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FND Diagnosis Communication — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatryFND Diagnosis CommunicationMRCPsych Paper B

A 45-year-old man is assessed for intermittent left leg weakness. The neurologist demonstrates a positive Hoover's sign, showing preserved automatic hip extension despite impaired voluntary movement, and diagnoses functional neurological disorder. The patient asks, "Are you saying that my tests are normal and nothing is wrong?" Which response is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — The weakness is real; the positive sign supports FND, a potentially reversible problem of nervous-system functioning rather than structural damage.

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

B is correct. FND should be explained as a positive, rule-in diagnosis rather than merely the absence of structural disease. The clinician should validate that the weakness is real and involuntary, explain the disturbance in nervous-system functioning, and use the positive Hoover's sign to show how the diagnosis was reached and why recovery may be possible. Normal investigations alone do not establish FND, so A and E are inadequate and potentially invalidating. C incorrectly assumes that symptoms must arise from unconscious psychological conflict or trauma; psychological stressors are neither necessary for diagnosis nor universal. D is wrong because a neurologist can diagnose FND from positive neurological features, without psychiatric confirmation. A clear explanation provides the foundation for appropriate rehabilitation and, where indicated, psychological treatment.

Reference: Stone J, Burton C, Carson A. Recognising and explaining functional neurological disorder. BMJ. 2020;371:m3745. https://www.plymouthhospitals.nhs.uk/display-pil/pil-fnd-understanding-the-diagnosis-8013