FACE (FELLOW OF THE AMERICAN COLLEGE ENDOCRINOLOGY)
EXAMINATION QUESTIONS AND 100% VERIFIED ANSWERS
RECENTLY UPDATED
Question 1
A 28-year-old woman with type 1 diabetes presents with frequent hypoglycemic
episodes despite reducing her insulin doses. She reports unintentional weight
loss of 10 pounds over the past 2 months and occasional diarrhea. Laboratory
evaluation is most likely to show:
Answer: Elevated anti-tissue transglutaminase antibodies, consistent with celiac
disease. Celiac disease occurs at a higher frequency in patients with type 1
diabetes (5-10%) and can present with hypoglycemia due to malabsorption of
nutrients with preserved insulin sensitivity.
Question 2
A 45-year-old man with newly diagnosed type 2 diabetes has an A1C of 10.2%.
He has no symptoms of hyperglycemia and his physical examination is normal
except for a BMI of 32 kg/m². The most appropriate initial management is:
Answer: Metformin plus lifestyle modification. For patients with markedly
elevated A1C (>9-10%) without symptoms of hyperglycemia or evidence of
metabolic decompensation, initial therapy with metformin combined with
lifestyle changes is appropriate according to ADA guidelines.
Question 3
A 67-year-old woman with type 2 diabetes on metformin and a GLP-1 receptor
agonist has an A1C of 8.6%. She has stage 3 chronic kidney disease (eGFR 45
mL/min/1.73m²). The most appropriate next step in her diabetes management is:
Answer: Add an SGLT-2 inhibitor. SGLT-2 inhibitors have demonstrated
cardiovascular and renal benefits in patients with type 2 diabetes and CKD.
Most are approved for use down to eGFR of 30 mL/min/1.73m².
Question 4
,Which of the following features best distinguishes diabetic ketoacidosis (DKA)
from hyperosmolar hyperglycemic state (HHS)?
Answer: Serum pH < 7.3. DKA is characterized by hyperglycemia, ketosis, and
metabolic acidosis with a pH below 7.3, while HHS features severe
hyperglycemia (often >600 mg/dL), hyperosmolality, and minimal or no ketosis
with a pH typically above 7.3.
Question 5
A 52-year-old woman with type 2 diabetes presents with sudden onset of
unilateral facial weakness. Brain MRI shows an acute infarct in the pons. The
most appropriate antihyperglycemic agent to avoid in this patient's regimen is:
Answer: Thiazolidinediones. Thiazolidinediones can cause fluid retention and
are contraindicated in patients with heart failure. After stroke, patients are at
increased risk for heart failure, making thiazolidinediones a less preferred
option.
Question 6
A 60-year-old man with type 2 diabetes and coronary artery disease has
persistent microalbuminuria despite optimal glucose and blood pressure control.
Which medication has demonstrated the most significant benefit for preventing
progression of diabetic nephropathy?
Answer: SGLT-2 inhibitors. Multiple clinical trials (CREDENCE, DAPA-
CKD, EMPA-KIDNEY) have shown that SGLT-2 inhibitors significantly
reduce progression of kidney disease in patients with type 2 diabetes and
established nephropathy.
Question 7
A 38-year-old woman with type 1 diabetes is planning pregnancy. Her current
A1C is 7.8%. What is the recommended A1C target before conception?
Answer: <6.5% without significant hypoglycemia. The ADA recommends that
women with diabetes who are planning pregnancy achieve an A1C as close to
normal as possible (<6.5%) without significant hypoglycemia prior to
conception to reduce the risk of congenital malformations.
Question 8
,A 72-year-old man with type 2 diabetes, hypertension, and stable coronary
artery disease has an A1C of 8.2% on metformin 1000 mg twice daily. His
eGFR is 62 mL/min/1.73m². Which second-line agent would provide the most
cardiovascular benefit?
Answer: GLP-1 receptor agonist. In patients with established atherosclerotic
cardiovascular disease, GLP-1 receptor agonists (particularly semaglutide,
dulaglutide, and liraglutide) have demonstrated significant cardiovascular risk
reduction.
Question 9
A 45-year-old woman with obesity (BMI 38 kg/m²) is diagnosed with type 2
diabetes. Her fasting glucose is 180 mg/dL and A1C is 9.0%. She has no
symptoms of hyperglycemia. The most effective initial approach for improving
her glycemic control is:
Answer: High-dose GLP-1 receptor agonist. For patients with obesity and type
2 diabetes, high-dose GLP-1 receptor agonists (such as semaglutide 2.4 mg
weekly) can provide both substantial weight loss (10-15% of body weight) and
significant glucose lowering.
Question 10
A 35-year-old man presents with polyuria, polydipsia, and 15-pound weight
loss. Laboratory results show glucose 324 mg/dL, bicarbonate 24 mEq/L,
negative urine ketones, and A1C 10.2%. C-peptide is low-normal and GAD65
antibodies are negative. The most likely diagnosis is:
Answer: Monogenic diabetes (MODY). The presentation suggests monogenic
diabetes, particularly Maturity Onset Diabetes of the Young (MODY). The
absence of ketosis, preserved beta-cell function (detectable C-peptide), and
negative autoantibodies in a young, non-obese patient are consistent with this
diagnosis.
Question 11
A 42-year-old woman with type 1 diabetes is hospitalized for pneumonia. Her
blood glucose has been ranging from 180-250 mg/dL. The most appropriate
inpatient diabetes management is:
Answer: Basal-bolus insulin therapy. For most non-critically ill hospitalized
patients with diabetes, a regimen of basal, nutritional, and correction insulin is
, the standard of care. Continuing basal insulin is essential for patients with type
1 diabetes to prevent ketosis.
Question 12
A 55-year-old man with type 2 diabetes develops symptoms consistent with
peripheral neuropathy. Which of the following findings would be atypical for
diabetic peripheral neuropathy?
Answer: Asymmetric presentation with motor predominance. Diabetic
peripheral neuropathy typically presents as a symmetric, distal sensory
polyneuropathy. Asymmetric presentation with motor predominance suggests
other etiologies, such as mononeuropathy multiplex, CIDP, or non-diabetic
causes.
Question 13
A 68-year-old woman with type 2 diabetes has been treated with insulin
glargine and insulin lispro for 5 years. She presents with recurrent episodes of
hypoglycemia unawareness. The most appropriate next step is:
Answer: Implement CGM and set higher glycemic targets. For patients with
hypoglycemia unawareness, raising glycemic targets (A1C target to 7-8%) is
recommended. Continuous glucose monitoring can help identify and prevent
hypoglycemic episodes.
Question 14
A 50-year-old man with type 2 diabetes and hypertension has persistent
albuminuria (urine albumin-to-creatinine ratio 400 mg/g) despite treatment with
an ACE inhibitor. His blood pressure is 138/82 mmHg. The most appropriate
next step is:
Answer: Add an SGLT-2 inhibitor. SGLT2 inhibitors have demonstrated
significant renoprotective effects independent of their glycemic effects and are
recommended for patients with type 2 diabetes and albuminuria >300 mg/g,
even when blood pressure is controlled.
Question 15
The primary mechanism of action of sodium-glucose cotransporter-2 (SGLT-2)
inhibitors is:
EXAMINATION QUESTIONS AND 100% VERIFIED ANSWERS
RECENTLY UPDATED
Question 1
A 28-year-old woman with type 1 diabetes presents with frequent hypoglycemic
episodes despite reducing her insulin doses. She reports unintentional weight
loss of 10 pounds over the past 2 months and occasional diarrhea. Laboratory
evaluation is most likely to show:
Answer: Elevated anti-tissue transglutaminase antibodies, consistent with celiac
disease. Celiac disease occurs at a higher frequency in patients with type 1
diabetes (5-10%) and can present with hypoglycemia due to malabsorption of
nutrients with preserved insulin sensitivity.
Question 2
A 45-year-old man with newly diagnosed type 2 diabetes has an A1C of 10.2%.
He has no symptoms of hyperglycemia and his physical examination is normal
except for a BMI of 32 kg/m². The most appropriate initial management is:
Answer: Metformin plus lifestyle modification. For patients with markedly
elevated A1C (>9-10%) without symptoms of hyperglycemia or evidence of
metabolic decompensation, initial therapy with metformin combined with
lifestyle changes is appropriate according to ADA guidelines.
Question 3
A 67-year-old woman with type 2 diabetes on metformin and a GLP-1 receptor
agonist has an A1C of 8.6%. She has stage 3 chronic kidney disease (eGFR 45
mL/min/1.73m²). The most appropriate next step in her diabetes management is:
Answer: Add an SGLT-2 inhibitor. SGLT-2 inhibitors have demonstrated
cardiovascular and renal benefits in patients with type 2 diabetes and CKD.
Most are approved for use down to eGFR of 30 mL/min/1.73m².
Question 4
,Which of the following features best distinguishes diabetic ketoacidosis (DKA)
from hyperosmolar hyperglycemic state (HHS)?
Answer: Serum pH < 7.3. DKA is characterized by hyperglycemia, ketosis, and
metabolic acidosis with a pH below 7.3, while HHS features severe
hyperglycemia (often >600 mg/dL), hyperosmolality, and minimal or no ketosis
with a pH typically above 7.3.
Question 5
A 52-year-old woman with type 2 diabetes presents with sudden onset of
unilateral facial weakness. Brain MRI shows an acute infarct in the pons. The
most appropriate antihyperglycemic agent to avoid in this patient's regimen is:
Answer: Thiazolidinediones. Thiazolidinediones can cause fluid retention and
are contraindicated in patients with heart failure. After stroke, patients are at
increased risk for heart failure, making thiazolidinediones a less preferred
option.
Question 6
A 60-year-old man with type 2 diabetes and coronary artery disease has
persistent microalbuminuria despite optimal glucose and blood pressure control.
Which medication has demonstrated the most significant benefit for preventing
progression of diabetic nephropathy?
Answer: SGLT-2 inhibitors. Multiple clinical trials (CREDENCE, DAPA-
CKD, EMPA-KIDNEY) have shown that SGLT-2 inhibitors significantly
reduce progression of kidney disease in patients with type 2 diabetes and
established nephropathy.
Question 7
A 38-year-old woman with type 1 diabetes is planning pregnancy. Her current
A1C is 7.8%. What is the recommended A1C target before conception?
Answer: <6.5% without significant hypoglycemia. The ADA recommends that
women with diabetes who are planning pregnancy achieve an A1C as close to
normal as possible (<6.5%) without significant hypoglycemia prior to
conception to reduce the risk of congenital malformations.
Question 8
,A 72-year-old man with type 2 diabetes, hypertension, and stable coronary
artery disease has an A1C of 8.2% on metformin 1000 mg twice daily. His
eGFR is 62 mL/min/1.73m². Which second-line agent would provide the most
cardiovascular benefit?
Answer: GLP-1 receptor agonist. In patients with established atherosclerotic
cardiovascular disease, GLP-1 receptor agonists (particularly semaglutide,
dulaglutide, and liraglutide) have demonstrated significant cardiovascular risk
reduction.
Question 9
A 45-year-old woman with obesity (BMI 38 kg/m²) is diagnosed with type 2
diabetes. Her fasting glucose is 180 mg/dL and A1C is 9.0%. She has no
symptoms of hyperglycemia. The most effective initial approach for improving
her glycemic control is:
Answer: High-dose GLP-1 receptor agonist. For patients with obesity and type
2 diabetes, high-dose GLP-1 receptor agonists (such as semaglutide 2.4 mg
weekly) can provide both substantial weight loss (10-15% of body weight) and
significant glucose lowering.
Question 10
A 35-year-old man presents with polyuria, polydipsia, and 15-pound weight
loss. Laboratory results show glucose 324 mg/dL, bicarbonate 24 mEq/L,
negative urine ketones, and A1C 10.2%. C-peptide is low-normal and GAD65
antibodies are negative. The most likely diagnosis is:
Answer: Monogenic diabetes (MODY). The presentation suggests monogenic
diabetes, particularly Maturity Onset Diabetes of the Young (MODY). The
absence of ketosis, preserved beta-cell function (detectable C-peptide), and
negative autoantibodies in a young, non-obese patient are consistent with this
diagnosis.
Question 11
A 42-year-old woman with type 1 diabetes is hospitalized for pneumonia. Her
blood glucose has been ranging from 180-250 mg/dL. The most appropriate
inpatient diabetes management is:
Answer: Basal-bolus insulin therapy. For most non-critically ill hospitalized
patients with diabetes, a regimen of basal, nutritional, and correction insulin is
, the standard of care. Continuing basal insulin is essential for patients with type
1 diabetes to prevent ketosis.
Question 12
A 55-year-old man with type 2 diabetes develops symptoms consistent with
peripheral neuropathy. Which of the following findings would be atypical for
diabetic peripheral neuropathy?
Answer: Asymmetric presentation with motor predominance. Diabetic
peripheral neuropathy typically presents as a symmetric, distal sensory
polyneuropathy. Asymmetric presentation with motor predominance suggests
other etiologies, such as mononeuropathy multiplex, CIDP, or non-diabetic
causes.
Question 13
A 68-year-old woman with type 2 diabetes has been treated with insulin
glargine and insulin lispro for 5 years. She presents with recurrent episodes of
hypoglycemia unawareness. The most appropriate next step is:
Answer: Implement CGM and set higher glycemic targets. For patients with
hypoglycemia unawareness, raising glycemic targets (A1C target to 7-8%) is
recommended. Continuous glucose monitoring can help identify and prevent
hypoglycemic episodes.
Question 14
A 50-year-old man with type 2 diabetes and hypertension has persistent
albuminuria (urine albumin-to-creatinine ratio 400 mg/g) despite treatment with
an ACE inhibitor. His blood pressure is 138/82 mmHg. The most appropriate
next step is:
Answer: Add an SGLT-2 inhibitor. SGLT2 inhibitors have demonstrated
significant renoprotective effects independent of their glycemic effects and are
recommended for patients with type 2 diabetes and albuminuria >300 mg/g,
even when blood pressure is controlled.
Question 15
The primary mechanism of action of sodium-glucose cotransporter-2 (SGLT-2)
inhibitors is:
