A 62-year-old man comes to the office due to tremors. The pati | Uworld | Step 2ck

A 62-year-old man comes to the office due to tremors. The patient first noticed them several years ago, but they have progressively worsened and now cause difficulty with daily activities such as drinking tea and buttoning clothing. His wife reports that he also has a mild head tremor. His father had similar symptoms, which worsened as he advanced in age. The patient has a history of osteoarthritis, hypertension, and gastroesophageal reflux disease. He does not drink alcohol. Blood pressure is 144/80 mm Hg and pulse is 82/min. Physical examination shows a mild tremor of the head and a tremor of the bilateral upper extremities when the arms are extended. The tremor worsens during finger-to-nose testing. Muscle tone, deep tendon reflexes, limb coordination, and gait are normal.