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Practice Paper 7: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Physiological tremors are seen in normal people, and have a frequency of 8–15 Hz. Physiological tremors can be exaggerated with anxiety, fatigue, fever and alcohol withdrawal. The resting tremor is pathognomonic of Parkinson’s disease and has a frequency of 4–6 Hz. It is characteristically pill-rolling and is usually asymmetrical. An intention tremor is a feature of cerebellar disease. There is a slow broad tremor that occurs at the end of a purposeful movement, such as trying to press a button. It is caused by a breakdown of feedback control of targeted movements. Asterixis results from failure of the parietal mechanisms required to maintain posture. For example, when the hands are extended at the wrist, the posture is periodically dropped, allowing the hands to drop briefly before the posture is taken up again. Asterixis is caused by renal failure, liver failure, hypercapnia and drug toxicity (phenytoin). Unilateral asterixis can be seen with focal parietal or thalamic lesions.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Clinical evaluation often yields substantial information in the assessment of the cancer patient who presents with jaundice. It is important to ascertain the tumor type and history to date, if known. The presence of pale stools is strongly suggestive of cholestasis. The abdomen is examined for evidence of hepatomegaly, ascites, and features of portal hypertension. Patients should undergo a brief mental status examination and neurological examination for evidence of asterixis and features of Parkinson's like psychomotor retardation [20].
The viva: the non-operative clinical practice of neurosurgery
Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
Signs of toxicity (use the mnemonic: SCAND): Slurred speech.Confusion – CNS depression.Asterixis.Nystagmus.Diplopia.
Raymond D. Adams and Joseph M. Foley: Elaborating the neurologic manifestations of hepatic encephalopathy (1949–1953)
Published in Journal of the History of the Neurosciences, 2021
Despite the irregular nature of the movements in asterixis, in 1972 Stanley Fahn classified asterixis as a postural “tremor” that was “unrelated to physiological tremor” (Fahn 1972, 2011, 954). Similarly, in 1981, asterixis was included in the “Classification of Extrapyramidal Disorders” of the Research Committee on Extrapyramidal Disease of the World Federation of Neurology, but inappropriately considered a “hyperkinesia” and a “tremor,” when instead the characteristic abnormal movement is an irregular movement related to a period of electrical silence in muscle(s) during sustained posture—neither a hyperkinesia nor a tremor: “Flapping tremor: is seen in the outstretched hands and consists of a brisk extension of the wrist followed by a drop of the hand, giving it a jerking quality (asterixis). It occurs in metabolic and toxic disorders” (Lakke 1981, 316).
Diffuse large B cell lymphoma primarily presenting as acute liver failure in a surviving patient
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Jumpei Shibata, Shingo Kurahashi, Takehito Naito, Isamu Sugiura
A 33-year-old Japanese woman without any medical history presented to our emergency department with upper abdominal pain, progressive jaundice, and skin rash on her face and trunk since 3 weeks. She was fully conscious and oriented. Physical examination did not reveal asterixis, hepatosplenomegaly, or lymphadenopathy. She had no history of blood transfusion, gastrointestinal bleeding, any surgical procedures, or hospitalization, nor any history of alcohol, substance abuse, or high-risk sexual behavior. Her family history was also not remarkable for hepatic disease or malignancy. Laboratory results, shown in Table 1, indicated severe hepatic damage with impaired synthetic function. The patient was diagnosed with ALF and underwent additional imaging studies to clarify the underlying cause.