Ms. X came to the OPD complaining about numbness that begins at the wrist and is experienced evenly across the hand and all fingers. All her medical investigation reports are normal and an underlying pathology is unable to be found. What will be the most probable diagnosis for her?

1. A

   Glove anaesthesia

2. B

   Glove paralysis

3. C

   La belle indifference

4. D

   Munchausen by proxy

Appeared in: UP NHM CHO 7 Sept 2022(shift-1st)

Explanation

• Glove anesthesia is a classic symptom of functional neurological symptom disorder (conversion disorder).
• It is characterized by a non-anatomical pattern of sensory loss, where numbness occurs in an area that would be covered by a glove.
• The diagnosis is strongly suggested when the patient's reported sensory loss does not follow any known dermatomal or peripheral nerve distribution.
• The fact that all medical investigations are normal helps to rule out organic causes, pointing towards a functional etiology.

Why Other Options Were Wrong

• Option B: This option describes a loss of motor function (paralysis), whereas the patient's complaint is about a sensory symptom (numbness).
• Option C: This describes a patient's emotional response (or lack thereof) to their symptoms, not the symptom itself. The question asks for the diagnosis of the physical complaint.
• Option D: This is a factitious disorder imposed on another person, typically a child by a caregiver. It does not describe a patient experiencing their own symptoms.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Functional Neurological Symptom Disorder (Conversion Disorder) to guide bedside assessment, documentation, and the next nursing action.
• Nurses must approach patients with suspected functional disorders with empathy and a non-judgmental attitude, recognizing that the symptoms are real to the patient.
• The nursing assessment should include a thorough history, focusing on recent stressors or psychological trauma, which can be triggers for conversion disorder.
• Management involves building a therapeutic relationship, avoiding reinforcement of the sick role, and encouraging participation in therapies that focus on coping with stress.

How to Approach the Question

• First, analyze the presenting complaint: numbness that begins at the wrist and covers the entire hand and fingers.
• Note the distribution of the symptom. A uniform 'glove-like' pattern is inconsistent with the known anatomical pathways of individual nerves or dermatomes.
• Consider the diagnostic findings: 'All her medical investigation reports are normal and an underlying pathology is unable to be found.' This rules out organic causes like neuropathy, nerve entrapment, or spinal cord lesions.
• Synthesize the information: The patient has a neurological symptom (numbness) without a neurological cause. This points to a functional neurological disorder.
• Evaluate the options. 'Glove anaesthesia' specifically describes this non-anatomical sensory loss. The other options describe motor loss, a behavioral sign, or a different psychiatric disorder.

Concept Tested & Keywords

• Concept Tested: Functional Neurological Symptom Disorder (Conversion Disorder)
• Stem keywords: numbness, wrist, hand, fingers, normal medical investigation, no underlying pathology
• Lead-in keywords: most probable diagnosis
• Clinical cues: The pattern of numbness covering the entire hand and all fingers evenly is a classic non-anatomical distribution.
• Clinical cues: Normal investigation reports are crucial for ruling out organic causes like nerve compression or neuropathy.

Question ID

QBihqwZsNNYJYOxCw_YtsO

Copy ID

Reference Book

E6 Medicine Macleod Clinical Examination 15e pp. 167-169, 170-172