Beta-blockers: masking of hypoglycaemia: practice question

A Pharmacology 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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Pharmacology · Beta-blockers: masking of hypoglycaemia

Sample item

A man with type 1 diabetes treated with insulin is started on propranolol for essential tremor and anxiety. Which warning symptom of hypoglycaemia is most likely to remain noticeable?

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

The answer and the reasoning

A. Sweating

Non-selective beta-blockers mask the adrenergic warning features of hypoglycaemia such as tremor and palpitations and may also delay recovery by blocking beta2-mediated glycogenolysis. Sweating is mediated by cholinergic sympathetic fibres acting on muscarinic receptors and is therefore preserved, and may even become the main warning sign.

Option by option

  • A. Sweating (correct)

    Correct. Sympathetic sweating uses muscarinic cholinergic transmission, which beta-blockers do not block.

  • B. Anxiety with tachycardia

    Tachycardia is a beta1 effect and is suppressed, so this cue is lost.

  • C. Tremor

    Tremor is a beta2-mediated effect and is blunted by propranolol.

  • D. Palpitations

    Palpitations depend on beta1 stimulation and are blocked.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Sweating. Non-selective beta-blockers mask the adrenergic warning features of hypoglycaemia such as tremor and palpitations and may also delay recovery by blocking beta2-mediated glycogenolysis.

Why is "Anxiety with tachycardia" not the answer?

Tachycardia is a beta1 effect and is suppressed, so this cue is lost.

Why is "Tremor" not the answer?

Tremor is a beta2-mediated effect and is blunted by propranolol.

Why is "Palpitations" not the answer?

Palpitations depend on beta1 stimulation and are blocked.

What concept does this question test?

It tests Beta-blockers: masking of hypoglycaemia in Pharmacology. Sweating is mediated by cholinergic sympathetic fibres acting on muscarinic receptors and is therefore preserved, and may even become the main warning sign.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Beta-blockers: masking of hypoglycaemia?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.