Injuries and wounds: keraunoparalysis in lightning: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Injuries and wounds: keraunoparalysis in lightning

Sample item

A hiker is struck by lightning and survives. In the first hour both legs are cold, mottled and pulseless, with loss of movement and sensation. Power returns to the limbs over a few hours. What is the mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Transient vasospasm and autonomic disturbance known as keraunoparalysis

Keraunoparalysis is a transient paralysis with a cold, pulseless, mottled and numb limb seen after a lightning strike, probably from sympathetic overactivity and arterial spasm. It usually recovers within hours, so early surgery for presumed arterial occlusion is not needed. Lower limbs are most often affected.

Option by option

  • A. Thrombosis of the femoral arteries needing amputation

    Thrombosis would be permanent without treatment, whereas this recovered.

  • B. Spinal cord transection from the current

    Cord transection would not recover within hours.

  • C. Transient vasospasm and autonomic disturbance known as keraunoparalysis (correct)

    Correct. Transient vasospasm explains the cold pulseless limbs that recover.

  • D. Hysterical conversion with no organic basis

    Mottled pulseless limbs are objective signs and are not conversion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Transient vasospasm and autonomic disturbance known as keraunoparalysis. Keraunoparalysis is a transient paralysis with a cold, pulseless, mottled and numb limb seen after a lightning strike, probably from sympathetic overactivity and arterial spasm.

Why is "Thrombosis of the femoral arteries needing amputation" not the answer?

Thrombosis would be permanent without treatment, whereas this recovered.

Why is "Spinal cord transection from the current" not the answer?

Cord transection would not recover within hours.

Why is "Hysterical conversion with no organic basis" not the answer?

Mottled pulseless limbs are objective signs and are not conversion.

What concept does this question test?

It tests Injuries and wounds: keraunoparalysis in lightning in Forensic Medicine. It usually recovers within hours, so early surgery for presumed arterial occlusion is not needed. Lower limbs are most often affected.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Injuries and wounds: keraunoparalysis in lightning?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.