Endocrinology Prometric exam questions with answers

1. Question 1Adrenal Disordersmedium

   A 42-year-old man has resistant hypertension on three drugs and a serum potassium of 3.1 mmol/L without diuretic use. What is the most appropriate initial screening test?

   1. APlasma free metanephrines
   2. B24-hour urinary free cortisol
   3. CRenal artery Doppler ultrasound
   4. DPlasma aldosterone-to-renin ratio
   Show answer and explanation▾

   Answer: D. Plasma aldosterone-to-renin ratio

   Resistant hypertension with spontaneous hypokalaemia strongly suggests primary aldosteronism, which is screened with the aldosterone-to-renin ratio. Metanephrines screen for phaeochromocytoma, which would usually cause paroxysmal symptoms rather than hypokalaemia.

2. Question 2Calcium, Bone and Parathyroidhard

   A 30-year-old asymptomatic man has calcium 2.75 mmol/L and a mildly raised PTH. His father had a failed neck exploration for hypercalcaemia. His calcium-to-creatinine clearance ratio is 0.006. What is the most likely diagnosis?

   1. APrimary hyperparathyroidism
   2. BTertiary hyperparathyroidism
   3. CParathyroid carcinoma
   4. DFamilial hypocalciuric hypercalcaemia
   Show answer and explanation▾

   Answer: D. Familial hypocalciuric hypercalcaemia

   A calcium-to-creatinine clearance ratio below 0.01 with a family history of failed parathyroid surgery strongly suggests FHH due to an inactivating CASR variant, which does not need surgery. Primary hyperparathyroidism usually gives a ratio above 0.02.

3. Question 3Calcium, Bone and Parathyroidmedium

   Twenty hours after total thyroidectomy, a woman has perioral tingling, carpopedal spasm and a corrected calcium of 1.70 mmol/L. What is the most appropriate immediate treatment?

   1. AOral calcium carbonate only
   2. BIV magnesium sulfate only
   3. CIV calcium gluconate
   4. DSubcutaneous teriparatide
   Show answer and explanation▾

   Answer: C. IV calcium gluconate

   Symptomatic acute hypocalcaemia with tetany needs IV calcium gluconate, followed by oral calcium and activated vitamin D for hypoparathyroidism. Oral calcium alone acts too slowly, and magnesium is only added if hypomagnesaemia is present.

4. Question 4Diabetes Mellitusmedium

   A 61-year-old man with type 2 diabetes and heart failure with reduced ejection fraction (LVEF 32%) has an HbA1c of 63 mmol/mol (7.9%) on metformin. eGFR is 58 mL/min/1.73 m2. Which additional agent is most appropriate?

   1. APioglitazone
   2. BSaxagliptin
   3. CGlimepiride
   4. DDapagliflozin
   Show answer and explanation▾

   Answer: D. Dapagliflozin

   SGLT2 inhibitors reduce heart failure hospitalisation and cardiovascular death in HFrEF independent of glucose lowering and are recommended at this eGFR. Pioglitazone causes fluid retention and is contraindicated in heart failure, and saxagliptin was associated with increased heart failure hospitalisation.

5. Question 5Pituitary and Hypothalamic Disorderseasy

   A 27-year-old woman with amenorrhoea and galactorrhoea has prolactin of 4,800 mU/L and a 14 mm pituitary adenoma without visual field loss. Pregnancy is excluded. What is the first-line treatment?

   1. ACabergoline
   2. BTranssphenoidal surgery
   3. CPituitary radiotherapy
   4. DOctreotide
   Show answer and explanation▾

   Answer: A. Cabergoline

   Dopamine agonists, preferably cabergoline, normalise prolactin and shrink most macroprolactinomas and are first-line even when the tumour is large. Surgery is reserved for intolerance or resistance, and somatostatin analogues are used in acromegaly rather than prolactinoma.

6. Question 6Diabetes Mellitusmedium

   A lean 23-year-old woman was diagnosed with diabetes at 19. Her mother and grandmother had diabetes diagnosed before 25. Islet autoantibodies are negative, C-peptide is preserved and genetic testing confirms an HNF1A variant. Which treatment is most appropriate?

   1. ABasal-bolus insulin
   2. BLow-dose sulfonylurea
   3. CNo treatment, monitor only
   4. DSGLT2 inhibitor monotherapy
   Show answer and explanation▾

   Answer: B. Low-dose sulfonylurea

   HNF1A-MODY is highly sensitive to sulfonylureas, which often allow good control at low doses without insulin. Observation alone suits GCK-MODY, which causes mild stable fasting hyperglycaemia, not HNF1A-MODY, which is progressive.

7. Question 7Thyroid Disordershard

   A 40-year-old man in thyroid storm is given propranolol, propylthiouracil and hydrocortisone. When should inorganic iodine (potassium iodide) be given?

   1. ABefore the first dose of propylthiouracil
   2. BAt least 1 hour after the propylthiouracil dose
   3. COnly after free T4 has normalised
   4. DSimultaneously with propranolol at presentation
   Show answer and explanation▾

   Answer: B. At least 1 hour after the propylthiouracil dose

   Iodine is given at least 1 hour after the thionamide so that the thionamide has blocked organification; otherwise the iodine load can be used as substrate for more hormone synthesis. Delaying until free T4 normalises would lose the rapid benefit of blocking hormone release.

8. Question 8Thyroid Disorderseasy

   A 38-year-old woman has fatigue, TSH 14 mU/L and low free T4. Which antibody most supports autoimmune (Hashimoto) thyroiditis as the cause?

   1. ATSH receptor stimulating antibody
   2. BAnti-thyroglobulin antibody alone
   3. CAnti-thyroid peroxidase antibody
   4. DAnti-GAD antibody
   Show answer and explanation▾

   Answer: C. Anti-thyroid peroxidase antibody

   Anti-TPO antibodies are present in the large majority of patients with Hashimoto thyroiditis and are the most useful marker. TSH receptor stimulating antibodies characterise Graves disease, and anti-thyroglobulin antibodies are less sensitive on their own.

9. Question 9Endocrine Emergencies, Ethics and Patient Safetymedium

   A handwritten order reading '6U insulin aspart' was given as 60 units, causing severe hypoglycaemia. Which practice change best prevents a repeat of this error?

   1. AAlways write the word 'units' in full
   2. BUse the abbreviation 'IU' instead
   3. CAdd a trailing zero after the dose
   4. DAllow verbal orders for insulin
   Show answer and explanation▾

   Answer: A. Always write the word 'units' in full

   The abbreviation 'U' can be misread as a zero, and safe-practice lists require the word 'units' to be written in full. 'IU' is also on the do-not-use list, and trailing zeros cause tenfold errors of their own.

10. Question 10Pituitary and Hypothalamic Disordersmedium

    A 48-year-old man has coarse facial features, enlarging hands, sweating and new hypertension. What is the best initial biochemical test for acromegaly?

    1. ARandom growth hormone
    2. BSerum IGF-1
    3. CInsulin tolerance test
    4. DSerum prolactin
    Show answer and explanation▾

    Answer: B. Serum IGF-1

    Serum IGF-1 reflects integrated growth hormone secretion and is the recommended first test, with a GH suppression test on OGTT used for confirmation. Random GH is pulsatile and unreliable for diagnosis.

11. Question 11Reproductive Endocrinology and Gonadal Disordersmedium

    A tall 19-year-old man has small firm testes, gynaecomastia, low testosterone and markedly raised LH and FSH. What is the most appropriate confirmatory test?

    1. APituitary MRI
    2. BGnRH stimulation test
    3. CScrotal ultrasound
    4. DPeripheral blood karyotype
    Show answer and explanation▾

    Answer: D. Peripheral blood karyotype

    Primary hypogonadism with small firm testes and gynaecomastia suggests Klinefelter syndrome, which is confirmed by a 47,XXY karyotype. Pituitary MRI is used for secondary hypogonadism, where LH and FSH are low or inappropriately normal.

12. Question 12Thyroid Disordersmedium

    A 29-year-old woman at 8 weeks of gestation has newly diagnosed Graves disease with free T4 well above the reference range. Which antithyroid drug is preferred at this stage of pregnancy?

    1. ACarbimazole
    2. BMethimazole
    3. CRadioactive iodine
    4. DPropylthiouracil
    Show answer and explanation▾

    Answer: D. Propylthiouracil

    Propylthiouracil is preferred in the first trimester because methimazole and carbimazole carry a risk of embryopathy during organogenesis. Radioactive iodine is absolutely contraindicated in pregnancy.

13. Question 13Thyroid Disordersmedium

    A 44-year-old woman has a 1.8 cm solid hypoechoic thyroid nodule with irregular margins and microcalcifications. TSH is normal. What is the most appropriate next step?

    1. AUltrasound-guided fine-needle aspiration
    2. BRadionuclide thyroid uptake scan
    3. CRepeat ultrasound in 2 years
    4. DStart levothyroxine suppression
    Show answer and explanation▾

    Answer: A. Ultrasound-guided fine-needle aspiration

    A solid hypoechoic nodule with irregular margins and microcalcifications is high-suspicion, and FNA is recommended at 1 cm or larger. A radionuclide scan is reserved for nodules with a suppressed TSH, and levothyroxine suppression is not recommended.

14. Question 14Thyroid Disordersmedium

    A 36-year-old woman has a painful tender thyroid 3 weeks after a viral illness, palpitations, low TSH, high free T4, raised ESR and very low radioiodine uptake. What is the most appropriate treatment?

    1. ACarbimazole
    2. BRadioactive iodine ablation
    3. CBeta-blocker and NSAID
    4. DTotal thyroidectomy
    Show answer and explanation▾

    Answer: C. Beta-blocker and NSAID

    Subacute granulomatous thyroiditis causes destructive thyrotoxicosis from release of stored hormone, so treatment is symptomatic with a beta-blocker and anti-inflammatory therapy, with prednisolone if severe. Carbimazole is ineffective because new hormone synthesis is not increased, and low uptake makes radioiodine useless.

15. Question 15Thyroid Disordersmedium

    A 74-year-old woman is admitted hypothermic and drowsy with TSH 85 mU/L and undetectable free T4. Myxoedema coma is diagnosed. Alongside IV levothyroxine, what should be given?

    1. AIV furosemide
    2. BIV hydrocortisone
    3. CRapid external rewarming blankets
    4. DOral liothyronine only
    Show answer and explanation▾

    Answer: B. IV hydrocortisone

    Stress-dose IV hydrocortisone is given until coexisting adrenal insufficiency is excluded, because thyroid hormone increases cortisol clearance and can precipitate adrenal crisis. Active rapid rewarming can cause vasodilatation and circulatory collapse, so passive rewarming is preferred.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.