Symptoms Summary

Case (patient name, DOB: ?/?/1954, Male)

Patient walks into examination room with a slow shuffling gait.

Presenting complaint.

‘Got the shakes’ in one of his hands.

History of presenting complaint.

Been happening for a few years - but worsened recently. Worse when sitting still e.g watching TV at night, gets better when doing things - drinking coffee? Writing? Although noticed his writing has gotten really hard to read lately - much smaller.

PMH

● Low mood/depression

● Sleep disturbance and insomnia

● Loss of sense of smell

● Postural instability

Social History

● Occupation : farmer

● Drinks a couple of beers a week - approx. 5 units

● Never smoked

Family History

No siginificant family history

Patient Examination

Classic triad of symptoms: Classic triad of symptoms:

● Resting tremor (tremor that is worst at rest)

● Rigidity (resisting passive movement)

● Bradykinesia (slowness of movement)

Handwritng - Micrographia (handwrittng gets smaller and smaller)

Walking - shuffling gait rapid frequency of steps to compensate.

Difficulty in initiating movement - going from standing still to walking, difficulty turning around (may take lots of little steps)

Clinical Features

Mr Jonhson presented with a typical symptomatology for Parkinson’s disease and Parkinson’s-like conditions. In summary the most common clinical features associated with PD are the following: