Candidate I.D.

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Endocrinology and
Metabolism
The following are examples of items that you
would find in a short-answer question (SAQ)
exam. Model answers are included for your
information.

[Date]

Confidential – all rights reserved – unauthorized reproduction or use prohibited.

Booklet 1 of 1
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Endocrinology and Metabolism

Instructions – Please Read Carefully

1. The time allowed for this examination is THREE hours.

2. Please use a ballpoint or fountain pen only. Do not use a felt-tip pen. It
produces a script that spreads or is too thick, and is therefore difficult or
impossible to read.

3. Please write or print as legibly as possible. The examiners cannot assign

marks for answers they cannot read.

4. Be as brief and direct as possible, making use of the space provided after
each question.

5. Examination booklets must be returned intact to the invigilator. You may

not copy and/or remove the questions in any way.

6. If a specific number of answers is requested (e.g. list FOUR), do not list

more than requested as they will not be marked (i.e. if four are requested,
only the first four will be marked).

7. Certain questions might contain more than one page. Please make sure that
you have completed all pages of each booklet.

8. Please affix your candidate number sticker in the space provided on the
COVER PAGE of each examination booklet.

NOTE:
After test administration, statistical analyses are conducted and a small number of
questions may be deleted if they do not meet standards for psychometric validity.
Question weighting may vary because of the importance of the question or the number
of answers required. Deleted questions are not included when calculating candidates'
final scores. Unanswered questions are scored as incorrect; therefore, you should
answer every question.

There is a standard process for evaluating changes in medicine that occur too late in the
test administration schedule to replace or modify any affected examination questions.
We advise candidates to answer all questions according to their understanding of
current clinical principles and practice. If it is determined that any question has been
compromised by new information (newly published findings), that question will be
reviewed to ensure that test-taker results are not adversely affected.
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Endocrinology and Metabolism

Marks
1. A 22-year-old woman is referred to you for evaluation and treatment of
hyperglycemia. Her random plasma glucose level is 16 mmol/L. Two days
ago, her random plasma glucose level was 18 mmol/L. She is on no
medications.
a) List EIGHT features of her history or physical examination that would 4
support the diagnosis of type 2 diabetes as opposed to type 1 diabetes.

b) Identify TWO findings from laboratory investigations that would favour 2

the diagnosis of type 2 diabetes as opposed to type 1 diabetes for this
patient.

Model Answer
a) (4 points)
Ethnic origin (high-risk populations); family history of type 2 diabetes; personal history
of glucose intolerance or impaired fasting glucose (1/2 pt.); gestational diabetes or
infant with macrosomia (1/2 pt.); exposure to diabetes in fetal life; overweight, obesity
or central obesity (1/2 pt.); diseases such as schizophrenia, dyslipidemia, hypertension,
vascular disease, polycystic ovary disease, acanthosis nigricans; presence of diabetic
complication; personal history of metabolic syndrome.
b) (2 points)
Absence of ketoacidosis/ketosis; absence of auto-antibodies (anti-glutamic acid
decarboxylase [anti-GAD], anti-islet, anti-insulin, etc.); persistent increased insulin and
C-peptide levels; absence of high-risk human leukocyte antigen (HLA) genotype.
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Endocrinology and Metabolism

Marks
2. You are asked to see an 18-year-old woman with significant diarrhea and
anorexia who has been hospitalized for a flare of her Crohn disease. She
developed carpopedal spasm, and was found to have a total serum calcium
level of 1.55 mmol/L with an albumin level of 30 g/L. At the moment, she
is receiving nothing by mouth (NPO) for bowel rest.
a) List THREE KEY components of the acute management of her calcium 3
levels.

b) Despite your treatment, her albumin corrected calcium and ionized 2

calcium levels remain low. Name TWO other laboratory tests that
should be ordered to help in understanding her hypocalcemia.

c) Two days later, she is able to tolerate oral feeding. What oral treatment 2
should be recommended for her calcium disorder?
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Endocrinology and Metabolism

Model Answer
a) (3 points: 1 point each: dose not required)
- 10 cc of 10% calcium gluconate solution followed by calcium gluconate infusion
- monitor calcium levels
- cardiac monitor
DO NOT ACCEPT INTUBATION OR ABCs

b) (2 points: 1 point each)

- Magnesium
- Parathyroid hormone (PTH)
- 25-OH vitamin D

c) (2 points: 1 point each, specific dose not required)

- Oral calcium carbonate/gluconate/citrate 1000-1500 mg elemental calcium
- High-dose vitamin D (high dose: 1000 or more units once daily)
OR potent vitamin D (calcitriol, 1-alpha-hydroxy-vitamin D3)
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Endocrinology and Metabolism

Marks
3. You are asked to assess a 25-year-old woman with secondary
amenorrhea. She is on no medications.
a) What is the MOST important condition that should be ruled out first? 1

b) Results of basic investigations show that she has normal thyroid 3

function and a normal prolactin level. Her LH and FSH levels are both in
the lower end of the normal range. List SIX causes that could explain
these findings.

c) If her LH and FSH levels were markedly elevated, state the MOST 1
important test to perform next.
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Endocrinology and Metabolism

Model Answer
(1 point)
a) Pregnancy

b) (3 points: 0.5 points each)

- Functional hypothalamic amenorrhea (or accept idiopathic functional/hypothalamic; or
accept two of stress, weight loss, severe illness)
- Polycystic ovary syndrome (PCOS)
- Hyperandrogenism (or accept ovarian tumour)
- Non-classic congenital adrenal hyperplasia (CAH)
- Idiopathic hyperandrogenism
- Pituitary tumour/sellar mass
- Hypopituitarism
- Asherman syndrome/uterine scarring
- Cushing syndrome
DO NOT ACCEPT pregnancy, premature ovarian failure, or abnormal karyotype.

(1 point)
c) Karyotype
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Endocrinology and Metabolism

Note: This Question is for Adult Endocrinology candidates only Marks

4. You are asked to see a 65-year-old woman who is 6 months post pituitary
surgery for a growth hormone-secreting tumour of the pituitary. Growth
hormone and IGF-1 levels have remained high postoperatively. Repeat
MRI shows residual tumour.
a) In the table below, list FIVE options that could be recommended for 5
treatment of her acromegaly at this time. Indicate ONE potential
adverse effect of EACH treatment.

Treatment Option Adverse Effect

b) Name TWO cardiovascular complications of acromegaly. 2

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Endocrinology and Metabolism

Model Answer

a) (5 points: 0.5 points for each treatment, 0.5 points for each adverse effect)

Treatment Option Adverse Effect

hypopituitarism, death, hemorrhage,

repeat surgery CSF leak, meningitis, sodium/water
imbalance

radiotherapy including
gamma knife (stereotaxic
radiation)
hypopituitarism,
damage to surrounding tissues such as
radionecrosis, cranial nerve damage,
cognitive changes and secondary
tumours.

increased gall stone formation, nausea,

somatostatin analogues abdominal cramps, diarrhea, hair loss,
injection site reactions

increased liver enzymes, tumour

pegvisomant (Somavert®)
progression, injection site reactions
dopamine nasal stuffiness, nausea, postural
agonists/cabergoline hypotension, fatigue, headache

b) (2 points: 1 point each)

hypertension
cardiomyopathy
left ventricular hypertrophy
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Endocrinology and Metabolism

Note: This question is for Pediatric Endocrinology candidates only Marks

5. You make a diagnosis of growth hormone deficiency based on 2 growth
hormone stimulation tests in a 3-year-old boy who has short stature and
low growth velocity.
a) List EIGHT physical examination features that are associated with 4
Growth Hormone deficiency.

b) List the TWO MOST important next steps in investigation. 2

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Endocrinology and Metabolism

Model Answer
(4 points: 0.5 points each)
a) Cleft lip/palate, single central incisor, increased weight for height, delayed tooth
eruption, microphallus, frontal bossing, high-pitched voice, "cherubic" features, choanal
atresia, fine thin hair, central fat

(2 points)
b)
- Neuroimaging with MRI
- Assessment of other pituitary hormones for deficiency of TSH, ACTH, etc.

Before you leave the room, please return your examination

End booklet(s) to the invigilator.