Endocrinology: insulinoma: practice question

A General 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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General Medicine · Endocrinology: insulinoma

Sample item

A 40-year-old woman has episodes of confusion on fasting that resolve with glucose. During an episode, glucose is 38 mg/dL with high insulin, high C-peptide and a negative sulfonylurea screen. What is the diagnosis?

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

The answer and the reasoning

A. Insulinoma

Whipple triad of symptoms of hypoglycaemia, low glucose and relief with glucose is present. High endogenous insulin with high C-peptide and a negative sulfonylurea screen indicates insulinoma, localised by CT, MRI or endoscopic ultrasound. Exogenous insulin gives low C-peptide, and sulfonylurea use gives positive screens.

Option by option

  • A. Insulinoma (correct)

    Correct. Inappropriately high insulin and C-peptide with negative screen indicates insulinoma.

  • B. Sulfonylurea ingestion

    A sulfonylurea screen would be positive.

  • C. Adrenal insufficiency

    Adrenal insufficiency causes low cortisol and suppressed insulin.

  • D. Exogenous insulin administration

    Exogenous insulin suppresses C-peptide.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Insulinoma. Whipple triad of symptoms of hypoglycaemia, low glucose and relief with glucose is present.

Why is "Sulfonylurea ingestion" not the answer?

A sulfonylurea screen would be positive.

Why is "Adrenal insufficiency" not the answer?

Adrenal insufficiency causes low cortisol and suppressed insulin.

Why is "Exogenous insulin administration" not the answer?

Exogenous insulin suppresses C-peptide.

What concept does this question test?

It tests Endocrinology: insulinoma in General Medicine. High endogenous insulin with high C-peptide and a negative sulfonylurea screen indicates insulinoma, localised by CT, MRI or endoscopic ultrasound. Exogenous insulin gives low C-peptide, and sulfonylurea use gives positive screens.

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 Endocrinology: insulinoma?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General 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.