MLA Domain 5 · Presentation
Tremor
15 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.
classic presentation · 5
Delirium tremens and withdrawal seizures are medical emergencies; suspected Wernicke’s → immediate parenteral thiamine
Sudden onset, asymmetry, rest tremor or other neurology → reconsider Parkinson disease / secondary cause
Thyroid storm (fever, agitation, tachyarrhythmia, delirium, often precipitated by illness/surgery) → emergency
Early falls/postural instability, vertical gaze palsy, early autonomic failure, or symmetry/poor levodopa response → a P
Acute (fulminant) liver failure in a young person → consider Wilson's (may need transplant)
recognised feature · 7
Severe alcoholic hepatitis (Maddrey discriminant function ≥32) → consider corticosteroids; high mortality
Must exclude organic neurological disease; new "functional" symptoms in the elderly warrant caution
Reduced consciousness/seizure; sulfonylurea-induced hypoglycaemia is prolonged → admit/observe
Severe neuroglycopenia (seizures, coma)
Acute relapse with disabling features; progressive course; tumefactive/atypical presentations
Hypertensive crisis (can be precipitated by anaesthesia, beta-blockade alone, or contrast) → emergency
Reduced colour vision, an RAPD, or reduced acuity → compressive (dysthyroid) OPTIC NEUROPATHY — urgent (sight-threatenin
differential of the above · 3
Dysthyroid optic neuropathy (reduced colour vision/acuity, RAPD) → urgent (sight-threatening — see ophthalmology)
Cirrhosis → hepatocellular carcinoma risk (surveillance); cardiomyopathy/arrhythmia
NEUROLEPTIC SENSITIVITY — antipsychotics can cause severe rigidity/irreversible deterioration; recurrent falls