Functional neurological symptoms — OSCE: diagnosis conversation and coordinated plan

Candidate brief

You are the general paediatrician. Mia is a 14-year-old referred for three weeks of a fluctuating abnormal gait after a minor ankle twist. Examination shows internally inconsistent weakness with a positive Hoover sign, non-dermatomal sensory loss split at the midline, and a gait that improves with distraction. MRI brain and spine are normal. She has missed two weeks of school and is increasingly withdrawn. Her parent is frightened, convinced "something has been missed", and is asking for more scans. ^[1]

You have eight minutes for Station A (the diagnosis conversation) and eight minutes for Station B (the coordinated plan). ^[1]