Rosh Internal Medicine Boost Practice Exam

What is the most likely diagnosis for a patient with a tremor that improves after consuming alcohol?

1. Essential tremor

2. Huntington disease

3. Parkinson disease

4. Wilson disease

The correct answer is: Essential tremor

A tremor that improves after consuming alcohol is characteristic of essential tremor. Essential tremor is a common movement disorder that often presents as a postural or kinetic tremor, typically of the hands and arms, and it may become more noticeable when the patient is under stress or trying to perform precise tasks. One of the unique features of essential tremor is that symptoms can be alleviated, even temporarily, with the ingestion of alcohol. This response is thought to be due to the psychoactive effects of alcohol on the nervous system, which can help dampen the abnormal neuronal activity responsible for the tremor. In contrast, other conditions listed have different implications. Huntington disease is a genetic disorder characterized by chorea and cognitive decline, and tremors typically do not improve with alcohol. Parkinson disease typically displays resting tremors that may not improve with alcohol consumption; in fact, they often remain constant or worsen. Wilson disease, a disorder of copper metabolism, can cause tremors alongside other systemic symptoms but does not demonstrate a consistent improvement with alcohol either. Thus, essential tremor’s specific response to alcohol consumption points towards it as the most likely diagnosis in this scenario.