By Aysha Gomaa (5th year Medical Student)
Name
Adrian Clarke
DOB
19/09/1939 (78 years)
Occupation
Retired musician
History
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
High blood pressure
Drug History
Amlodipine, Ramipril. NKDA
Family History
Father died from a heart attack
Social History
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.
Introduction & consent

Name, age, occupation

Asks open question

Site (fingers, hands etc.)

Onset

Exacerbating/Alleviating factors: deliberate movements, rest, when doing actions, when stressed, alcohol, caffeine intake

Time course (intermittent or continuous, particular time of day)

Screens for Parkinson's disease (flat expression, bradykinesia, difficulty turning, falls, rigidity)

Screens for Hyperthyroidism (unintentional weight loss, palpitations, heat intolerance)

Screens for Anxiety (feeling anxious, triggers, palpitations)

Screens for alcohol & drug withdrawal (previous use and if has suddenly stopped)

Screens for red flags: raised intracranial pressure, sensory or motor symptoms, loss of consciousness, speech disturbance (cerebellar)

Checks impact of symptoms on occupation, daily tasks e.g. driving, eating & drinking, dressing, ADLs

Past medical history (e.g. hyperthyroidism)

Family history (Parkinson's disease, essential tremor)

Drug history (e.g. salbutamol), smoking and allergies

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)

Summarises back to patient

Gives reasonable differential diagnosis (Parkinson's disease, Essential tremor)