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FND – Positive Diagnostic Signs — SCE Neurology MCQ

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HardNeuropsychiatryFND – Positive Diagnostic SignsSCE Neurology

A 35-year-old woman with FND (functional limb weakness and dissociative seizures) asks about positive diagnostic signs. Her neurologist explains that FND is NOT a diagnosis of exclusion. What positive clinical signs support the diagnosis?

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Correct answer: C — Hoover sign, tremor entrainment and distractibility

The best answer is “Hoover sign, tremor entrainment and distractibility”. NICE bases epilepsy diagnosis and treatment on seizure type, syndrome, recurrence risk, comorbidity, pregnancy potential and medicine harms; typical provoked seizures are managed by correcting the provoking cause. The alternatives “Normal imaging without a positive neurological sign”, “Improvement after reassurance during one appointment”, “Psychiatric comorbidity without examination inconsistency”, “Failure to identify an established structural diagnosis” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations