Confirms Patient S Name and Age s1

38 Tremor

Checklist / P / MP / F /
Appropriate introduction
Confirms patient’s name and age
Explain reason for consultation
Obtains consent
Open question to elicit presenting complaint
Allows patient to open up, listens carefully, remains silent and does not interrupt the patient
Signposts: e.g. ‘Mr Gregory, thank you for telling me about this problem. I would like to ask a few more detailed questions. Is that all right?’
History of presenting complaint:
• Site (hands, arms, head)
• Bilateral, unilateral, symmetrical
• Onset:
• On deliberate movement (e.g. turning on a light switch, reaching for a cup of tea)
• At rest
• When anxious/worried
• Constant or intermittent:
• If intermittent, duration and frequency of episodes
• Time of day
• Alleviating factors: alcohol
• Exacerbating factors:
• Stress, fatigue
• Anxiety
• Caffeine (how many cups of coffee?)
• Coordination, gait
• Previous episodes
• General neurological symptoms:
• Headaches
• Motor weakness, sensory symptoms
• Loss of consciousness
• Asks if patient is suffering from any other symptoms
• Asks about any recent illnesses
• Previous episodes of tremor
Associated symptoms:
• Parkinson’s disease (slowing, rigidity, falls, depression)
• Hyperthyroidism (palpitations, weight loss, heat intolerance)
• Benign essential tremor (family history, eased by alcohol, exacerbated by stress)
• Cerebellar disease (slurred/staccato speech, incoordination, imbalance)
• Anxiety (sweating, palpitations)
• Salbutamol overuse (frequency of inhaler use, poorly controlled asthma)
• Alcohol withdrawal (excess intake, sudden recent reduction)
‘Red flags’:
• Headache with features of raised intracranial pressure (early morning, vomiting, worse on coughing, bending down)
• Loss of consciousness
Review of systems
Past medical history:
• Hyperthyroidism
• Alcohol/drug addiction
Family history:
• Benign essential tremor
• Parkinson’s disease
Drug history:
• Salbutamol
• Thyroxine
• Benzodiazepines (withdrawal)
• Over-the-counter medication
Allergies
Social history:
• Caffeine
• Alcohol
• Illicit drug use
• Smoking
• Occupation
• Driving
• Activities of daily living, functional impairment:
• Drinking from a cup
• Doing buttons
• Writing
Use of non-verbal cues, e.g. good eye contact, nodding head and good body posture
Systematic approach
Explores and responds to ICE:
• Ideas
• Concerns
• Expectations
Shows empathy
Non-verbal skills
Avoids technical jargon
Devises holistic management plan and addresses psychosocial issues as well as medical problems
Summarises
Offers to answer any questions
Thanks patient

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran.