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Medicine Review MCQs-IV

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In patients of porphyria predisposed to neurovisceral attacks all of the following can be a part of management EXCEPT-

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Intravenous glucose,-terminate acute attacks through a reduction in δ-aminolaevulinic acid (ALA) synthetase activity, leading to reduced ALA and porphyrin synthesis.


Administration of haem (haematin or haem arginate) has been shown to reduce metabolite excretory rates, relieve pain and accelerate recovery.
Gonadotrophin-releasing hormone analogues - suppression of the menstrual cycle.
Exogenous oestrogens -Oral contraceptive pill is a common precipitating factor

Pseudohypoglycemia is an event during which the person with diabetes reports typical symptoms of hypoglycemia but has a measured glucose level

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Pseudohypoglycemia is an event during which the person with diabetes reports typical symptoms of hypoglycemia but has a measured glucose level >70 mg/dL

Which is the first Physiologic response to hypoglycemia in normal subjects?

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First defense- decrease in insulin secretion
glycemic threshold of 80 to 85 mg/dL


Second defense - increase in glucagon secretion
glycemic threshold for glucagon is 65 to 70 mg
Third defense - increase in epinephrine secretion
glycemic threshold for epinephrine secretion is also 65 to 70 mg/dL

Which is the first Physiologic response to hypoglycemia in patients with type 1 diabetes and longstanding type 2 diabetes. ?

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First defense- to suppress insulin release, cannot occur in patients with absolute beta cell failure, ie, those with type 1 diabetes and longstanding type 2 diabetes.


Main defense against hypoglycemia is increased release of counter-regulatory hormones- glucagon and epinephrine, which raise plasma glucose concentrations by stimulating glucose production and by antagonizing the insulin-induced increase in glucose utilization.

Hypoglycemia causes neuronal death when glucose levels have fallen below ------- for some period.

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Hypoglycemia causes neuronal death when glucose levels have fallen below 18 mg/dL for some period.

Impairment of action and judgment usually becomes obvious below -------- mg/dl

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Impairment of action and judgment usually becomes obvious below 2.2 mmol/l (40 mg/dl).
As blood glucose levels fall below 0.55 mmol/l (10 mg/dl), most neurons become electrically silent and nonfunctional, resulting in coma.

Neuroglycopenia without hypoglycemia is called -

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Hypoglycorrhachia is defined as an abnormally low glucose concentration within the cerebrospinal fluid is often suggestive of an underlying infectious or systemic process.
This is often defined as a glucose concentration less than 40 mg/dL.


Hypoglycorrhachia - Severe neuroglycopenic effects occurred despite normal blood glucose levels.

Symptomatic hypoglycemia occurring within four hours after a high carbohydrate meal is

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Reactive hypoglycemia- is a term describing recurrent episodes of symptomatic hypoglycemia occurring within four hours after a high carbohydrate meal in people with and without diabetes.

In the US, hypoglycemia is when the blood glucose level is below ----- mg/dl within the first 24 hours of life and below ------ mg/dl thereafter

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In the US, hypoglycemia is when the blood glucose level is below 30 mg/dl within the first 24 hours of life and below 45 mg/dl thereafter

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