1. Symptoms
   1. uncontrollable movements of Lt hand
   2. on & off Lt hand tremor for several weeks
      1. Types of tremors
         1. Rest Tremor
         2. Postural Action Tremor
         3. Intention Tremor
   3. tremors worsened by stress
2. Assessment
   1. Parkinson's Disease
      1. Dfn
         1. progressive degenerative neuronal disease
      2. S & S
         1. Brady kinesia
         2. Rigidity
         3. Stooped posture
         4. tremor
         5. Stooped posture
         6. Shuffling gait
         7. Mask Face
         8. Glabellar tap reflex is positive
      3. Risk Factors
         1. Age
         2. Hereditary
         3. sex
         4. exposure
      4. Pathophysiology
      5. Complications
         1. pneumonia
         2. falling-related injuries
         3. and choking
         4. can lead to death
      6. Psychology
         1. mood disorders
         2. psychotic symptoms
         3. cognitive impairment
         4. impulsive and compulsive behaviors
      7. Prognosis
         1. average life expectancy is similar to normal people
   2. Hantington Disease
3. Plan
   1. History taking
   2. P/E
   3. ECG
   4. Investigations
      1. Functioning CTscan and MRI
      2. Transcranial sonography
      3. Positron emission tomography
      4. Ct scan
      5. MRI
      6. 18-fluorodopa positron emission tomography (PET)
      7. Genetic testing
   5. Management
      1. Pharmacological Treatment
         1. Drugs that increase levels of dopamine
            1. Dopamine precursors..
            2. Dopamine agonists..
            3. Monoamine oxidase [MAO] inhibitors..
            4. Catechol-O-methyltransferase [COMT] inhibitors..
         2. Inhibit the actions of acetylcholine
            1. anticholinergic agents
      2. Deep Brain Stimulation
4. Signs
   1. pill-rolling tremor at rest
   2. Lack of facial expression
   3. stiff walk with small slow steps
      1. shivering gait
   4. stooping posture
5. Demographics
   1. Male, Ahmed
   2. 55 yrs old
   3. Teacher
   4. Widower
   5. Living alone
   6. No family history of similar case/ no trauma/not on medication