DHA Endocrinology exam questions

6 worked Endocrinology practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Adrenal Disorders

   A 39-year-old woman has a 4 cm adrenal phaeochromocytoma with markedly raised plasma normetanephrine. Surgery is planned. What is the correct preoperative medical preparation?

   1. ABeta-blocker first, then add an alpha-blocker
   2. BAlpha-blocker first, adding a beta-blocker later if needed
   3. CBeta-blocker alone for two weeks before surgery
   4. DNo blockade, with IV fluids on the day of surgery
   Show answer and explanation

   Correct answer: B. Alpha-blocker first, adding a beta-blocker later if needed

   Alpha-adrenergic blockade (for example phenoxybenzamine or doxazosin) is started first, usually 7-14 days before surgery, with liberal salt and fluid intake. Starting a beta-blocker first leaves alpha-mediated vasoconstriction unopposed and can precipitate a hypertensive crisis.

   Reference: Endocrine Society Clinical Practice Guideline: Pheochromocytoma and Paraganglioma 2014

2. Question 2 · Calcium, Bone and Parathyroid

   A 62-year-old postmenopausal woman has DXA T-scores of -1.6 at the lumbar spine and -2.7 at the femoral neck. How is her bone density classified?

   1. AOsteoporosis
   2. BOsteopenia
   3. CNormal bone density
   4. DSevere established osteoporosis
   Show answer and explanation

   Correct answer: A. Osteoporosis

   The WHO defines osteoporosis as a T-score of -2.5 or lower at the spine, femoral neck or total hip, and the lowest site is used. Severe established osteoporosis also requires a fragility fracture, which she does not have.

   Reference: WHO Technical Report Series 843 (1994)

3. Question 3 · Diabetes Mellitus

   A 46-year-old asymptomatic man has a routine HbA1c measured with a standardised laboratory assay. Which HbA1c value, if confirmed on repeat testing, meets the diagnostic threshold for diabetes mellitus?

   1. A42 mmol/mol (6.0%)
   2. B39 mmol/mol (5.7%)
   3. C48 mmol/mol (6.5%)
   4. D53 mmol/mol (7.0%)
   Show answer and explanation

   Correct answer: C. 48 mmol/mol (6.5%)

   An HbA1c of 48 mmol/mol (6.5%) or higher is diagnostic of diabetes when confirmed in an asymptomatic person. Values of 39-47 mmol/mol (5.7-6.4%) define prediabetes in ADA criteria, so 42 mmol/mol indicates increased risk rather than diabetes.

   Reference: ADA Standards of Care in Diabetes 2025

4. Question 4 · Lipids, Obesity and Metabolism

   A 44-year-old man with poorly controlled type 2 diabetes has fasting triglycerides of 14 mmol/L and LDL that cannot be calculated. He has had no pancreatitis. Besides glycaemic control and stopping alcohol, what is the most appropriate drug to reduce pancreatitis risk?

   1. AEzetimibe
   2. BColesevelam
   3. CEvolocumab
   4. DFenofibrate
   Show answer and explanation

   Correct answer: D. Fenofibrate

   Triglycerides above 10 mmol/L carry a substantial risk of pancreatitis, and fibrates are the most effective oral agents for lowering them. Bile acid sequestrants such as colesevelam can raise triglycerides further and are avoided.

   Reference: ESC/EAS Guidelines for the Management of Dyslipidaemias 2019

5. Question 5 · Pituitary and Hypothalamic Disorders

   A malnourished 58-year-old man with alcohol use disorder and hypokalaemia has chronic asymptomatic hyponatraemia with sodium 112 mmol/L. To minimise the risk of osmotic demyelination, what is the maximum rise in sodium over the first 24 hours?

   1. A16 mmol/L
   2. B12 mmol/L
   3. C8 mmol/L
   4. D20 mmol/L
   Show answer and explanation

   Correct answer: C. 8 mmol/L

   In patients at high risk of osmotic demyelination, such as those with alcoholism, malnutrition or hypokalaemia, correction should not exceed 8 mmol/L in any 24-hour period. Limits of 10-12 mmol/L apply to lower-risk patients, so 12 mmol/L is too fast here.

   Reference: European Clinical Practice Guideline on Hyponatraemia 2014

6. Question 6 · Pituitary and Hypothalamic Disorders

   A 31-year-old man with polyuria undergoes a water deprivation test. After deprivation, urine osmolality is 210 mOsm/kg with rising plasma osmolality. After desmopressin, urine osmolality rises to 640 mOsm/kg. What is the most likely diagnosis?

   1. APrimary (dipsogenic) polydipsia
   2. BNephrogenic diabetes insipidus
   3. COsmotic diuresis from glycosuria
   4. DCentral diabetes insipidus
   Show answer and explanation

   Correct answer: D. Central diabetes insipidus

   Failure to concentrate urine during deprivation followed by a large rise after desmopressin shows that the kidney responds to vasopressin but none is being secreted, which is central diabetes insipidus. In nephrogenic disease urine osmolality would barely change after desmopressin.

   Reference: Oxford Textbook of Endocrinology and Diabetes, 3rd ed.