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An 18-year-old woman presents with bilateral tremor of the hands
18 years old | Female
Vignette:
An 18-year-old woman presents with bilateral tremor of the hands. She is a senior in high school and during the year her grades have plummeted to the point that she is failing. She says her memory is now poor, and she has trouble focusing on tasks. Her behavior has changed in the past 6 months in that she has frequent episodes of depression, separated by episodes of bizarre behavior, including shoplifting and excessive drinking. Her parents and other authorities have begun to suspect her of using street drugs, which she denies. Her handwriting has become very sloppy. Her parents have noted slight slurring of her speech. Physical exam reveals upper extremity tremor, mild dystonia of the upper extremities, and mild incoordination involving her hands. Slit-lamp examination reveals Kayser-Fleischer rings.
Summary:
bilateral tremor of the hands | poor memory | trouble focusing on tasks | behavior has changed | change mental status | months | frequent | episode | depression | bizarre behavior | shoplifting drinking | excessive drinking | sloppy handwriting | speech slurring | upper extremity tremor | dystonia of the upper extremities | incoordination hands | Kayser-Fleischer rings
Dx:
Wilson disease
Ref:
https://online.epocrates.com/diseases/42722/Wilson-disease/Common-Vignette
Rank |
Disease |
Weight |
|---|---|---|
| 1 | Wilson disease | 460.0 |
| 2 | Hepatic Encephalopathy | 409.0 |
| 3 | Hypothyroidism | 301.0 |
| 4 | Multiple Sclerosis | 295.0 |
| 5 | Primary biliary cirrhosis | 283.0 |
| 6 | Acute Liver Failure | 273.0 |
| 7 | Primary sclerosing cholangitis | 268.0 |
| 8 | Fibromyalgia | 263.0 |
| 9 | Spontaneous bacterial peritonitis | 254.0 |
| 10 | Hyperosmolar Hyperglycemic state | 244.0 |
| 11 | Adrenocortical carcinoma | 229.0 |
| 12 | Biliary cirrhosis | 223.0 |
| 13 | Chronic bacterial prostatitis | 220.0 |
| 14 | Toxic Megacolon | 216.0 |
| 15 | Foreign body ingestion | 216.0 |
| 16 | Cushing syndrome | 212.0 |
| 17 | Intussusception | 204.0 |
| 18 | biliary SOD | 198.0 |
| 19 | Chronic prostatitis | 198.0 |
| 20 | Acute Bacterial Prostatitis | 198.0 |
| 21 | Prostatitis | 198.0 |
| 22 | Listerial gastroenteritis | 197.0 |
| 23 | Bacterial gastroenteritis | 197.0 |
| 24 | Hemorrhagic stroke | 195.0 |
| 25 | Globus Sensation | 195.0 |
| 26 | Hyperparathyroidism | 194.0 |
| 27 | Ovarian Cancer | 189.0 |
| 28 | Mesenteric ischemia | 186.0 |
| 29 | Acute Cholangitis | 182.0 |
| 30 | pancreatic cancer | 181.0 |
| 31 | Alzheimer disease | 180.0 |
| 32 | Graves Disease | 179.0 |
| 33 | Eclampsia | 178.0 |
| 34 | Hypercalcemia | 177.0 |
| 35 | Chronic Hepatitis | 177.0 |
| 36 | Preeclampsia | 174.0 |
| 37 | Atopic dermatitis | 171.0 |
| 38 | COPD Exacerbation | 171.0 |
| 39 | Acute disseminated encephalomyelitis | 166.0 |
| 40 | Biliary cyst | 166.0 |
| 41 | Choledochal Cyst | 166.0 |
| 42 | Fungal meningitis | 165.0 |
| 43 | Hemolytic uremic syndrome | 155.0 |
| 44 | Irritable Bowel Syndrome | 154.0 |
| 45 | Parkinson disease | 150.0 |
| 46 | Essential Tremor | 149.0 |
| 47 | Anaphylaxis | 149.0 |
| 48 | Ruptured ectopic pregnancy | 149.0 |
| 49 | Ischemic stroke | 145.0 |
| 50 | Acute bacterial meningitis in adults | 144.0 |
| 51 | Systemic lupus erythematosus | 143.0 |
| 52 | Amphetamine use disorder | 142.0 |
| 53 | Liver Cirrhosis | 142.0 |
| 54 | Obstructive Sleep Apnea | 140.0 |
| 55 | Stroke | 139.0 |
| 56 | Acute intermittent porphyria | 139.0 |
| 57 | Acute peptic ulcer | 137.0 |
| 58 | Influenza | 137.0 |
| 59 | Bladder Cancer | 137.0 |
| 60 | Celiac Disease | 136.0 |
| 61 | Brucellosis | 136.0 |
| 62 | Hyperaldosteronism | 135.0 |
| 63 | Acute respiratory failure | 135.0 |
| 64 | Aseptic meningitis | 130.0 |
| 65 | Gallbladder Dyskinesia | 130.0 |
| 66 | pancreatic SOD | 130.0 |
| 67 | Cholecystitis | 130.0 |
| 68 | Erectile dysfunction | 129.0 |
| 69 | Liver disease | 128.0 |
| 70 | Malaria | 128.0 |
| 71 | biliary colic | 125.0 |
| 72 | Autoimmune hepatitis | 124.0 |
| 73 | Optic neuritis | 123.0 |
| 74 | Neuropapillitis | 123.0 |
| 75 | Non-diabetic hypoglycemia | 121.0 |
| 76 | Menopause | 118.0 |
| 77 | Premenstrual syndrome | 118.0 |
| 78 | Chronic liver disease | 118.0 |
| 79 | Budd Chiari Syndrome | 112.0 |
| 80 | Non-alcoholic Fatty Liver Disease | 111.0 |
| 81 | Acute bacterial meningitis in neonates | 111.0 |
| 82 | Chronic Pancreatitis | 111.0 |
| 83 | Chronic pelvic pain in women | 110.0 |
| 84 | Allergic rhinitis | 108.0 |
| 85 | Hiatus hernia | 106.0 |
| 86 | Lactose intolerance | 106.0 |
| 87 | Ileus | 106.0 |
| 88 | Acute fatty liver of pregnancy | 106.0 |
| 89 | Acute viral meningitis | 106.0 |
| 90 | Chronic fatigue syndrome | 106.0 |
| 91 | Rheumatoid Arthritis | 104.0 |
| 92 | Acute pyelonephritis in adults | 104.0 |
| 93 | COVID19 | 104.0 |
| 94 | Bullous pemphigoid | 102.0 |
| 95 | Hyperthyroidism | 102.0 |
| 96 | Addison Disease | 102.0 |
| 97 | Candidal intertrigo | 101.0 |
| 98 | Candida Balanitis | 101.0 |
| 99 | Oropharyngeal and esophageal candidiasis | 101.0 |
| 100 | Vulvovaginal candidiasis | 101.0 |
| 101 | Oral candidiasis | 101.0 |
| 102 | Tics | 101.0 |
| 103 | Acute heart failure | 100.0 |
| 104 | mucosal Eosinophilic gastroenteritis | 100.0 |
| 105 | Muscle Layer Eosinophilic gastroenteritis | 100.0 |
| 106 | subserosal eosinophilic gastroenteritis | 100.0 |
| 107 | Sialadenitis | 100.0 |
| 108 | Gastric Volvulus | 100.0 |
| 109 | Rocky Mountain spotted fever | 99.0 |
| 110 | Acute Pancreatitis | 99.0 |
| 111 | Alcoholic hepatitis | 99.0 |
| 112 | Gallstone pancreatitis | 99.0 |
| 113 | Acromegaly | 98.0 |
| 114 | Polyarteritis nodosa | 97.0 |
| 115 | Campylobacter infection | 97.0 |
| 116 | Central hypothyroidism | 96.0 |
| 117 | Subdural hematoma | 96.0 |
| 118 | Duodenal Ulcer | 96.0 |
| 119 | Gastric Ulcer | 96.0 |
| 120 | Type 2 Diabetes mellitus | 95.0 |
| 121 | Migraine | 95.0 |
| 122 | Shigellosis | 95.0 |
| 123 | Type 1 Diabetes mellitus | 94.0 |
| 124 | Pyogenic Liver Abscess | 94.0 |
| 125 | Klebsiella pneumoniae liver abscess | 94.0 |
| 126 | Familial Mediterranean fever | 93.0 |
| 127 | Adrenal crisis | 92.0 |
| 128 | Heparin-induced thrombocytopenia | 92.0 |
| 129 | Choledocholithiasis | 92.0 |
| 130 | Dyspepsia | 92.0 |
| 131 | Infectious mononucleosis | 91.0 |
| 132 | Sarcoidosis | 90.0 |
| 133 | Osteoarthritis | 90.0 |
| 134 | Chronic Cholecystitis | 90.0 |
| 135 | Acalculous Cholecystitis | 90.0 |
| 136 | Crohn Disease | 89.0 |
| 137 | Churg-Strauss Syndrome | 89.0 |
| 138 | Psychogenic polydipsia | 89.0 |
| 139 | Ulcerative Colitis | 88.0 |
| 140 | Blepharitis | 88.0 |
| 141 | Esophagitis | 87.0 |
| 142 | End Stage Renal Disease | 87.0 |
| 143 | Carpal Tunnel Syndrome | 87.0 |
| 144 | Graves ophthalmopathy | 86.0 |
| 145 | Diabetic Kidney Disease | 86.0 |
| 146 | Giardiasis | 86.0 |
| 147 | Short bowel syndrome | 85.0 |
| 148 | Osteoporosis | 85.0 |
| 149 | Non-ST-elevation myocardial infarction | 85.0 |
| 150 | Transient ischemic attack | 84.0 |
| 151 | Colorectal cancer | 84.0 |
| 152 | Diverticulitis | 84.0 |
| 153 | Insomnia in adults | 83.0 |
| 154 | Diabetic Ketoacidosis | 82.0 |
| 155 | Leiomyomas | 82.0 |
| 156 | Tinea versicolor | 82.0 |
| 157 | Eosinophilic gastroenteritis | 81.0 |
| 158 | Gastroesophageal reflux disease | 80.0 |
| 159 | Systemic sclerosis | 80.0 |
| 160 | Mitral Stenosis | 79.0 |
| 161 | Acute peritonitis | 79.0 |
| 162 | Sigmoid volvulus | 79.0 |
| 163 | Chronic Kidney Diseases | 78.0 |
| 164 | Secondary hypogonadism | 78.0 |
| 165 | Acetaminophen overdose | 77.0 |
| 166 | Acute bacterial meningitis in children | 77.0 |
| 167 | Primary Myelofibrosis | 76.0 |
| 168 | Travelers diarrhea | 76.0 |
| 169 | Migraine headache in adults | 75.0 |
| 170 | Cholangiocarcinoma | 75.0 |
| 171 | Goiter | 74.0 |
| 172 | Diffuse nontoxic goiter | 74.0 |
| 173 | Toxic multinodular goiter | 74.0 |
| 174 | Cervical goiter | 74.0 |
| 175 | Obstructive cervical goiters | 72.0 |
| 176 | Multiple Myeloma | 72.0 |
| 177 | Hypoparathyroidism | 72.0 |
| 178 | Chronic Mitral regurgitation | 72.0 |
| 179 | Ovarian Hyperstimulation Syndrome | 71.0 |
| 180 | Bacterial pharyngitis | 71.0 |
| 181 | Peutz-Jeghers Syndrome | 71.0 |
| 182 | Tinnitus | 71.0 |
| 183 | ST-elevation myocardial infarction | 71.0 |
| 184 | Asthma | 70.0 |
| 185 | Congenital Myasthenic Syndromes | 70.0 |
| 186 | Renal and perinephric abscess | 70.0 |
| 187 | Pulmonary Embolism | 70.0 |
| 188 | Acute otitis media | 69.0 |
| 189 | Extraintestinal Entamoeba histolytica amebiasis | 68.0 |
| 190 | Acute Cholecystitis | 68.0 |
| 191 | Acute Appendicitis | 68.0 |
| 192 | Acute perforated appendicitis | 68.0 |
| 193 | Ectopic Pregnancy | 68.0 |
| 194 | Panic disorder in adults | 68.0 |
| 195 | Aortic coarctation | 67.0 |
| 196 | Common cutaneous drug reactions | 66.0 |
| 197 | Peptic Ulcer | 66.0 |
| 198 | Tuberculous Peritonitis | 65.0 |
| 199 | Amyloidosis | 64.0 |
| 200 | Phenylketonuria | 64.0 |
| 201 | Gastroenteritis | 64.0 |
| 202 | Systemic vasculitis | 63.0 |
| 203 | Infertility in women | 63.0 |
| 204 | Sexual abuse and assault | 63.0 |
| 205 | Primary hypogonadism | 63.0 |
| 206 | Hereditary hemochromatosis | 62.0 |
| 207 | Multiple endocrine neoplasia 2A | 62.0 |
| 208 | Hepatocellular carcinoma | 62.0 |
| 209 | Gestational diabetes mellitus | 62.0 |
| 210 | Chronic heart failure | 61.0 |
| 211 | Balanitis | 61.0 |
| 212 | Zollinger-Ellison Syndrome | 61.0 |
| 213 | Aortic Dissection | 60.0 |
| 214 | Kawasaki disease | 60.0 |
| 215 | Hyperglycemia | 60.0 |
| 216 | Gout | 60.0 |
| 217 | Renal vein thrombosis | 60.0 |
| 218 | Chronic Renal vein thrombosis | 60.0 |
| 219 | Acute Renal vein thrombosis | 60.0 |
| 220 | Autoimmune hemolytic anemia | 60.0 |
| 221 | Pharyngitis | 60.0 |
| 222 | STI HIV Pharyngitis | 60.0 |
| 223 | Herpes pharyngitis | 60.0 |
| 224 | Chronic atrial fibrillation | 58.0 |
| 225 | Diabetes Mellitus | 58.0 |
| 226 | posteriorischemic optic neuropathy | 58.0 |
| 227 | Ischemic optic neuropathy | 58.0 |
| 228 | anterior ischemic optic neuropathy | 58.0 |
| 229 | Guillain-Barre syndrome | 57.0 |
| 230 | Cryptococcosis | 57.0 |
| 231 | Abetalipoproteinemia | 57.0 |
| 232 | Viral Gastroenteritis | 56.0 |
| 233 | Prinzmetal angina | 56.0 |
| 234 | Hereditary Angioedema | 55.0 |
| 235 | cholestatic liver disease | 54.0 |
| 236 | Viral pharyngitis | 54.0 |
| 237 | Amebiasis | 53.0 |
| 238 | Acute Cystitis(Men) | 53.0 |
| 239 | Gastric Outlet Obstruction | 52.0 |
| 240 | Pheochromocytoma | 52.0 |
| 241 | Achalasia | 51.0 |
| 242 | Peyronie Disease | 51.0 |
| 243 | Anthrax | 50.0 |
| 244 | Hypertriglyceridemia | 50.0 |
| 245 | Myasthenia Gravis | 50.0 |
| 246 | Neonatal Myasthenia Gravis | 50.0 |
| 247 | Intestinal Entamoeba histolytica amebiasis | 50.0 |
| 248 | Discogenic low back pain | 50.0 |
| 249 | Autoimmune Pancreatitis | 50.0 |
| 250 | Alcoholic Liver Disease | 49.0 |
| 251 | Drowning | 49.0 |
| 252 | Central diabetes insipidus | 48.0 |
| 253 | Immune thrombocytopenia | 48.0 |
| 254 | Cholera | 48.0 |
| 255 | Pseudohypoparathyroidism | 47.0 |
| 256 | Croup | 47.0 |
| 257 | Milk-alkali syndrome | 47.0 |
| 258 | Acute Milk-alkali syndrome | 47.0 |
| 259 | Chronic Milk-alkali syndrome | 47.0 |
| 260 | Rumination Syndrome | 47.0 |
| 261 | Meniere disease | 47.0 |
| 262 | Secondary hyperparathyroidism | 46.0 |
| 263 | Pneumonia | 46.0 |
| 264 | Varicose veins | 46.0 |
| 265 | Painless thyroiditis | 45.0 |
| 266 | Disseminated intravascular coagulation | 45.0 |
| 267 | Ruptured Tuboovarian abscess | 45.0 |
| 268 | Insect bites and stings | 45.0 |
| 269 | Acute bacterial rhinosinusitis | 44.0 |
| 270 | Acute Myeloid Leukemia in children | 44.0 |
| 271 | Acute Lymphocytic Leukemia in Adults | 43.0 |
| 272 | Gilbert syndrome | 43.0 |
| 273 | Acute Rhinosinusitis | 43.0 |
| 274 | Acute viral rhinosinusitis | 43.0 |
| 275 | Familial adenomatous polyposis syndrome | 43.0 |
| 276 | Acne vulgaris | 43.0 |
| 277 | Acne fulminans | 43.0 |
| 278 | Acne conglobata | 43.0 |
| 279 | Gram-negative folliculitis | 43.0 |
| 280 | Excoriated acne | 43.0 |
| 281 | Temporomandibular joint syndrome | 43.0 |
| 282 | Chronic Clonorchiasis | 42.0 |
| 283 | Musculoskeletal lower back pain | 42.0 |
| 284 | Acute atrial fibrillation | 42.0 |
| 285 | Herpes zoster | 41.0 |
| 286 | Inflammatory Bowel Diseases | 41.0 |
| 287 | Acute Mitral regurgitation | 41.0 |
| 288 | Acute Lymphoblastic leukemia in children | 40.0 |
| 289 | Paraphimosis | 40.0 |
| 290 | Dubin-Johnson syndrome | 40.0 |
| 291 | Alcoholic Liver Cirrhosis | 39.0 |
| 292 | chronic cholestatic liver disease | 39.0 |
| 293 | Ascites | 38.0 |
| 294 | Non-small cell lung cancer | 38.0 |
| 295 | Endometriosis | 38.0 |
| 296 | Hyperprolactinemia | 38.0 |
| 297 | Stable ischemic heart disease | 38.0 |
| 298 | Analgesic nephropathy | 37.0 |
| 299 | Ovarian Torsion | 36.0 |
| 300 | Toxic thyroid adenoma | 36.0 |
| 301 | Adrenal Suppression | 36.0 |
| 302 | Salmonella infection | 36.0 |
| 303 | Aortic stenosis | 36.0 |
| 304 | Gastritis | 35.0 |
| 305 | Multiple endocrine neoplasia 2B | 34.0 |
| 306 | Common cold(children) | 34.0 |
| 307 | Meckel diverticulum | 34.0 |
| 308 | Common cold(adults) | 33.0 |
| 309 | Non-cholera Vibrio infections | 33.0 |
| 310 | Glomerulonephritis | 33.0 |
| 311 | Open Angle Glaucoma | 33.0 |
| 312 | Candidiasis | 33.0 |
| 313 | Alcoholic Fatty Liver | 32.0 |
| 314 | Penis Carcinoma | 32.0 |
| 315 | Primary ciliary dyskinesia | 32.0 |
| 316 | Kartagener syndrome | 32.0 |
| 317 | Thrombotic thrombocytopenic purpura | 31.0 |
| 318 | Ankylosing spondylitis | 31.0 |
| 319 | Emphysematous cholecystitis | 31.0 |
| 320 | Gallbladder cancer | 31.0 |
| 321 | Anaplastic thyroid cancer | 30.0 |
| 322 | Bruxism | 30.0 |
| 323 | Cystic Fibrosis | 30.0 |
| 324 | Osteomyelitis | 30.0 |
| 325 | Henoch-Schonlein purpura | 30.0 |
| 326 | Rotor syndrome | 29.0 |
| 327 | Rosacea | 29.0 |
| 328 | Autosomal Dominant Polycystic Kidney Disease | 29.0 |
| 329 | Abdominal compartment syndrome | 29.0 |
| 330 | Stable angina | 28.0 |
| 331 | Foodborne E coli infection | 28.0 |
| 332 | Intrahepatic cholestasis of pregnancy | 28.0 |
| 333 | Peritoneal dialysis associated peritonitis | 28.0 |
| 334 | Medullary thyroid cancer | 27.0 |
| 335 | Nephrogenic diabetes insipidus | 27.0 |
| 336 | Peroneal Neuropathy | 27.0 |
| 337 | Inguinal hernia | 26.0 |
| 338 | Typhoid infection | 26.0 |
| 339 | Acute Myeloid Leukemia in adults | 26.0 |
| 340 | chronic acalculous cholecystitis | 26.0 |
| 341 | Malt lymphoma | 26.0 |
| 342 | Hepatorenal Syndrome | 25.0 |
| 343 | Testicular cancer | 24.0 |
| 344 | Substernal goiter | 24.0 |
| 345 | Acute Clonorchiasis | 24.0 |
| 346 | Gastroparesis | 24.0 |
| 347 | Food poisoning | 23.0 |
| 348 | Chronic Myeloid Leukemia | 22.0 |
| 349 | Granulomatosis with polyangiitis | 21.0 |
| 350 | Amebic Liver Abscess | 21.0 |
| 351 | Gastrointestinal Hemorrhage | 21.0 |
| 352 | Lower gastrointestinal hemorrhage | 21.0 |
| 353 | Upper gastrointestinal hemorrhage | 21.0 |
| 354 | Chronic Lymphocytic Leukemia | 20.0 |
| 355 | Paraneoplastic Syndromes | 20.0 |
| 356 | Abnormal uterine bleeding | 20.0 |
| 357 | Nasal polyps | 20.0 |
| 358 | Pancreatic Pseudocyst | 20.0 |
| 359 | Intestinal Pseudo Obstruction | 20.0 |
| 360 | Prolactinoma | 20.0 |
| 361 | Intestinal Obstruction | 19.0 |
| 362 | Ramsay Hunt syndrome | 19.0 |
| 363 | Sunburn | 18.0 |
| 364 | Limited cutaneous systemic sclerosis | 18.0 |
| 365 | Intraperitoneal bleeding | 18.0 |
| 366 | Endometrial cancer | 17.0 |
| 367 | Mirizzi Syndrome | 17.0 |
| 368 | Cholestasis | 17.0 |
| 369 | Intrahepatic Cholestasis | 17.0 |
| 370 | Breast Cancer | 17.0 |
| 371 | Acute cervical spine trauma | 16.0 |
| 372 | Bed bugs | 15.0 |
| 373 | Gastric cancer | 15.0 |
| 374 | Anemia of chronic disease | 15.0 |
| 375 | Periorbital and orbital cellulitis | 14.0 |
| 376 | Renal Cell Carcinoma | 14.0 |
| 377 | Annular pancreas | 14.0 |
| 378 | Epiploic appendagitis | 14.0 |
| 379 | Intra-abdominal abscess | 14.0 |
| 380 | Exocrine pancreatic insufficiency | 14.0 |
| 381 | Tetanus | 13.0 |
| 382 | Gallstones | 13.0 |
| 383 | Thyroid lymphoma | 12.0 |
| 384 | Hemorrhoids | 12.0 |
| 385 | Ichthyosis | 12.0 |
| 386 | Chronic pyelonephritis | 11.0 |
| 387 | Ovarian and fallopian tube torsion | 11.0 |
| 388 | Acute Bronchitis | 10.0 |
| 389 | Clonorchiasis | 10.0 |
| 390 | Mallory-Weiss syndrome | 9.0 |
| 391 | Umbilical hernia | 9.0 |
| 392 | Lung Cancer | 8.0 |
| 393 | Extrahepatic Cholestasis | 8.0 |
| 394 | Acute Hepatitis | 7.0 |
| 395 | Alopecia areata | 6.0 |
| 396 | Premature labor | 6.0 |
| 397 | Chlamydia pneumoniae infection | 5.0 |
| 398 | Animal bites | 5.0 |
| 399 | Liver Abscess | 5.0 |
| 400 | Hypogammaglobulinemia | 5.0 |
| 401 | Osteomalacia | 4.0 |
| 402 | Splenic Rupture | 4.0 |
| 403 | Intestinal malrotation | 4.0 |
| 404 | Clostridium difficile infection | 3.0 |
| 405 | Bell palsy | 0.0 |
| 406 | Labyrinthitis | 0.0 |
| 407 | Myoclonus | 0.0 |
| 408 | Chalazion | 0.0 |