100+ Free Cert Endocrinology(SA) Phys Practice Questions

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2026 Statistics

Key Facts: Cert Endocrinology(SA) Phys 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

College of Physicians

Exam Body

Colleges of Medicine of South Africa

The Cert Endocrinology(SA) Phys is a rigorous two-component exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) validating specialist competence in clinical endocrinology, diabetes, and metabolic medicine in South Africa.

Sample Cert Endocrinology(SA) Phys Practice Questions

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

1According to the 2024 SEMDSA guidelines for type 2 diabetes mellitus, which pharmacological class is recommended as first-line add-on therapy to metformin in a patient with established atherosclerotic cardiovascular disease (ASCVD), regardless of baseline HbA1c?

A.GLP-1 receptor agonist with proven CV benefit or SGLT2 inhibitor

B.Dipeptidyl peptidase-4 (DPP-4) inhibitor

C.Thiazolidinedione (e.g., pioglitazone)

D.Second-generation sulfonylurea (e.g., gliclazide MR)

Explanation: Both SEMDSA and ADA/EASD guidelines recommend that patients with type 2 diabetes and established ASCVD (or high cardiovascular risk) be prescribed a GLP-1 receptor agonist with proven cardiovascular benefit or an SGLT2 inhibitor independent of baseline HbA1c or individualized HbA1c target.

2A 45-year-old asymptomatic man undergoes routine health screening. His fasting plasma glucose is 7.4 mmol/L. Repeat testing 3 days later reveals a fasting plasma glucose of 7.2 mmol/L. What is the correct diagnostic categorization?

A.Impaired Glucose Tolerance (IGT)

B.Impaired Fasting Glucose (IFG)

C.Normal Fasting Glucose

D.Diabetes Mellitus

Explanation: Diabetes mellitus is diagnosed when fasting plasma glucose (FPG) is >= 7.0 mmol/L on two separate occasions in an asymptomatic individual. FPG values of 6.1-6.9 mmol/L represent Impaired Fasting Glucose.

3When should screening for diabetic retinopathy and diabetic nephropathy initially be performed in a newly diagnosed adult patient with Type 2 Diabetes Mellitus?

A.5 years after diagnosis

B.Only when symptoms of visual loss or proteinuria develop

C.At the time of diabetes diagnosis

D.3 years after diagnosis

Explanation: In Type 2 Diabetes Mellitus, subclinical microvascular complications may already be present at diagnosis because the exact onset of hyperglycemia often precedes clinical diagnosis by several years. Screening for retinopathy (dilated eye exam) and nephropathy (UACR and eGFR) must occur at diagnosis.

4What is the primary physiological mechanism by which SGLT2 inhibitors lower blood glucose levels?

A.Inhibition of sodium-glucose cotransporter 2 in the renal proximal convoluted tubule, inducing glucosuria

B.Enhancement of peripheral insulin sensitivity in skeletal muscle via PPAR-gamma activation

C.Inhibition of hepatic gluconeogenesis via AMP-activated protein kinase activation

D.Stimulation of insulin secretion from pancreatic beta cells in a glucose-dependent manner

Explanation: SGLT2 inhibitors selective inhibit sodium-glucose cotransporter 2 in the S1 segment of the renal proximal convoluted tubule. This reduces renal glucose reabsorption, lowering the renal threshold for glucose and promoting urinary glucose excretion (glucosuria).

5In a non-pregnant adult with Type 1 Diabetes Mellitus utilizing continuous glucose monitoring (CGM), what is the standardized international target for Time in Range (TIR, 3.9–10.0 mmol/L)?

A.> 95%

B.> 85%

C.> 50%

D.> 70%

Explanation: International consensus on CGM metrics specifies that non-pregnant adults with T1D or T2D should achieve a Time in Range (TIR 3.9–10.0 mmol/L [70–180 mg/dL]) of > 70%, with Time Below Range (< 3.9 mmol/L) kept at < 4%.

6Which laboratory parameter most definitively distinguishes Hyperosmolar Hyperglycemic State (HHS) from classic Diabetic Ketoacidosis (DKA)?

A.Effective serum osmolality > 320 mOsm/kg with minimal/absent ketoacidosis

B.Blood glucose level > 15.0 mmol/L

C.Elevated serum lactate level > 4.0 mmol/L

D.Serum potassium level < 3.0 mmol/L

Explanation: HHS is characterized by profound hyperglycemia (often > 33.3 mmol/L), severe dehydration, and high effective serum osmolality (> 320 mOsm/kg), with minimal or absent ketoacidosis (arterial pH > 7.30, serum bicarbonate > 18 mmol/L, serum beta-hydroxybutyrate < 3.0 mmol/L). DKA requires ketoacidosis with high anion gap.

7What is the recommended initial intravenous fluid resuscitation protocol for an adult presenting with Diabetic Ketoacidosis (DKA) without cardiogenic shock?

A.Ringer's Lactate containing 50 mEq/L potassium chloride immediately

B.5% Dextrose in Water at 500 mL/h

C.0.45% Sodium Chloride at 2000 mL over the first hour

D.0.9% Sodium Chloride at 1000–1500 mL (15–20 mL/kg) over the first hour

Explanation: The initial step in DKA fluid resuscitation is expanding intravascular volume using 0.9% NaCl at 15–20 mL/kg/h (typically 1.0 to 1.5 L) over the first hour, followed by tailored fluid selection based on corrected serum sodium and hydration status.

8Which agent is recommended as a first-line pharmacological treatment for painful diabetic peripheral neuropathy?

A.Duloxetine

B.Pethidine

C.Indomethacin

D.Prednisone

Explanation: First-line agents for painful diabetic peripheral neuropathy include SNRI antidepressants (Duloxetine) or gabapentinoids (Pregabalin / Gabapentin) or tricyclic antidepressants (Amitriptyline).

9In clinical trials and continuous glucose monitoring guidelines, how is Level 2 (clinically significant) hypoglycemia defined?

A.Glucose < 3.0 mmol/L (< 54 mg/dL)

B.Glucose < 4.5 mmol/L (< 81 mg/dL)

C.Glucose < 3.9 mmol/L (< 70 mg/dL)

D.Severe cognitive impairment requiring external third-party assistance regardless of glucose level

Explanation: Level 1 hypoglycemia is defined as glucose < 3.9 mmol/L (70 mg/dL) but >= 3.0 mmol/L. Level 2 hypoglycemia is defined as glucose < 3.0 mmol/L (54 mg/dL), representing a threshold where neuroglycopenia begins. Level 3 is severe hypoglycemia requiring third-party assistance.

10A 38-year-old woman with T2DM treated with empagliflozin, metformin, and basal insulin presents with nausea, vomiting, abdominal pain, and deep sighing breathing. Laboratory investigation reveals arterial pH 7.22, serum bicarbonate 14 mmol/L, anion gap 18 mmol/L, serum beta-hydroxybutyrate 4.2 mmol/L, but plasma glucose is only 9.8 mmol/L. What is the immediate initial management strategy?

A.Increase empagliflozin dose and start oral antiemetics

B.Administer oral sodium bicarbonate and discharge on increased basal insulin dose

C.Discontinue empagliflozin immediately, start IV 0.9% saline infusion, IV dextrose 5–10%, and IV fixed-rate continuous insulin infusion

D.Administer IV glucagon 1 mg intramuscularly and hold insulin

Explanation: This patient has euglycemic DKA (euDKA) secondary to SGLT2 inhibitor therapy. Key management steps are immediate cessation of the SGLT2 inhibitor, IV volume expansion, IV insulin infusion to suppress lipolysis/ketogenesis, and co-administration of IV dextrose (5–10%) because plasma glucose is < 14 mmol/L.

About the Cert Endocrinology(SA) Phys Exam

The Sub-specialty Certificate in Endocrinology and Metabolism Cert Endocrinology(SA) Phys is the exit sub-specialty examination administered by the College of Physicians of South Africa. It assesses sub-specialist clinical expertise in complex diabetes care, neuroendocrinology, bone and mineral metabolism, thyroid disease, adrenal disorders, reproductive endocrinology, lipidology, and hereditary endocrine tumor syndromes required for registration as an Endocrinologist with the HPCSA.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 5 blueprint domains: Diabetes Mellitus (30%), Thyroid & Parathyroid Disorders, Osteoporosis (25%), Pituitary & Neuroendocrinology (20%), Adrenal & Gonadal Disorders, Endocrine Tumours (15%), and Metabolic Syndrome & Lipid Disorders (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 (College of Physicians of South Africa (Colleges of Medicine of South Africa))

Cert Endocrinology(SA) Phys Exam Content Outline

30%

Diabetes Mellitus (Types 1/2, Complications, Technology)

Pathophysiology, diagnostics, glycemic targets, continuous glucose monitoring (CGM), insulin pumps, SGLT2 inhibitors, GLP-1 receptor agonists, diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), microvascular and macrovascular complications, SEMDSA guidelines.

25%

Thyroid & Parathyroid Disorders, Osteoporosis

Thyrotoxicosis, hypothyroidism, thyroid nodules and carcinoma, hyperparathyroidism, hypoparathyroidism, calcium homeostasis, osteoporosis management (bisphosphonates, denosumab, teriparatide, romosozumab), metabolic bone diseases.

20%

Pituitary & Neuroendocrinology

Pituitary adenomas (prolactinomas, acromegaly, Cushing's disease, non-functioning), hypopituitarism, diabetes insipidus (central vs nephrogenic), SIADH, sellar masses, hypothalamic pathology.

15%

Adrenal & Gonadal Disorders, Endocrine Tumours

Primary aldosteronism, Cushing's syndrome, adrenal insufficiency (Addison's disease), pheochromocytoma/paraganglioma, congenital adrenal hyperplasia, male/female hypogonadism, PCOS, NETs, MEN1/MEN2 syndromes.

10%

Metabolic Syndrome & Lipid Disorders

Familial hypercholesterolemia, hypertriglyceridemia, atherogenic dyslipidemia, metabolic dysfunction-associated steatotic liver disease (MASLD), statins, ezetimibe, PCSK9 inhibitors, cardiovascular risk stratification.

How to Pass the Cert Endocrinology(SA) Phys 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 blueprint domains: Diabetes Mellitus (30%), Thyroid & Parathyroid Disorders, Osteoporosis (25%), Pituitary & Neuroendocrinology (20%), Adrenal & Gonadal Disorders, Endocrine Tumours (15%), and Metabolic Syndrome & Lipid Disorders (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) Phys Study Tips from Top Performers

1Master the SEMDSA 2024 Guidelines for Type 2 Diabetes Management, including organ-protection indications for SGLT2 inhibitors and GLP-1 receptor agonists in CKD and heart failure.

2Understand dynamic endocrine diagnostic testing protocols (e.g. saline infusion test for primary aldosteronism, overnight dexamethasone suppression test, insulin tolerance test, water deprivation test).

3Be fluent in thyroid cancer risk stratification (ATA guidelines), parathyroid surgery indications, and sequential osteoporosis therapies (anabolic followed by antiresorptive agents).

Frequently Asked Questions

What is the format of the CMSA Cert Endocrinology(SA) Phys examination?

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 are the eligibility requirements for Cert Endocrinology(SA) Phys?

Candidates must hold an FCP(SA) or equivalent primary specialist qualification in Internal Medicine, maintain active HPCSA registration as a specialist physician, and complete 24 months of accredited sub-specialty endocrinology fellowship training.

Which clinical guidelines are emphasized in the South African exam?

The exam incorporates evidence-based international guidelines (Endocrine Society, ATA, ADA, EASD, AACE) alongside local South African recommendations, particularly the SEMDSA (Society for Endocrinology, Metabolism and Diabetes of South Africa) guidelines.