Free Specialty Certificate Examination in Endocrinology and Diabetes Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Specialty Certificate Examination in Endocrinology and Diabetes practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1An asymptomatic adult has a laboratory HbA1c just above the diabetes threshold, with no hyperglycaemic crisis. What is the appropriate next diagnostic step?

   1. A.Diagnose diabetes from the single result alone
   2. B.Use urine glucose as the confirmatory test
   3. C.Use a one-day CGM trace as the confirmatory test
   4. D.Obtain a confirmatory abnormal laboratory resultCorrect answer: D

   Explanation: An isolated abnormal result in this asymptomatic setting needs confirmation. The source states: "In the absence of unequivocal hyperglycemia (e.g., hyperglycemic crises), diagnosis requires confirmatory testing".

   Reference: ADA Standards of Care 2026: Diagnosis and Classification — Recommendation 2.1b

2. 2A 70-kg adult with DKA has glucose 26 mmol/L and potassium 4.8 mmol/L. The team starts the JBDS fixed-rate insulin regimen at 0.1 units/kg/hour. What infusion rate is required?

   1. A.0.7 units/hour
   2. B.7 units/hourCorrect answer: B
   3. C.14 units/hour
   4. D.70 units/hour

   Explanation: The guideline specifies 0.1 unit/kg/hr. Multiplying 70 kg by 0.1 units/kg/hour gives 7 units/hour. The alternatives result from dividing by an extra 10, using 0.2 units/kg/hour, or omitting the 0.1 multiplier. The guideline states: "Action 2: Commence a fixed rate intravenous insulin infusion (FRIII). (0.1unit/kg/hr based on estimate of weight)".

   Reference: JBDS 02: The Management of Diabetic Ketoacidosis in Adults — page 9, Box 1, Action 2

3. 3Retinal examination in a patient with diabetes shows new vessels arising in response to retinal ischaemia. Which stage of diabetic retinopathy does this identify?

   1. A.Mild nonproliferative diabetic retinopathy
   2. B.Moderate nonproliferative diabetic retinopathy
   3. C.Severe nonproliferative diabetic retinopathy
   4. D.Proliferative diabetic retinopathyCorrect answer: D

   Explanation: New vessel formation defines the proliferative stage. The source states: "neovascularization can occur; this is proliferative diabetic retinopathy (PDR).".

   Reference: ADA Standards of Care 2026: Retinopathy, Neuropathy, and Foot Care — Diabetic Retinopathy

4. 4A clinically stable patient with a pituitary macroadenoma is being assessed for central adrenal insufficiency. At what time should the first-line serum cortisol sample be collected?

   1. A.08:00–09:00Correct answer: A
   2. B.12:00–13:00
   3. C.16:00–17:00
   4. D.23:00–00:00

   Explanation: The guideline states: "We suggest measuring serum cortisol levels at 8–9 AM as the first-line test for diagnosing central adrenal insufficiency". An early-morning sample is recommended; a random afternoon or midnight sample is not the first-line assessment.

   Reference: Endocrine Society: Hormone Replacement in Hypopituitarism — Recommendation 1.1

5. 5An adult has a persistently suppressed TSH with normal free T4 and free T3. Which thyroid diagnosis describes this biochemical pattern?

   1. A.Overt hyperthyroidism
   2. B.Central hypothyroidism
   3. C.Primary hypothyroidism
   4. D.Subclinical hyperthyroidismCorrect answer: D

   Explanation: Normal circulating free hormones with suppressed TSH define the subclinical pattern. The source states: "Subclinical hyperthyroidism occurs with low or suppressed TSH in the presence of normal free T4 and free T3.".

   Reference: NHS Borders: Thyroid clinical referral and management guidance — Subclinical Hyperthyroidism

6. 6An adult with known primary adrenal insufficiency presents with vomiting, hypotension and suspected adrenal crisis. What immediate hydrocortisone bolus is recommended by the Society for Endocrinology?

   1. A.50 mg IV or IM
   2. B.100 mg IV or IMCorrect answer: B
   3. C.10 mg IV or IM
   4. D.20 mg IV or IM

   Explanation: The guidance states: "Hydrocortisone (immediate bolus injection of 100 mg hydrocortisone i.v. or i.m.". This is followed by ongoing stress-dose hydrocortisone and fluid resuscitation.

   Reference: Society for Endocrinology: Emergency management of adrenal crisis — Management of adrenal crisis

7. 7A man has symptoms compatible with androgen deficiency and repeatedly low morning testosterone. Which hormone measurements distinguish primary testicular failure from hypothalamic–pituitary hypogonadism?

   1. A.TSH and free T4
   2. B.ACTH and cortisol
   3. C.IGF-1 and growth hormone
   4. D.LH and FSHCorrect answer: D

   Explanation: Gonadotrophins identify whether the defect is primary or central. The source states: "distinguishing between primary (testicular) and secondary (pituitary–hypothalamic) hypogonadism by measuring serum luteinizing hormone and follicle stimulating hormone concentrations.".

   Reference: Endocrine Society: Testosterone Therapy in Men With Hypogonadism — Recommendation 1.3

8. 8An adult has persistent hypercalcaemia and a PTH concentration that is inappropriately within the normal range. Which diagnosis should be considered?

   1. A.Primary hyperparathyroidismCorrect answer: A
   2. B.Humoral hypercalcaemia of malignancy
   3. C.Vitamin D intoxication
   4. D.Granulomatous hypercalcaemia

   Explanation: The consensus states: "PHPT is diagnosed with the combination of hypercalcemia and elevated or inappropriately normal PTH". PTH-dependent hypercalcaemia supports primary hyperparathyroidism; the other listed causes generally suppress PTH. Other PTH-dependent differential diagnoses still need appropriate investigation.

   Reference: AACE Consensus Statement on Management of MEN1 — Patients with MEN1-related parathyroid tumors: Prevalence and Presentation

9. 9A woman using injectable semaglutide for weight management plans pregnancy. What minimum washout period is specified before a planned pregnancy?

   1. A.6 months
   2. B.2 monthsCorrect answer: B
   3. C.2 weeks
   4. D.1 month

   Explanation: The product information specifies a minimum two-month interval. The source states: "Semaglutide should be discontinued at least 2 months before a planned pregnancy due to the long half-life".

   Reference: Novo Nordisk: Wegovy semaglutide UK Summary of Product Characteristics — Section 4.6, Pregnancy

10. 10A laboratory receives a blood sample several hours after collection without prompt cell separation. Which measured analyte may be falsely low because cellular glycolysis continued before processing?

    1. A.Potassium
    2. B.GlucoseCorrect answer: B
    3. C.Lactate
    4. D.Ammonia

    Explanation: Continued ex-vivo glycolysis consumes glucose. The source states: "Glucose concentrations will be falsely low if samples are not processed and analyzed promptly". Potassium, lactate and ammonia are real analytes affected by delayed handling, but they are not the glucose consumed by glycolysis.

    Reference: ADA Standards of Care 2026: Diagnosis and Classification — Use of Fasting Plasma Glucose or 2-Hour Plasma Glucose