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tremor

Practice targeted AMC-style multiple-choice questions on tremor.

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neurologyadverse drug reactionrigidityaltered mental statusbipolar disorderelderly patientendocrinologygeriatricshypothyroidismmuscle weakness

A 68-year-old woman presents with a 2-week history of progressive weakness in her right arm and leg, associated with a tremor in the right hand. She also reports feeling more tired than usual. Her general practitioner noted an elevated TSH (12 mIU/L, reference range 0.4-4.0 mIU/L) on routine blood tests done a month ago, but free T4 was within the normal range (15 pmol/L, reference range 10-20 pmol/L). On examination, she has mild right-sided hemiparesis (MRC grade 4/5) and a coarse tremor in the right hand, worse with action. Reflexes are brisk on the right. The rest of the neurological exam is unremarkable. She has mild bradycardia (55 bpm) but no other signs of overt hypothyroidism. What is the most appropriate initial investigation?

A. Cerebrospinal fluid analysis
B. Serum anti-thyroid antibodies (e.g., TPO antibodies)
C. CT angiography of the head and neck
D. Repeat thyroid function tests including free T3
E. MRI brain
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A 30-year-old woman with bipolar disorder is prescribed risperidone for manic episodes. She develops tremors and rigidity. What is the most likely diagnosis?

A. Extrapyramidal symptoms (EPS)
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Serotonin syndrome
E. Akathisia
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Which of the following is a key feature that helps confirm the diagnosis of Serotonin Syndrome?

A. Miosis
B. Hypotension
C. Hyperreflexia
D. Bradycardia
E. Hypertonia
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