Spontaneous Hypoglycemia (Non-diabetic) MCQ Quiz | Endocrinology & Metabolism

Welcome to this multiple-choice quiz on Spontaneous Hypoglycemia in non-diabetic individuals. This module is a critical component of the Endocrinology syllabus for MBBS students, focusing on the diagnostic challenges and diverse etiologies beyond diabetes. This quiz contains 25 questions designed to test your understanding of Whipple’s triad, the distinction between fasting and reactive hypoglycemia, and the workup for conditions like insulinoma, non-islet cell tumors, and adrenal insufficiency. Evaluate your knowledge of interpreting lab results, including insulin, C-peptide, and proinsulin levels, to pinpoint the underlying cause. After submitting your answers, you will see your score and can review the correct responses. You can also download all questions with their correct answers in a PDF format for future revision.

1. Which of the following constitutes Whipple’s triad for diagnosing hypoglycemia?

2. In an otherwise healthy adult, what is the most common cause of endogenous hyperinsulinemic fasting hypoglycemia?

3. A patient presents with fasting hypoglycemia. Which set of laboratory findings is most consistent with an insulinoma?

4. Surreptitious (factitious) injection of exogenous insulin is characterized by which of the following laboratory profiles during a hypoglycemic episode?

5. What is considered the “gold standard” diagnostic test for insulinoma?

6. Non-islet cell tumor hypoglycemia (NICTH) is most commonly mediated by the overproduction of which substance?

7. A patient who underwent gastric bypass surgery two years ago now presents with postprandial hypoglycemic episodes occurring 2-3 hours after meals. This condition is best classified as:

8. A “critical sample” drawn during a spontaneous episode of symptomatic hypoglycemia should ideally include measurement of:

9. Which laboratory profile is characteristic of hypoglycemia induced by surreptitious sulfonylurea ingestion?

10. Primary adrenal insufficiency (Addison’s disease) can cause fasting hypoglycemia primarily due to a deficiency of which hormone?

11. In a patient with fulminant hepatic failure, the primary mechanism leading to hypoglycemia is:

12. A patient presents with hypoglycemia. Labs reveal suppressed insulin and C-peptide levels, but elevated beta-hydroxybutyrate. This profile points towards a cause that is:

13. Autoimmune hypoglycemia (Hirata’s disease) is characterized by the presence of:

14. After biochemical confirmation of an insulinoma, which imaging modality is generally considered the most sensitive for localization of the tumor?

15. What is the definitive treatment for a single, localized insulinoma?

16. A 6-month-old infant presents with severe fasting hypoglycemia, hepatomegaly, lactic acidosis, and hyperlipidemia. This clinical picture is most suggestive of:

17. During a 72-hour fast, what is the primary purpose of administering glucagon once hypoglycemia is documented?

18. Nesidioblastosis, a cause of persistent hyperinsulinemic hypoglycemia of infancy (PHHI), refers to:

19. A patient consistently develops neuroglycopenic symptoms 4-5 hours after a high-carbohydrate meal. This pattern is characteristic of:

20. Besides insulin and sulfonylureas, which class of drugs is well-recognized to cause severe hypoglycemia, especially in the elderly and those with renal impairment?

21. A mixed-meal test is primarily used in the diagnostic workup of which condition?

22. In a patient with non-islet cell tumor hypoglycemia (NICTH), what are the expected levels of insulin, C-peptide, and proinsulin during a hypoglycemic episode?

23. What is the primary mechanism of alcohol-induced hypoglycemia, particularly in a malnourished individual?

24. For a patient with biochemically confirmed endogenous hyperinsulinism but negative non-invasive imaging (CT, MRI, EUS), what is the next appropriate invasive localization procedure?

25. Which medication is commonly used for the medical management of inoperable or metastatic insulinoma by inhibiting insulin secretion?