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MS – Heat Sensitivity Management — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Heat Sensitivity ManagementSCE Neurology

A patient has a variable hand tremor that changes frequency to match a paced tapping rhythm performed by the contralateral hand and markedly diminishes during a complex distraction task. MRI shows incidental mild small-vessel disease. Which conclusion is best supported?

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Correct answer: D — Entrainment and distractibility are positive signs of functional tremor despite incidental MRI abnormalities

Explanation lettering: E = shown as A · D = shown as C · C = shown as D · A = shown as E

A is wrong because functional tremor is a positive bedside diagnosis and can coexist with structural abnormalities. B ignores the marked variability and entrainment that distinguish functional from essential tremor. C is correct: frequency entrainment to a competing rhythm and improvement with distraction are internally inconsistent with a fixed pathological oscillator and provide positive evidence for functional tremor. D is wrong because DSM-5 does not require an identifiable psychological stressor. E misinterprets entrainment; cerebellar tremor is not expected to adopt a voluntary tapping frequency.

Reference: Functional neurological disorders: the neurological assessment as treatment: https://pn.bmj.com/content/16/1/7