100+ Free Cert Endocrinology(SA) Paed Practice Questions

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2026 Statistics

Key Facts: Cert Endocrinology(SA) Paed Exam

2 components

Written + oral/OSCE

CMSA Regulations

50% each

Subminimum per component

CMSA Regulations

R24 650

Exam Fee

CMSA Sub-specialty Fee Schedule

50% overall

Pass Mark

CMSA Regulations

CMSA

Exam Body

College of Paediatricians

The Cert Endocrinology(SA) Paed is a two-component sub-specialty exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) for paediatricians completing fellowship training in paediatric endocrinology and diabetes in South Africa.

Sample Cert Endocrinology(SA) Paed Practice Questions

Try these sample questions to test your Cert Endocrinology(SA) Paed exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 7-year-old child presents with a 3-week history of polyuria, polydipsia, and weight loss. A random plasma glucose level is 15.2 mmol/L. According to ISPAD guidelines, which of the following is required to confirm the diagnosis of diabetes mellitus?

A.An oral glucose tolerance test (OGTT) must be performed immediately

B.Fasting plasma glucose must be checked on two separate mornings

C.No further laboratory testing is required to confirm diabetes in a classic symptomatic child

D.An HbA1c level >8.5% is mandatory before initiating therapy

Explanation: In the presence of classic osmotic symptoms (polyuria, polydipsia, weight loss), a single random plasma glucose measurement of >=11.1 mmol/L (200 mg/dL) is sufficient to diagnose diabetes mellitus. Performing an OGTT in a symptomatic child with overt hyperglycaemia is unnecessary and potentially dangerous as it risks delaying treatment and precipitating DKA.

2An 8-year-old girl with newly diagnosed Type 1 Diabetes presents in moderate Diabetic Ketoacidosis (DKA) with 8% dehydration but stable blood pressure. According to ISPAD 2022 guidelines, what is the initial fluid resuscitation bolus?

A.20 mL/kg of 5% dextrose in water as a rapid IV push

B.10-20 mL/kg of 0.9% sodium chloride over 30-60 minutes

C.30 mL/kg of Ringer's lactate over 15 minutes

D.5 mL/kg of 3% hypertonic saline over 10 minutes

Explanation: ISPAD 2022 guidelines recommend initiating fluid resuscitation in paediatric DKA with 10–20 mL/kg of isotonic saline (0.9% NaCl or balanced crystalloid such as Plasma-Lyte) over 30–60 minutes. This restores circulating volume while avoiding rapid osmotic shifts that could contribute to cerebral oedema.

3Which of the following describes the correct timing and dosage for starting intravenous insulin in a paediatric patient undergoing treatment for Diabetic Ketoacidosis (DKA)?

A.Administer an immediate IV bolus of 0.1 units/kg regular insulin followed by 0.2 units/kg/hour infusion

B.Start insulin infusion immediately prior to starting IV fluids to clear ketonemia rapidly

C.Administer subcutaneous glargine 1.0 unit/kg immediately and delay IV insulin until glucose is <15 mmol/L

D.Start regular insulin infusion at 0.05-0.1 units/kg/hour approximately 1 hour after starting fluid resuscitation

Explanation: Intravenous regular insulin should be initiated at a rate of 0.05 to 0.1 units/kg/hour starting approximately 1 hour after fluid replacement therapy has commenced. An initial insulin bolus is contraindicated as it precipitously drops serum osmolality and increases cerebral oedema risk.

4According to international consensus guidelines for Continuous Glucose Monitoring (CGM) in children with Type 1 Diabetes, what is the target percentage for Time in Range (TIR, 3.9-10.0 mmol/L)?

A.>90%

B.>70%

C.>50%

D.>35%

Explanation: The international consensus recommendation for children and adolescents using CGM is to achieve >70% Time in Range (TIR: 3.9–10.0 mmol/L [70–180 mg/dL]), while maintaining Time Below Range (<3.9 mmol/L) at <4% and <3.0 mmol/L at <1%.

5A 6-year-old child (weight 20 kg) with Type 1 Diabetes is brought to the emergency department unconscious following a hypoglycaemic seizure at home. IV access cannot be immediately established. What is the most appropriate initial pharmacological treatment?

A.Oral 15 grams of fast-acting glucose gel rubbed on the buccal mucosa

B.Intramuscular glucagon 0.5 mg (or 3 mg nasal glucagon)

C.Subcutaneous regular insulin 0.1 units/kg

D.Intramuscular hydrocortisone 100 mg

Explanation: Severe hypoglycaemia with altered consciousness or seizures outside of established IV access should be treated immediately with glucagon: 0.5 mg IM/SC for children <25 kg (or <5 years old), 1.0 mg for >=25 kg, or 3 mg intranasal glucagon if available.

6Children with Type 1 Diabetes have an increased risk of associated autoimmune conditions. According to ISPAD guidelines, how should screening for Coeliac Disease be performed in a newly diagnosed child with T1D?

A.Screen with anti-nuclear antibodies (ANA) and anti-dsDNA annually

B.Perform routine upper gastrointestinal endoscopy and duodenal biopsy at diagnosis

C.Screen with anti-tissue transglutaminase (tTG) IgA and total serum IgA at diagnosis

D.Screen with serum IgE coeliac antibodies only if chronic diarrhoea is present

Explanation: ISPAD guidelines recommend screening for coeliac disease at T1D diagnosis using serum anti-tissue transglutaminase (tTG) IgA antibodies combined with total serum IgA (to exclude IgA deficiency, which requires IgG-based testing e.g. tTG IgG or DGP IgG). Screening is repeated after 1–2 and 5 years.

7At what age and duration of diabetes does ISPAD recommend starting annual screening for microvascular complications (diabetic retinopathy and microalbuminuria) in paediatric Type 1 Diabetes?

A.Starting at birth regardless of duration

B.Starting at age 11 years with 2-5 years duration of diabetes

C.Starting at age 18 years regardless of duration

D.Starting immediately at diagnosis in all prepubertal children

Explanation: Annual screening for diabetic retinopathy (fundus photography/dilated eye exam) and diabetic nephropathy (urine albumin-to-creatinine ratio) is recommended starting at age 11 years (or at pubertal onset) after 2 to 5 years of diabetes duration.

8Which of the following clinical and laboratory criteria defines the partial clinical remission phase ('honeymoon phase') in paediatric Type 1 Diabetes?

A.Complete absence of anti-GAD autoantibodies on repeat testing

B.Normal oral glucose tolerance test after stopping all insulin for 1 month

C.Total daily insulin requirement <0.5 units/kg/day with HbA1c <6.5% (48 mmol/mol)

D.Zero requirement for basal insulin with random C-peptide >2000 pmol/L

Explanation: Partial clinical remission is defined by a total daily insulin dose (TDD) of <0.5 units/kg/day while maintaining an HbA1c <6.5% (48 mmol/mol). The Insulin Dose-Adjusted A1c (IDAA1c) formula [HbA1c (%) + 4 x insulin dose (U/kg/day)] <=9 also defines remission.

9A 12-year-old boy with Type 1 Diabetes plans to participate in a 45-minute moderate aerobic soccer practice. His blood glucose immediately prior to exercise is 5.8 mmol/L. What is the recommended management?

A.Administer a rapid-acting insulin bolus of 1 unit to prevent exercise-induced hyperglycaemia

B.Cancel exercise immediately as glucose is critically low

C.Drink 500 mL of plain water and check glucose only after finishing exercise

D.Consume 10-15 grams of rapid-acting carbohydrates before starting exercise

Explanation: For planned aerobic exercise when blood glucose is between 5.0 and 7.0 mmol/L, ISPAD guidelines advise consuming 10–15 g of fast-acting carbohydrate before starting exercise to prevent hypoglycaemia during activity.

10During the resuscitation of a 10-year-old child with severe DKA, initial lab results show serum potassium of 4.2 mmol/L. Urine output has been confirmed. According to ISPAD DKA guidelines, how should potassium replacement be managed?

A.Withhold potassium until serum potassium drops below 3.0 mmol/L

B.Administer a rapid IV bolus of 20 mmol KCl over 10 minutes

C.Add 40 mmol/L potassium (KCl or potassium phosphate) to rehydration IV fluids immediately

D.Give oral potassium chloride 40 mEq every 2 hours

Explanation: Potassium replacement should begin after initial fluid resuscitation once urine output is documented, regardless of whether serum potassium is normal (3.5-5.5 mmol/L). 40 mmol/L of potassium (50% KCl and 50% K-phosphate) should be added to IV fluids because insulin infusion drives potassium rapidly into cells.

About the Cert Endocrinology(SA) Paed Exam

The Sub-specialty Certificate in Endocrinology and Metabolism of the College of Paediatricians of South Africa [Cert Endocrinology(SA) Paed] is the sub-specialist credentialing examination for paediatricians specializing in endocrinology and diabetes. Candidates are tested on complex clinical decision-making, physiological principles, lab interpretation, and treatment guidelines for childhood endocrine diseases.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 core domains: Type 1 Diabetes, DKA & Technology (30%), Growth Disorders & Pituitary (25%), DSD & Puberty (20%), Thyroid & Adrenal Disorders (15%), and Bone & Calcium Metabolism (10%).

Time Limit

Written short-answer papers plus an OSCE and viva component.

Passing Score

Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).

Exam Fee

R24 650 (Colleges of Medicine of South Africa (CMSA), College of Paediatricians)

Cert Endocrinology(SA) Paed Exam Content Outline

30%

Type 1 Diabetes, DKA & Technology in Paediatric Diabetes

Pathophysiology, ISPAD guidelines for DKA, continuous glucose monitoring (CGM), insulin pump therapy, hybrid closed-loop systems, hypoglycaemia management, diabetic nephropathy, retinopathy, and microvascular screening.

25%

Growth Disorders, Pituitary & Hypothalamic Dysfunction

Short and tall stature evaluation, GH-IGF-1 axis testing, idiopathic short stature, craniopharyngioma, hypopituitarism, central and nephrogenic diabetes insipidus, septo-optic dysplasia, and hypothalamic lesions.

20%

Disorders of Sexual Development & Puberty

Central and peripheral precocious puberty, delayed puberty, constitutional delay, 46,XX and 46,XY DSD, congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome, 5-alpha-reductase deficiency, Turner and Klinefelter syndromes.

15%

Thyroid & Adrenal Disorders in Children

Congenital hypothyroidism screening and treatment, Hashimoto thyroiditis, Graves disease, thyroid nodule management, primary/secondary adrenal insufficiency, Cushing syndrome, pheochromocytoma/paraganglioma, and monogenic adrenal syndromes.

10%

Bone & Calcium Metabolism

Hypocalcaemia, hypercalcaemia, nutritional and hereditary rickets, pseudohypoparathyroidism, osteogenesis imperfecta, hypophosphatasia, FGF23 mediated disorders, and DXA evaluation in paediatrics.

How to Pass the Cert Endocrinology(SA) Paed Exam

What You Need to Know

Passing score: Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).
Assessment: Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 core domains: Type 1 Diabetes, DKA & Technology (30%), Growth Disorders & Pituitary (25%), DSD & Puberty (20%), Thyroid & Adrenal Disorders (15%), and Bone & Calcium Metabolism (10%).
Time limit: Written short-answer papers plus an OSCE and viva component.
Exam fee: R24 650

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Cert Endocrinology(SA) Paed Study Tips from Top Performers

1Thoroughly study the ISPAD 2022 Clinical Practice Consensus Guidelines for DKA fluid resuscitation and continuous insulin titration.

2Review the diagnostic algorithms for 46,XY and 46,XX DSD, including steroidogenic enzyme deficiencies (21-hydroxylase, 11-beta-hydroxylase, 17-alpha-hydroxylase, 3-beta-HSD, 17-beta-HSD3).

3Understand the laboratory evaluation and management of neonatal hypocalcaemia, rickets, and calcium sensor receptor mutations.

Frequently Asked Questions

What is the examination structure for Cert Endocrinology(SA) Paed?

The exit examination has two components, each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Candidates must achieve an overall 50% with a 50% subminimum in each component. This free question bank provides 100 practice MCQs as a study aid and does not replicate the official format.

What is the examination fee for the CMSA sub-specialty certificate?

The fee is R24 650 according to the CMSA fee structure.

What proportion of content covers paediatric diabetes and diabetes technology?

30% of the content is dedicated to Type 1 diabetes, diabetic ketoacidosis (DKA), continuous glucose monitoring (CGM), insulin pumps, and diabetes management.