By Aysha Gomaa (5th year Medical Student)
Name
Barbara Davies
DOB
08/11/1981 (36 years)
Occupation
Hair Salon Owner
History
I have this terrible shaking in my right arm and hand which I noticed when I start doing something. It’s really bad at work when I pick up or use equipment to do my client’s hair; I have even dropped things because of how bad the shaking is. I found that drinking really helps, but I don’t want to drink much. I don’t notice anything when I am sitting down in the evening and weekends. I think it has been getting worse over the last couple of years, I am definitely noticing it more often now than I used to. It’s starting to affect my work a lot and can be quite embarrassing, I also feel nervous when I go out with friends because I am scared people will stare at me in restaurants. It mainly happens in my right arm but very occasionally in my left too. I have no other symptoms or complaints.
Past Medical History
Nil
Drug History
Penicillin allery - causes all over rash
Family History
I’m not really sure but my father had a similar thing with shaking of his hands but was not formally diagnosed with anything.
Social History
I live in a house with my husband and 9 year old daughter. I work as a hairdresser in my own salon. I have never smoked and drink 2 small glasses of wine a day to help with the shaking at work
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 (Essential Tremor, Anxiety)