Functional neurological symptoms

Question 1

Functional symptoms in GI

Answer 1

IBS

Question 2

Functional symptoms in resp medicine

Answer 2

Chronic cough

Question 3

Functional symptoms in rheumatology

Answer 3

Fibromyalgia

Question 4

Functional symptoms in gynaecology

Answer 4

Chronic pelvic pain

Dysmenorrhoea

Question 5

Functional symptoms in cardiology

Answer 5

Atypical/non-cardiac chest pain

Question 6

Functional symptoms in ENT

Answer 6

Functional dysphonia

Question 7

Define functional symptoms

Answer 7

change in function rather than structure of a system

Question 8

Questions to ask when taking a history of someone with functional symptoms (6)

Answer 8

List all symptoms
If it has disabled their daily living activities
When did it start
Any dissociative symptoms - not in touch with their surroundings
What do they think it is
How is their social life

Question 9

What may be found on examination of someone with functional neurological symptoms (7)

Answer 9

Inconsistency of signs
Positive functional signs
Absence of signs of disease
Eye movements: convergence spasm
Tremor: disappears with distraction, entrainment
Paralysis
Fixed dystonia - contracture

Question 10

What special sign may be a sign of functional weakness

Answer 10

Hoover’s sign - Hip extension is weak when tested directly. (B) Hip extension is normal when the patient is asked to flex the opposite hip.

Question 11

Management of functional symptoms (4)

Answer 11

Explain what they have + reassure it is real
Use metaphors to explain their condition
Discuss antidepressants
Referral to secondary care