A patient with cirrhosis shows hand-flapping tremors. How is this finding documented?

• A. Constructional apraxia
• B. Asterixis
• C. Fetor hepaticus
• D. Ataxia

Answer: (B)

Asterixis is the hand-flapping tremor seen in hepatic encephalopathy from liver disease. When the patient extends the wrists and holds the arms up, brief lapses in postural muscle tone cause a fleeting, rhythmic flapping motion of the hands. Document this as asterixis (liver flap) present on the neurologic exam. This sign signals metabolic dysfunction from cirrhosis and elevated ammonia affecting brain function.

Constructional apraxia would present as difficulty performing purposeful tasks like drawing, not a transient flapping tremor. Fetor hepaticus is a distinctive musty breath odor, not a motor sign. Ataxia involves lack of coordination from cerebellar dysfunction, not the brief postural lapse seen with asterixis.