She has no pets and her hobbies include knitting and watching television. On examination, the patient's vital signs are normal. The patient is noted to be alert and to have a fine tremor at rest. She is oriented to person, place and time and has intact long-term memory. The patient does have short-term memory difficulty.
Reflexes are symmetric and normal.
No ataxia is noted. The patient has good hand grip strength, but is unable to get out of a chair without assistance. This patient's presentation is consistent with a toxic myopathy. As in this case, there is usually diffuse and symmetric involvement. Myopathic weakness is noted more in the proximal muscles and sensory findings are lacking.