Set 1: For each patient, select the most appropriate glucose-lowering option.
A. Semaglutide
B. Gliclazide
C. Pioglitazone
D. Dapagliflozin
E. Sitagliptin
F. Insulin glargine
G. Acarbose
H. Metformin
1. A 54-year-old man is newly diagnosed with type 2 diabetes. His HbA1c is 61 mmol/mol. He has BMI 32 kg/m², eGFR 86 mL/min/1.73 m², no heart failure, no established cardiovascular disease and no symptoms of hyperglycaemia. Lifestyle advice has been discussed.
Which option is most appropriate first-line?
2. A 66-year-old woman with type 2 diabetes takes metformin 1 g twice daily. Her HbA1c is 68 mmol/mol. She has chronic heart failure with reduced ejection fraction and eGFR 58 mL/min/1.73 m². She has no recurrent genital infections and no history of ketoacidosis.
Which option is most appropriate to consider adding?
Set 2: For each patient, select the most appropriate intervention.
A. Add rapid-acting insulin before breakfast
B. Treat as diabetic ketoacidosis
C. Stop all insulin permanently
D. Start gliclazide
E. Switch to once-weekly insulin without review
F. Reduce basal insulin dose and review fasting glucose pattern
G. Ignore because hypoglycaemia is expected in insulin therapy
H. Increase basal insulin dose
3. A 72-year-old man with type 2 diabetes takes insulin glargine 28 units at night. His glucose readings are repeatedly 3.1–3.8 mmol/L before breakfast, but 7–9 mmol/L later in the day. He has had two overnight sweats.
Which option is most appropriate?
4. A 29-year-old woman with type 1 diabetes has vomiting, abdominal pain and rapid breathing. Her glucose is 15 mmol/L and blood ketones are 4.2 mmol/L. She omitted insulin because she was not eating.
Which option is most appropriate?
Set 3: For each patient, select the most appropriate advice or action.
A. Treat as uncomplicated hypoglycaemia only
B. Double metformin during vomiting illness
C. Continue insulin, monitor glucose and ketones, maintain fluids and seek urgent help if ketones or symptoms worsen
D. Stop insulin whenever unable to eat
E. Restart SGLT2 inhibitor during acute illness
F. Use loperamide to treat ketones
G. Consider euglycaemic diabetic ketoacidosis and arrange urgent assessment
H. Reassure because glucose below 11 mmol/L excludes ketoacidosis
5. A 24-year-old man with type 1 diabetes has gastroenteritis. He is eating very little but can drink fluids. His glucose is 13 mmol/L and blood ketones are 1.1 mmol/L. He asks whether he should stop insulin until eating normally.
Which option is most appropriate?
6. A 61-year-old man with type 2 diabetes takes empagliflozin. He has vomiting, abdominal pain, drowsiness and rapid breathing. His glucose is 9.8 mmol/L.
Which option is most appropriate?
Set 4: For each patient, select the most appropriate medicine-related action.
A. Treat hypoglycaemia and review sulfonylurea use because recurrence can occur
B. Add another sulfonylurea
C. Reassure because gliclazide cannot cause hypoglycaemia
D. Increase gliclazide during missed meals
E. Start dapagliflozin during dehydration
F. Give rapid-acting insulin immediately
G. Ignore renal function in diabetes medicine choice
H. Avoid pioglitazone because it can worsen heart failure
7. An 80-year-old woman with type 2 diabetes takes gliclazide 80 mg twice daily. She has been eating poorly during a chest infection and is found confused and sweaty. Capillary glucose is 2.5 mmol/L.
Which option is most appropriate?
8. A 76-year-old man with type 2 diabetes and heart failure is taking metformin. His HbA1c remains above target. A prescriber suggests pioglitazone.
Which option is most appropriate?
Set 5: For each patient, select the most appropriate option.
A. Radioiodine
B. Carbimazole
C. Levothyroxine
D. Stop levothyroxine because TSH normalises
E. Separate levothyroxine from calcium or iron administration
F. Urgent thyroid function testing and clinical review
G. Propranolol
H. Liothyronine as first-line for all hypothyroidism
9. A 46-year-old woman takes levothyroxine 100 micrograms daily. Her TSH has increased despite adherence. She recently started taking calcium carbonate every morning with her levothyroxine.
Which option is most appropriate?
10. A 39-year-old woman has tiredness, weight gain, constipation and cold intolerance. Blood tests confirm primary hypothyroidism with raised TSH and low free T4.
Which option is most appropriate?
Set 6: For each patient, select the most appropriate action.
A. Continue carbimazole and ignore symptoms
B. Start levothyroxine for all palpitations
C. Use iodine supplements from a health shop
D. Increase carbimazole without blood tests
E. Consider propranolol for symptom control if suitable while definitive treatment is arranged
F. Start oral iron
G. Stop carbimazole and arrange urgent full blood count because agranulocytosis is possible
H. Reassure because sore throat is unrelated to antithyroid medicines
11. A 32-year-old woman taking carbimazole for Graves’ disease develops fever, mouth ulcers and sore throat. She is due to collect her next prescription today.
Which option is most appropriate?
12. A 41-year-old man has new hyperthyroidism with tremor, sweating, palpitations and anxiety. He is awaiting endocrinology review. He has no asthma, heart block or severe peripheral vascular disease.
Which option is most appropriate for short-term symptom relief?
Set 7: For each patient, select the most appropriate option.
A. Stop all antithyroid treatment until delivery
B. Start carbimazole at high dose without review
C. Reassure because untreated hyperthyroidism is harmless in pregnancy
D. Urgent specialist review because thyroid disease in pregnancy needs careful management
E. Use radioiodine during pregnancy
F. Treat pregnancy sickness as thyroid storm
G. Take levothyroxine with iron tablets to improve absorption
H. Ignore thyroid function tests until after delivery
13. A 28-year-old woman taking carbimazole for Graves’ disease tells you she is 7 weeks pregnant. She has not informed her GP or endocrinologist.
Which option is most appropriate?
14. A 34-year-old woman taking levothyroxine becomes pregnant. She asks whether thyroid control still matters because she feels well.
Which option is most appropriate?
Set 8: For each patient, select the most appropriate management option.
A. Stop prednisolone abruptly
B. Discuss tapering and adrenal suppression risk before stopping
C. Reassure because adrenal crisis occurs only in children
D. Double gliclazide to replace steroids
E. Avoid steroid emergency cards
F. Give emergency hydrocortisone and urgent medical assessment for possible adrenal crisis
G. Treat adrenal crisis with loperamide only
H. Replace hydrocortisone with ibuprofen during illness
15. A 58-year-old man has taken prednisolone 40 mg daily for 7 weeks for inflammatory disease. He feels better and wants to stop today because of insomnia and weight gain.
Which option is most appropriate?
16. A 44-year-old woman with known Addison’s disease presents with severe vomiting, abdominal pain, dizziness and confusion. Her blood pressure is 84/50 mmHg.
Which option is most appropriate?
Set 9: For each patient, select the most likely condition or management option.
A. Hypercalcaemia requiring urgent clinical assessment
B. Hypocalcaemia requiring urgent assessment
C. Vitamin D deficiency treatment and bone health review
D. Reassurance only
E. Primary hyperparathyroidism assessment
F. Start calcium supplements immediately in hypercalcaemia
G. Stop all fluids
H. Treat with insulin only
17. A 69-year-old woman presents with confusion, constipation, thirst and polyuria. Corrected calcium is 3.15 mmol/L.
Which option is most appropriate?
18. A 57-year-old woman has tingling around the mouth, carpopedal spasm and prolonged QT interval. Corrected calcium is 1.78 mmol/L.
Which option is most appropriate?
Set 10: For each patient, select the most appropriate safety concern or action.
A. Monitor for genital infections, dehydration and ketoacidosis risk with SGLT2 inhibitor
B. Monitor TSH weekly in all stable levothyroxine patients
C. Avoid all vaccines in diabetes
D. Ignore renal function when prescribing metformin
E. Continue metformin during severe dehydration and acute kidney injury
F. Add sulfonylurea without hypoglycaemia counselling
G. Use steroid tablets without counselling on sick-day rules
H. Monitor for pancreatitis symptoms with GLP-1 receptor agonist
19. A 63-year-old man starts dapagliflozin for type 2 diabetes and heart failure. He asks what adverse effects or warning symptoms he should know about.
Which option is most appropriate?
20. A 52-year-old woman starts semaglutide for type 2 diabetes and obesity. Three weeks later she develops severe persistent upper abdominal pain radiating to the back with vomiting.
Which option is most appropriate?
Endocrine Questions
Answers and Rationale
1. H
Metformin remains an appropriate first-line option for many adults with type 2 diabetes when renal function is adequate and there are no specific indications to prioritise another agent. His HbA1c is above target but not in the severe symptomatic range.
2. D
An SGLT2 inhibitor such as dapagliflozin is appropriate to consider in type 2 diabetes with heart failure, provided renal function, ketoacidosis risk, genital infection history and sick-day counselling are addressed.
3. F
Repeated fasting hypoglycaemia and overnight sweats suggest excessive basal insulin. The basal dose should be reviewed and reduced, rather than increased or adding mealtime insulin.
4. B
Vomiting, abdominal pain, rapid breathing, raised glucose and blood ketones indicate diabetic ketoacidosis. Omitting insulin during illness is a common precipitant and urgent treatment is required.
5. C
People with type 1 diabetes should not stop insulin during illness. Sick-day rules include continuing insulin, monitoring glucose and ketones, maintaining fluids and seeking urgent help if ketones rise or symptoms worsen.
6. G
SGLT2 inhibitors can cause euglycaemic DKA, where glucose may be only mildly raised. Vomiting, abdominal pain, drowsiness and rapid breathing require urgent assessment and ketone testing.
7. A
Sulfonylureas such as gliclazide can cause hypoglycaemia, especially in older adults, poor intake or acute illness. Hypoglycaemia should be treated promptly and recurrence risk reviewed.
8. H
Pioglitazone can cause fluid retention and worsen heart failure, so it is usually unsuitable in this context. Alternative glucose-lowering options should be considered.
9. E
Calcium and iron can reduce levothyroxine absorption. Separating administration times and reviewing adherence can help correct a rising TSH.
10. C
Raised TSH with low free T4 confirms primary hypothyroidism. Levothyroxine is standard replacement therapy, with dosing and monitoring individualised.
11. G
Carbimazole can rarely cause agranulocytosis. Fever, sore throat and mouth ulcers require stopping the medicine and urgent full blood count assessment.
12. E
Beta-blockers such as propranolol can help relieve adrenergic symptoms of hyperthyroidism, including tremor and palpitations, while definitive treatment is arranged. Suitability must be assessed.
13. D
Antithyroid treatment in early pregnancy requires urgent specialist review because both uncontrolled hyperthyroidism and antithyroid medicines can carry risks. Treatment choice may need adjustment.
14. D
Thyroid hormone requirements can change in pregnancy, and adequate control is important for maternal and fetal health. She should have prompt clinical review and thyroid function monitoring.
15. B
Abruptly stopping systemic corticosteroids after several weeks can cause adrenal insufficiency. Tapering and prescriber review are needed, balancing adverse effects with relapse risk.
16. F
Vomiting, abdominal pain, hypotension and confusion in Addison’s disease suggest adrenal crisis. Emergency hydrocortisone and urgent medical care are required.
17. A
Confusion, constipation, thirst and polyuria with markedly raised corrected calcium suggest clinically significant hypercalcaemia. This needs urgent assessment and management.
18. B
Perioral tingling, carpopedal spasm, prolonged QT and low corrected calcium suggest symptomatic hypocalcaemia. Urgent assessment and calcium replacement may be needed.
19. A
SGLT2 inhibitors require counselling on genital infections, dehydration, sick-day rules and ketoacidosis symptoms, including euglycaemic DKA. Patients should know when to seek urgent help.
20. H
GLP-1 receptor agonists can be associated with gastrointestinal adverse effects and rarely pancreatitis. Severe persistent abdominal pain radiating to the back with vomiting needs urgent review.
Here are 20 extended matching questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.