> FNA

seems like according to uworld FNA is the last step instead of the first