Movement Disorder Module DDA Bonnie comes in today with complaints of shaking

Movement Disorder Module DDA Bonnie comes in today with complaints of shaking. She says that at first she thought this shaking was related to her nerves, now she is convinced that it is not. She says that overall, she has been doing well. Her allergies have been under control with the Flonase. She says that her depression is controlled on the Zoloft. Bonnie says that she sleeps well, feels energized and that things are just going great. Her history of depression is what made her think that these “shakes” were perhaps related to that, but since they have just been bothersome for the last few months, she is convinced that they have no relation.


She says that when she is relaxed, they are not noticeable except maybe her head shakes “a little”. But “give me a cup of coffee, and it is all over the place,” she states. The patient reports no change in handwriting, no falls or change in ability to get up and around. She denies a family historyfamily history of movement disorder.

She does not drink alcohol, so when the nurse practitioner asks her if alcohol makes it worse or better, she cannot give information in that regard.


Bonnie is not allergic to any medications. She takes Flonase [2] sprays to each nare daily; Zoloft 50 mg daily; Premarin 0.625 mg daily; Vitamins E, C and B6 daily. She also takes Oscal with Vitamin D [2] daily.


PMH is significant for allergic rhinitis and depression. Previous surgeries include TAH and tonsillectomy as a child.


She does not smoke or drink alcohol. She is married. She is a church secretary. She works 3 days per week. She has a good relationship with her husband and two grown daughters.


On physical exam Bonnie is pleasant. She is a 55 year old white female. She is well groomed. You note a slight tremor of her head, but no other tremor of other extremities. She is oriented to person, place and time.


VS:                 98-88-20-110/60 [sitting]    112/68 [standing]


On exam, her lungs are clear and her cardiac exam reveals no murmur, gallop or rub. Her cardiac rhythm is regular. Her muscle strength and development is normal 5/5 bilaterally. There is no obvious rigidity. When you ask her to write her name, you notice a lot of tremor of her hand. No micrographia is seen on the document that you had her write for you.


The remainder of the exam is stone cold normal.



What is her Medical diagnosis?

What are some differential diagnosis?

What diagnostics are needed?

What prescriptions does she need?

What education does she need?

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