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Name
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Adrian Clarke
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DOB
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19/09/1939 (78 years)
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Occupation
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Retired musician
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History
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For the last few months I have noticed my left hand shaking without intentionally doing so. I have noticed it more often when I am sitting watching TV or reading the paper. It has been getting worse recently and my wife has pointed it out several times too. It stops when I reach out to pick something up. My wife also says I look sad, but I feel fine in myself and find that very strange. I have noticed that I am a bit slower when I walk especially when I stop then have need to start walking again for example when crossing the road. If asked, my sense of smell has really reduced but this was many months ago.
I have no chest pain, shortness of breath, nausea and vomiting, headache, dizziness, abdominal pain and normal urine and bowel habits. |
Past Medical History
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High blood pressure
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Drug History
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Amlodipine, Ramipril. NKDA
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Family History
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Father died from a heart attack
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Social History
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I live with my wife in a 2 bedroom house, independent with ADLs. I quit smoking 20 years ago and used to smoke for 10 years 15 cigarettes a day. I drink a glass of wine with dinner four times a week.
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Introduction & consent
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Name, age, occupation
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Asks open question
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Site (fingers, hands etc.)
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Onset
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Exacerbating/Alleviating factors: deliberate movements, rest, when doing actions, when stressed, alcohol, caffeine intake
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Time course (intermittent or continuous, particular time of day)
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Screens for Parkinson's disease (flat expression, bradykinesia, difficulty turning, falls, rigidity)
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Screens for Hyperthyroidism (unintentional weight loss, palpitations, heat intolerance)
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Screens for Anxiety (feeling anxious, triggers, palpitations)
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Screens for alcohol & drug withdrawal (previous use and if has suddenly stopped)
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Screens for red flags: raised intracranial pressure, sensory or motor symptoms, loss of consciousness, speech disturbance (cerebellar)
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Checks impact of symptoms on occupation, daily tasks e.g. driving, eating & drinking, dressing, ADLs
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Past medical history (e.g. hyperthyroidism)
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Family history (Parkinson's disease, essential tremor)
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Drug history (e.g. salbutamol), smoking and allergies
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Ideas
"Was there anything you thought it might be?" | |
Concerns
"What about it is worrying you in particular?" | |
Expectations
"Is there anything in particular you were hoping we would to today?" | |
Communication skills (empathy and avoids jargon)
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Summarises back to patient
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Gives reasonable differential diagnosis (Parkinson's disease, Essential tremor)
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