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MMLU / A 70-year-old woman comes to the office because of worsening tremor of her…

Problem

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question

A 70-year-old woman comes to the office because of worsening tremor of her hands. The tremor has been present for most of her life and initially was mild and would occur only when she was tired or stressed. During the past month the shaking has become more noticeable and frequent. She is now embarrassed to eat with other people because of how obvious the tremor has become. The patient has been taking fluoxetine for the past 3 weeks to help her to cope with the death of her husband 2 months ago. Medical history is also remarkable for essential hypertension controlled with lisinopril and hyperlipidemia controlled with atorvastatin. Her only other medication is occasional ibuprofen for joint pain. She used to drink one to two alcoholic beverages monthly but now drinks one glass of wine daily because, she says, it reduces her tremor. She is 168 cm (5 ft 6 in) tall and weighs 70 kg (155 lb); BMI is 25 kg/m2 . Vital signs are temperature 36.4°C (97.6°F), pulse 80/min, respirations 18/min, and blood pressure 130/85 mm Hg. Physical examination shows a moderate tremor of both hands that is not present at rest. Complete blood count, serum chemistry profile, and serum thyroid function tests are ordered and results are pending. Which of the following is the most likely cause of the patient's worsening tremor?

choices

  1. Adverse effect of fluoxetine therapy
  2. Bereavement reaction
  3. Early Parkinson disease
  4. Increase in alcohol consumption

subject

professional_medicine

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Source and history

task_id
ef288852-1278-547a-8206-5e6f35683bb6
task_key
all--test--ef288852-1278-547a-8206-5e6f35683bb6
task_revision_id
1
config / split
all / test

Official source

initial import