Asterixis is commonly described on exam as what sign?

• A. Liver flap
• B. Flapping tremor
• C. Resting tremor
• D. Intention tremor

Answer: (D)

Asterixis is described as a liver flap or flapping tremor. It’s a negative motor phenomenon seen in metabolic encephalopathy (most classically hepatic failure). When you have the patient extend their arms and dorsiflex the wrists, the hands show brief, irregular lapses in tone and flap up and down instead of maintaining steady posture. This is not a true tremor.

This helps distinguish it from other tremors: a resting tremor occurs when the limb is not moved (as in Parkinson disease), and an intention tremor worsens with purposeful movement and points to cerebellar dysfunction. So the sign most often described in exams is the liver flap or flapping tremor.