Prometric Exam Questions for Endocrinology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the END5492 Paper

The endocrinology specialist paper (END5492; consultants sit CEN6052) is weighted towards diabetes, which affects roughly one in five adults in several Gulf states, with thyroid, adrenal, pituitary and bone disease making up the rest. It is written for the endocrine registrar who runs a diabetes clinic in the morning and manages an adrenal crisis in the afternoon. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the endocrinologist and diabetologist guide. For timed papers use the Endocrinology specialist bank or the consultant bank; the Internal Medicine bank covers the overlap.

Diabetes

Question 1

A 58-year-old with type 2 diabetes, an HbA1c of 8.5% on metformin, a BMI of 36 and chronic kidney disease with albuminuria (eGFR 50) needs intensification. The best choice is:

1. A sulfonylurea
2. An SGLT2 inhibitor for kidney and cardiovascular protection, with a GLP-1 receptor agonist added or chosen for weight and cardiovascular benefit, independent of HbA1c
3. Pioglitazone
4. Insulin as the only option

Answer: B. SGLT2 inhibitors slow CKD progression down to low eGFR thresholds; GLP-1 agonists reduce events and weight. Metformin is dose-reduced below eGFR 45 and stopped below 30.

Question 2

A 22-year-old with type 1 diabetes has recurrent nocturnal hypoglycaemia on twice-daily premixed insulin. The best change is:

1. Stop insulin at night
2. A basal-bolus regimen with a long-acting analogue and rapid-acting analogues at meals, carbohydrate counting education, and continuous glucose monitoring, with pump therapy or automated insulin delivery considered
3. Add a sulfonylurea
4. Reduce total insulin by half

Answer: B. Analogue basal-bolus regimens and CGM reduce hypoglycaemia; premixed regimens have little flexibility.

Question 3

A 70-year-old with type 2 diabetes presents with a glucose of 45 mmol/L, serum osmolality of 340 mOsm/kg, no ketonaemia and a pH of 7.35. The management differs from DKA in that:

1. Insulin is started at a higher rate immediately
2. Fluid replacement is the priority with insulin started at a low fixed rate only once glucose stops falling with fluids alone, sodium and osmolality are corrected slowly, and VTE prophylaxis is given because of the high thrombosis risk in hyperosmolar hyperglycaemic state
3. Bicarbonate is given routinely
4. No potassium is required

Answer: B. HHS carries higher mortality than DKA; rapid osmolality shifts cause cerebral oedema. Potassium is monitored and replaced as in DKA.

Question 4

A woman with type 2 diabetes on metformin and an SGLT2 inhibitor is planning pregnancy. Preconception advice includes:

1. Continue all current drugs
2. Stop the SGLT2 inhibitor and any statin or ACE inhibitor, switch to insulin (metformin may continue in some guidelines), aim for an HbA1c below about 6.5% before conception, take 5 mg folic acid, and arrange retinal and renal screening
3. Start a GLP-1 agonist
4. No changes until pregnancy is confirmed

Answer: B. Preconception glycaemic control reduces congenital anomalies; most non-insulin agents are stopped.

Thyroid

Question 5

A 30-year-old woman has weight loss, tremor, a diffuse goitre, a suppressed TSH, raised free T4 and positive TSH receptor antibodies. First-line management options are:

1. Thyroidectomy immediately
2. Carbimazole (or methimazole) with a beta blocker for symptoms, usually for 12 to 18 months, with radioiodine or surgery for relapse or by preference, and propylthiouracil preferred in the first trimester of pregnancy
3. Levothyroxine
4. Observation only

Answer: B. Graves' disease is treated medically first in most young patients; agranulocytosis warning (sore throat, fever) is mandatory counselling. Radioiodine is avoided in active eye disease and pregnancy.

Question 6

A 45-year-old has a 2.5 cm thyroid nodule with microcalcifications and irregular margins on ultrasound (TI-RADS high suspicion). The next step is:

1. Repeat ultrasound in a year
2. Ultrasound-guided fine-needle aspiration, with management by the Bethesda cytology category: surgery for malignant or suspicious results, molecular testing or diagnostic lobectomy for indeterminate results
3. Radioiodine
4. Thyroid suppression with levothyroxine

Answer: B. FNA thresholds depend on size and sonographic risk; TSH is checked first, and a suppressed TSH prompts an uptake scan because hot nodules are rarely malignant.

Question 7

A 68-year-old with untreated hypothyroidism presents with hypothermia, bradycardia, hyponatraemia and reduced consciousness after a chest infection. The management is:

1. Oral levothyroxine at the usual dose
2. Treat as myxoedema coma: intravenous levothyroxine (with or without liothyronine), intravenous hydrocortisone until adrenal insufficiency is excluded, passive rewarming, supportive care and treatment of the precipitant in a high-dependency setting
3. Active rapid rewarming only
4. Diuretics for the hyponatraemia

Answer: B. Steroids are given before thyroid hormone in case of coexisting adrenal insufficiency; mortality remains high.

Adrenal and pituitary

Question 8

A 35-year-old on long-term prednisolone for asthma presents with vomiting, hypotension and a sodium of 128 mmol/L after missing doses during a gastroenteritis. The immediate management is:

1. Wait for a cortisol result
2. Intravenous hydrocortisone 100 mg immediately then continued, intravenous fluids, treatment of the precipitant, and sick-day rule education with a steroid card before discharge
3. Oral steroids only
4. Fludrocortisone alone

Answer: B. Adrenal crisis is treated on suspicion. Long-term exogenous steroids suppress the axis, and sick-day rules (double the dose when unwell, injectable hydrocortisone if vomiting) prevent crises.

Question 9

A 40-year-old has hypertension resistant to three drugs and a potassium of 3.1 mmol/L. The screening test and its interpretation are:

1. 24-hour urinary catecholamines; high means Conn's syndrome
2. Plasma aldosterone-to-renin ratio after correcting potassium and withdrawing interfering drugs where possible; a raised ratio suggests primary aldosteronism, confirmed by suppression testing and localised by CT and adrenal vein sampling before surgery
3. Dexamethasone suppression test only
4. No test; add a fourth drug

Answer: B. Primary aldosteronism is the commonest secondary cause of hypertension; unilateral adenomas are cured by adrenalectomy, bilateral disease is treated with spironolactone.

Question 10

A 32-year-old woman has galactorrhoea, amenorrhoea and a prolactin of 4,500 mU/L; MRI shows a 7 mm pituitary microadenoma. First-line treatment is:

1. Transsphenoidal surgery
2. A dopamine agonist such as cabergoline, after excluding drug causes, hypothyroidism and pregnancy, with surgery reserved for resistance or intolerance
3. Radiotherapy
4. Oral contraceptive only

Answer: B. Prolactinomas respond to dopamine agonists even when large; macroadenomas also need visual field assessment and pituitary function testing.

Question 11

A 50-year-old man has enlarging hands and feet, coarse facial features, sweating and new diabetes. The diagnostic test and treatment are:

1. Random growth hormone; levodopa
2. IGF-1 as the screening test, with failure of growth hormone suppression on an oral glucose tolerance test confirming acromegaly, then pituitary MRI and transsphenoidal surgery as first-line treatment, with somatostatin analogues for residual disease
3. Prolactin only
4. Thyroid function only

Answer: B. Acromegaly increases cardiovascular, metabolic and colonic neoplasia risk; colonoscopy screening is part of care.

Calcium, bone, PCOS and obesity

Question 12

A 60-year-old woman has a calcium of 2.85 mmol/L, a PTH at the upper end of normal, a low phosphate and a history of kidney stones. The diagnosis and management are:

1. Hypercalcaemia of malignancy; bisphosphonates
2. Primary hyperparathyroidism, because an inappropriately non-suppressed PTH with hypercalcaemia is diagnostic; parathyroidectomy is indicated for stones, osteoporosis, calcium above 0.25 mmol/L over the upper limit, reduced eGFR or age under 50, after localisation imaging
3. Vitamin D excess; stop supplements
4. Familial hypocalciuric hypercalcaemia; no action

Answer: B. A 24-hour urine calcium excludes FHH. Vitamin D deficiency, very common in the Gulf, is corrected before interpreting borderline cases.

Question 13

A 65-year-old woman has a DXA T-score of −2.8 at the femoral neck with no prior fracture, and a vitamin D of 25 nmol/L. The management is:

1. Calcium alone
2. Replace vitamin D and ensure calcium intake first, then an oral bisphosphonate as first line (or denosumab or zoledronate where oral therapy is unsuitable), with fracture risk reassessment and anabolic therapy for very high risk
3. No treatment until a fracture
4. Hormone replacement as first line at this age

Answer: B. Bisphosphonates are given only after vitamin D repletion to avoid hypocalcaemia; dental review precedes antiresorptives.

Question 14

A 26-year-old woman with irregular cycles, hirsutism and polycystic ovaries on ultrasound has a BMI of 31 and impaired glucose tolerance; she does not want to conceive now. Management includes:

1. Clomifene
2. Lifestyle intervention for weight loss, a combined oral contraceptive for cycle regulation and hirsutism (if no contraindications), metformin for metabolic features, and screening for diabetes, dyslipidaemia and sleep apnoea
3. Oral steroids
4. Oophorectomy

Answer: B. PCOS is a lifelong metabolic condition; ovulation induction with letrozole is reserved for when pregnancy is desired.

Question 15

A 45-year-old man with a BMI of 38, hypertension and prediabetes has failed structured lifestyle programmes. Appropriate next-step options are:

1. Very low energy diet unsupervised for a year
2. Pharmacotherapy with a GLP-1 or dual GIP/GLP-1 receptor agonist alongside lifestyle support, with referral for bariatric surgery assessment given a BMI over 35 with comorbidity
3. Thyroid hormone to speed metabolism
4. No further options

Answer: B. Incretin-based therapies produce 15 to 20% weight loss; bariatric surgery remains the most effective treatment and is widely available in the Gulf.

How to use these questions

• Learn the diabetes drug algorithm by comorbidity: CKD, cardiovascular disease, obesity, pregnancy.
• Know the emergencies as sequences: DKA, HHS, adrenal crisis, myxoedema coma, thyroid storm, severe hypercalcaemia.
• Memorise the diagnostic tests for adrenal, pituitary and calcium disorders and their interfering factors.
• Practise under time in the Endocrinology bank with the error-log method.

Internal medicine content overlaps heavily (internal medicine sample questions), and dietitians share the diabetes and obesity material (dietitian sample questions). Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool; endocrinologists and diabetologists are in high demand across the Gulf.

Frequently asked questions

How many questions are in the endocrinology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and about 70% for consultants.

How much of the paper is diabetes?

A large share, often a third or more, reflecting the regional disease burden.

Can a DM or MRCP endocrinology holder skip the exam?

Often, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.