Endocrine Practice Questions
Endocrine questions focus on diabetes, the most-tested endocrine topic: diagnostic thresholds, first-line and add-on therapy, and hypoglycemia, which is high-yield on the MCCQE, USMLE Step 2 CK, and PLAB. These four sample questions come from MediLingo's bank of 3,900+ questions across 23 specialties.
Sample questions
Question 1
Which of the following meets the diagnostic criteria for diabetes mellitus?
a) Fasting plasma glucose of 6.5 mmol/L
b) HbA1c ≥6.5% OR fasting glucose ≥7.0 mmol/L OR 2-hour OGTT ≥11.1 mmol/L ✓ Correct
c) Random plasma glucose of 10.0 mmol/L in an asymptomatic patient
d) 2-hour OGTT of 8.5 mmol/L with normal HbA1c and fasting glucose
Key teaching point: Diabetes: HbA1c ≥6.5%, FPG ≥7.0 mmol/L, 2h-OGTT ≥11.1 mmol/L, or random ≥11.1 with symptoms. Confirm unless symptomatic.
Question 2
Why is metformin the first-line therapy for Type 2 diabetes?
a) It promotes weight gain and increases insulin secretion from pancreatic beta cells
b) It lowers glucose without causing hypoglycemia, is weight-neutral, and has cardiovascular safety ✓ Correct
c) It directly stimulates insulin secretion and restores beta-cell function over time
d) It is the most recently developed oral agent with the strongest cardiovascular outcome data
Key teaching point: Metformin first-line: no hypoglycemia, weight-neutral, CV safe, cheap. Adjust dose for eGFR (reduce at <45, stop at <30). Side effects: GI upset, B12 deficiency.
Question 3
Which additional benefit do SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) provide beyond glucose lowering?
a) Weight gain and fluid retention through sodium reabsorption in the proximal tubule
b) Cardiovascular protection, heart failure hospitalization reduction, and kidney protection ✓ Correct
c) Increased bone mineral density and reduced fracture risk through calcium reabsorption
d) Improved beta-cell function and increased endogenous insulin secretion over time
Key teaching point: SGLT2i: CV benefit, HF reduction, kidney protection. Prescribe for Type 2 with ASCVD, HF, or CKD. Risks: euglycemic DKA, UTI/genital infections, volume depletion.
Question 4
At what blood glucose level is hypoglycemia defined in diabetes?
a) <5.0 mmol/L, as symptoms can begin at this level in some patients
b) <4.0 mmol/L ✓ Correct
c) <2.0 mmol/L, as this is the level at which neuroglycopenic symptoms appear
d) <3.0 mmol/L, as autonomic symptoms reliably appear below this level
Key teaching point: Hypoglycemia: <4.0 mmol/L. Rule of 15: 15g carbs → recheck in 15 min → repeat if still <4.0. Severe (unconscious): glucagon IM/SC or IV dextrose.
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