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 anaesthesia is a sensory loss pattern that covers the hand up to the wrist, not matching any nerve or dermatome.
• This presentation is typical of conversion disorder, where psychological stress manifests as neurological symptoms.
• True nerve lesions affect specific areas, not the entire hand evenly.
• Absence of organic findings and normal investigations support a functional diagnosis.

Why Other Options Were Wrong

• Option B: Glove paralysis refers to loss of movement, not sensation. The case describes numbness, not inability to move.
• Option C: La belle indifference is a psychological attitude of unconcern about symptoms, not a sensory loss pattern.
• Option D: Munchausen by proxy involves a caregiver fabricating or inducing illness in another person, not self-experienced symptoms.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition of glove anaesthesia as a functional (conversion) disorder symptom to guide bedside assessment, documentation, and the next nursing action.
• Nurses must recognize glove anaesthesia as a sign of conversion disorder to avoid unnecessary investigations and reassure the patient.
• Early identification prevents iatrogenic harm and focuses care on psychological support.
• What if? If the numbness followed a specific nerve distribution, a peripheral nerve lesion like carpal tunnel syndrome would be suspected instead.

How to Approach the Question

• Identify the pattern of sensory loss described in the stem.
• Recall that true nerve lesions follow anatomical distributions; glove-like patterns do not.
• Note the absence of organic findings and normal investigations.
• Eliminate options that refer to motor loss, emotional response, or factitious disorder imposed on others.
• Select the diagnosis that matches a non-anatomical, psychological sensory loss pattern.

Concept Tested & Keywords

• Concept Tested: Recognition of glove anaesthesia as a functional (conversion) disorder symptom
• Stem keywords: numbness, wrist, hand, all fingers, normal investigations, no pathology
• Lead-in keywords: most probable diagnosis
• Clinical cues: Numbness not following nerve distribution
• Clinical cues: No organic cause found

Question ID

QBihqwZsNNYJYOxCw_YtsO

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 1103-1105