Margaret is a 59-year-old Caucasian female who presents to the clinic for follow-up of her hypertension.  She reports that she has a worsening of a tremor in her hand over the last few months. She was seen by a neurologist previously and was diagnosed with an essential tremor but opted to not take medication because it wasn’t particularly bothersome.  She reports now that she has difficulty pouring a drink, drinking from a cup, using utensils to eat, and writing or drawing.  Margaret also reports that since you started her on Clonidine last month for her blood pressure, she has been having some difficulties with headaches, dizziness, dry mouth and difficulty urinating. You plan to discontinue the clonidine. 

Past Medical History: Hypertension, essential tremor and seasonal allergies. 

Surgical History: Tonsillectomy. 

Family History: Mother HTN & essential tremor, Father Diabetes, Sister Diabetes all deceased. 

Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week. 

Allergies: NKA  

Current medications: Multivitamin with Iron 1 tab PO daily, Allegra 10mg PO prn for allergies, Clonidine 0.1mg PO BID  

All vaccines up to date. 

Vitals: Height 57 inches, Weight 145 pounds, BP 156/85, P 70, R 16.   

Physical exam is normal.