100+ Free ABIM Endocrinology Practice Questions

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Question 1

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A 32-year-old woman with type 1 diabetes presents with a 24-hour history of nausea, vomiting, and polyuria. Labs: glucose 512 mg/dL, pH 7.12, bicarbonate 8 mEq/L, anion gap 24, beta-hydroxybutyrate 5.8 mmol/L, K+ 3.1 mEq/L. Which is the most appropriate next step?

Start IV regular insulin bolus 0.1 U/kg immediately

Begin potassium replacement before starting insulin

Administer IV bicarbonate

Give subcutaneous glargine at home-equivalent dose

to track

2026 Statistics

Key Facts: ABIM Endocrinology Exam

~$2,990

ABIM Endo Exam Fee

ABIM 2026

~220 MCQs

Exam Length

4 modules, ~10 hr day

24 months

Endo Fellowship

ACGME-accredited

Annually

Exam Frequency

Fall administration

90-95%

First-Time Pass Rate

ABIM historical

ADA 2024

Diabetes Standard

GLP-1/SGLT2 priority

ABIM Endocrinology, Diabetes, and Metabolism is one of the highest-volume internal medicine subspecialties, with ~500-600 new certifications annually from ~150 ACGME fellowship programs. The exam heavily emphasizes ADA 2024 Standards of Care (GLP-1 RA or SGLT2i for ASCVD/HF/CKD independent of A1c, semaglutide 2.4 mg Wegovy and tirzepatide 15 mg Zepbound for obesity), thyroid management (ATA 2015 cancer, Bethesda/TIRADS, Afirma/ThyroSeq molecular tests, PTU 1st-trimester pregnancy), adrenal workup (1-mg DST, 24-hr UFC, late-night salivary cortisol; alpha-then-beta blockade for pheo; AACE/ESE 2023 incidentaloma), bone (FRAX, denosumab rebound risk, romosozumab CV BBW), and lipid management (PCSK9i, inclisiran, REDUCE-IT icosapent ethyl). Board-certified endocrinologists earn median compensation of $250K-$325K with high demand driven by diabetes and obesity epidemic.

Sample ABIM Endocrinology Practice Questions

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

1A 32-year-old woman with type 1 diabetes presents with a 24-hour history of nausea, vomiting, and polyuria. Labs: glucose 512 mg/dL, pH 7.12, bicarbonate 8 mEq/L, anion gap 24, beta-hydroxybutyrate 5.8 mmol/L, K+ 3.1 mEq/L. Which is the most appropriate next step?

A.Start IV regular insulin bolus 0.1 U/kg immediately

B.Begin potassium replacement before starting insulin

C.Administer IV bicarbonate

D.Give subcutaneous glargine at home-equivalent dose

Explanation: In DKA with K+ <3.3 mEq/L, potassium must be replaced BEFORE insulin is started. Insulin drives K+ intracellularly and can cause severe, life-threatening hypokalemia with arrhythmias and respiratory muscle weakness. ADA guidelines specify holding insulin until K+ is at least 3.3 mEq/L with potassium replacement initiated first.

2According to the ADA 2024 Standards of Care, which initial therapy is preferred for a patient with newly diagnosed type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), regardless of baseline A1c?

A.Metformin alone

B.Metformin plus a GLP-1 receptor agonist or SGLT2 inhibitor with proven CV benefit

C.Insulin glargine

D.Sulfonylurea plus metformin

Explanation: The ADA 2024 Standards of Care recommend initiating a GLP-1 RA (semaglutide, liraglutide, dulaglutide) or SGLT2 inhibitor (empagliflozin, canagliflozin) with proven CV benefit in patients with T2DM and established ASCVD, heart failure, or CKD, independent of baseline A1c or metformin use. This represents a major shift from glucose-centric to organ-protective therapy.

3A 45-year-old woman presents with weight loss, palpitations, and tremor. Labs: TSH <0.01 mIU/L, free T4 3.8 ng/dL, TRAb positive. She is 10 weeks pregnant. Which is the most appropriate antithyroid drug?

A.Methimazole 20 mg daily

B.Propylthiouracil (PTU)

C.Radioactive iodine ablation

D.Levothyroxine

Explanation: PTU is preferred during the first trimester of pregnancy because methimazole is associated with embryopathy (aplasia cutis, choanal/esophageal atresia). After the first trimester, transition to methimazole is recommended because PTU carries a higher risk of hepatotoxicity. RAI is contraindicated in pregnancy.

4A 50-year-old man with resistant hypertension (on 3 agents) has aldosterone 25 ng/dL and plasma renin activity 0.3 ng/mL/hr. What is the next best diagnostic step?

A.Adrenal vein sampling

B.Confirmatory oral sodium loading or saline infusion test

C.Abdominal CT only

D.Start spironolactone empirically

Explanation: An aldosterone:renin ratio >30 (with aldosterone >15 ng/dL) suggests primary aldosteronism but requires confirmatory testing before proceeding to subtype localization. Confirmatory tests include oral sodium loading (24-hr urine aldosterone >12 mcg), IV saline infusion, captopril challenge, or fludrocortisone suppression. Adrenal vein sampling is the subtype localization step AFTER biochemical confirmation.

5A 28-year-old woman presents with galactorrhea, amenorrhea, and headaches. Prolactin is 220 ng/mL. MRI shows a 1.5 cm pituitary adenoma. Which is the first-line therapy?

A.Transsphenoidal surgery

B.Cabergoline

C.Radiation therapy

D.Bromocriptine

Explanation: Cabergoline is first-line for prolactinomas (including macroadenomas) due to superior efficacy, tolerability, and twice-weekly dosing versus bromocriptine. It normalizes prolactin in >85% of patients and shrinks macroadenomas in most cases. Surgery is reserved for dopamine agonist failure, intolerance, or acute visual loss from apoplexy.

6A 60-year-old postmenopausal woman has a DEXA T-score of -2.8 at the lumbar spine and -2.5 at the femoral neck. FRAX 10-year major osteoporotic fracture risk is 28%. Which treatment option has a black box warning for MI/stroke?

A.Alendronate

B.Denosumab

C.Romosozumab

D.Teriparatide

Explanation: Romosozumab (sclerostin inhibitor) carries a black box warning for increased risk of MI, stroke, and cardiovascular death and is contraindicated in patients with MI or stroke within the preceding year. It is reserved for postmenopausal women at very high fracture risk. Denosumab has a rebound fracture risk on discontinuation but no CV black box.

7A 55-year-old man has a 2.5 cm adrenal incidentaloma on CT with Hounsfield unit of 5. Biochemical workup is negative. According to 2024 AACE/ESE guidelines, what is the most appropriate next step?

A.Adrenalectomy

B.Repeat imaging and biochemistry in 6-12 months

C.PET-CT

D.Adrenal biopsy

Explanation: 2023/2024 AACE/ESE guidelines on adrenal incidentaloma recommend that for benign-appearing masses (<4 cm, HU <10, homogeneous) without hormonal hypersecretion, follow-up imaging and repeat biochemical testing in 6-12 months is appropriate. Surgery is indicated for functioning tumors, imaging features concerning for malignancy (HU >20, size >4 cm, heterogeneous), or size growth.

8A 42-year-old woman has episodic headaches, palpitations, and hypertension. Plasma free metanephrines are 3x the upper limit of normal. CT shows a 4 cm right adrenal mass (35 HU). Prior to surgery, which is the most appropriate preoperative preparation?

A.Start beta-blocker first, then alpha-blocker

B.Start alpha-blocker (phenoxybenzamine or doxazosin) first, then beta-blocker

C.Calcium channel blocker alone

D.No preoperative blockade needed

Explanation: Pheochromocytoma requires preoperative alpha-blockade (phenoxybenzamine 10-40 mg BID or doxazosin) for 10-14 days BEFORE beta-blockade. Starting a beta-blocker first causes unopposed alpha stimulation and hypertensive crisis. High-sodium diet and volume expansion are added. Beta-blocker is added only after adequate alpha-blockade for reflex tachycardia.

9A 35-year-old woman with hirsutism, irregular menses, and polycystic ovaries on ultrasound meets Rotterdam criteria for PCOS. Her BMI is 34. She has fasting glucose 108 mg/dL and A1c 6.0%. Which combination is most appropriate for insulin resistance and weight management?

A.Metformin alone

B.Metformin plus a GLP-1 receptor agonist (semaglutide)

C.Thiazolidinedione

D.Clomiphene

Explanation: In PCOS with obesity, prediabetes, and insulin resistance, combining metformin with a GLP-1 receptor agonist (e.g., semaglutide 2.4 mg weekly) addresses both glucose metabolism and weight loss, and has been shown to improve hyperandrogenism and ovulation. GLP-1 RAs are increasingly used in obese PCOS patients. Clomiphene is for ovulation induction when fertility is desired.

10A 38-year-old man has a serum sodium of 118 mEq/L. He is euvolemic. Serum osmolality is 255 mOsm/kg, urine osmolality 450 mOsm/kg, urine sodium 60 mEq/L. Thyroid and adrenal function are normal. What is the most likely diagnosis?

A.Hypovolemic hyponatremia

B.SIADH

C.Cerebral salt wasting

D.Diabetes insipidus

Explanation: Euvolemic hyponatremia with hypotonic serum, inappropriately concentrated urine (>100 mOsm/kg), and elevated urine sodium (>30 mEq/L), with normal thyroid/adrenal function, is classic for SIADH. Causes include CNS disease, malignancy (small cell lung), drugs (SSRIs, carbamazepine), and pulmonary disease. Treatment: fluid restriction, salt tablets, tolvaptan if severe.

About the ABIM Endocrinology Exam

The ABIM Endocrinology, Diabetes, and Metabolism subspecialty exam certifies internists who have completed a 24-month ACGME-accredited endocrinology fellowship. It covers diabetes (T1DM, T2DM, MODY, LADA, DKA, HHS, pump/CGM technology), thyroid disease (Graves', Hashimoto's, nodules, cancer), adrenal (Addison's, Cushing's, aldosteronism, pheochromocytoma), pituitary (prolactinoma, acromegaly, DI), parathyroid/bone (hyperparathyroidism, osteoporosis), lipid/obesity management, reproductive endocrinology (PCOS, hypogonadism), neuroendocrine tumors, and gender-affirming hormone therapy.

Questions

220 scored questions

Time Limit

~10-hour exam day (four ~2-hour modules)

Passing Score

Criterion-referenced scaled score (pass/fail; specific cut not published)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM Endocrinology Exam Content Outline

30%

Diabetes Mellitus

T1DM pathophysiology/insulin pumps/CGM/AID hybrid closed-loop systems; T2DM with ADA 2024 step-wise therapy emphasizing GLP-1 RA and SGLT2i for CV/renal protection; MODY (GCK, HNF1A, HNF4A); LADA with GAD-65+; DKA (insulin 0.1 U/kg/hr, K>=3.3 before insulin, avoid bicarbonate) and HHS; hypoglycemia unawareness; pregnancy in diabetes; GLP-1/GIP tirzepatide; bariatric surgery indications.

20%

Thyroid Disorders

Graves' disease (TRAb+, methimazole except 1st-trimester PTU, RAI, surgery); Hashimoto's; subacute de Quervain thyroiditis; silent/postpartum lymphocytic; thyroid storm Burch-Wartofsky; myxedema coma (IV T4 + hydrocortisone); pregnancy TSH targets; thyroid nodule Bethesda + TIRADS + Afirma/ThyroSeq; thyroid cancer AJCC 8th, ATA risk-stratified TSH suppression; medullary thyroid (calcitonin, CEA, RET testing).

15%

Adrenal Disorders

Addison's (ACTH stim test, hydrocortisone 15-25 mg/day + fludrocortisone, sick-day rules); Cushing's screening (UFC, overnight DST, salivary) and localization (ACTH, high-dose DST, BIPSS); pheochromocytoma (plasma free metanephrines, alpha-then-beta blockade); aldosteronism (aldo:renin ratio, AVS); CAH; adrenal incidentaloma AACE/ESE 2023; adrenocortical carcinoma; APS/MEN2.

10%

Pituitary and Hypothalamus

Prolactinoma (cabergoline first-line even for macro); acromegaly (IGF-1, OGTT GH nadir, TSS, octreotide/lanreotide/pasireotide, pegvisomant); Cushing's disease; diabetes insipidus (central vs nephrogenic; lithium); SIADH; pituitary apoplexy (IV hydrocortisone + urgent neurosurgery); Sheehan's; empty sella; hypopituitarism with replacement priority (GC before T4).

10%

Bone, Mineral, and Parathyroid

Primary HPT (surgery criteria: age <50, Ca >1 above ULN, stones, T-score <=-2.5); FHH (low urine Ca, CASR); secondary/tertiary HPT in CKD (cinacalcet, etelcalcetide); osteoporosis T-score <=-2.5 and FRAX; bisphosphonates, denosumab (rebound fracture risk on discontinuation), teriparatide/abaloparatide 2-yr limit, romosozumab CV black box warning.

10%

Lipid, Obesity, and Metabolism

ACC/AHA 2018 + 2022 update statin intensity by ASCVD risk; ezetimibe, PCSK9i (alirocumab, evolocumab), inclisiran, bempedoic acid; icosapent ethyl (REDUCE-IT); familial hypercholesterolemia cascade; severe hypertriglyceridemia with pancreatitis; obesity BMI, semaglutide 2.4 mg Wegovy, tirzepatide 5-15 mg Zepbound; bariatric surgery BMI >=35 or BMI >=30 with T2DM.

Reproductive, Neuroendocrine, Electrolytes

PCOS (Rotterdam 2-of-3, metformin + GLP-1 for IR + obesity); POI workup; male hypogonadism (obesity-related functional vs primary vs secondary); gender-affirming hormone therapy (estradiol/spironolactone, testosterone cypionate); neuroendocrine tumors (insulinoma 72-hr fast, gastrinoma ZES + MEN1, glucagonoma NME, VIPoma, somatostatinoma); MEN1/2A/2B; hyponatremia and hypokalemia workup; porphyria.

How to Pass the ABIM Endocrinology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail; specific cut not published)
Exam length: 220 questions
Time limit: ~10-hour exam day (four ~2-hour modules)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Endocrinology Study Tips from Top Performers

1Master ADA 2024 Standards of Care cold: T2DM with ASCVD, HF, or CKD should receive a GLP-1 RA or SGLT2i with proven CV/renal benefit regardless of A1c or metformin use. Semaglutide and empagliflozin are the prototypical agents. For obesity, memorize the dose ladders: semaglutide 2.4 mg weekly (Wegovy) and tirzepatide 5/10/15 mg weekly (Zepbound).

2For DKA management, know the protocol step-by-step: fluid resuscitation first, check potassium BEFORE starting insulin (hold if K <3.3), insulin 0.1 U/kg/hr IV, add dextrose when glucose <250, continue insulin until anion gap closes (not just glucose). Avoid bicarbonate except pH <6.9. Watch for cerebral edema in pediatric/adolescent DKA.

3Learn Cushing's workup in three tiers: (1) screening with any of overnight 1-mg DST, 24-hr UFC x 2, or late-night salivary cortisol; (2) confirm dependence/independence with ACTH; (3) localize with pituitary MRI and high-dose DST for ACTH-dependent (BIPSS if equivocal), or adrenal CT for ACTH-independent. Know pheochromocytoma alpha-before-beta blockade.

4Thyroid nodule management follows Bethesda system and TIRADS. Bethesda III/IV: consider molecular testing (Afirma GSC, ThyroSeq v3). Know ATA 2015 thyroid cancer risk stratification for TSH suppression targets (high: <0.1, intermediate: 0.1-0.5, low: 0.5-2.0). Medullary thyroid cancer requires RET testing in ALL cases (MEN2A/B).

5For osteoporosis, remember the pharmacology ladder: bisphosphonates first-line (oral alendronate/risedronate, IV zoledronate); denosumab for alternative or renal dysfunction but DON'T stop abruptly (rebound vertebral fractures); teriparatide/abaloparatide limited to 2 years cumulative; romosozumab has a black box warning for MI/stroke. Vitamin D target >=30 ng/mL, calcium 1000-1200 mg daily.

Frequently Asked Questions

Who is eligible for the ABIM Endocrinology, Diabetes, and Metabolism exam?

Candidates must hold current ABIM certification in Internal Medicine and must have completed a 24-month (2-year) ACGME-accredited fellowship in Endocrinology, Diabetes, and Metabolism. A valid, unrestricted US medical license and verification of clinical competence from the program director are also required.

How often is the endocrinology board exam offered and how is it structured?

ABIM administers the Endocrinology, Diabetes, and Metabolism subspecialty exam annually in the fall. It is a single-day, computer-based exam at Pearson VUE containing approximately 220 single-best-answer MCQs delivered in four modules of roughly two hours each, with an overall ~10-hour exam day including tutorial and breaks.

What does the ABIM Endocrinology exam cost?

The ABIM application plus exam fee for Endocrinology, Diabetes, and Metabolism is approximately $2,990 in 2026. Late fees apply after the regular deadline. Check the current ABIM fee schedule, as fees change annually.

What is the pass rate for the ABIM Endocrinology boards?

ABIM-reported first-time pass rates for Endocrinology, Diabetes, and Metabolism are historically in the 90-95% range, reflecting the rigor of the 2-year ACGME fellowship training pipeline. Pass rates for repeat takers are lower. See ABIM's annual pass-rate report for the most recent data.

What topics are highest yield on the ABIM Endocrinology boards?

Diabetes management following ADA 2024 Standards (including GLP-1 RA and SGLT2i for ASCVD/HF/CKD, insulin pumps with CGM, DKA/HHS management), thyroid disease (Graves, thyroid nodules with Bethesda and molecular testing, thyroid cancer), adrenal disorders (Cushing's screening/localization, pheochromocytoma workup, adrenal incidentaloma), pituitary (prolactinoma, acromegaly, DI), and bone disease (osteoporosis, parathyroid disease) are the highest-yield areas.

What references are recommended for board prep?

ADA 2024 Standards of Medical Care in Diabetes, Endocrine Society Clinical Practice Guidelines (Cushing's, pheo, incidentaloma, gender-affirming care, testosterone), ATA thyroid guidelines (2015 cancer, 2017 pregnancy), Williams Textbook of Endocrinology, and targeted board review resources (Mayo Clinic Endocrinology Board Review, AACE Annual Scientific Meeting). Practice questions with detailed rationales are critical.

How do I maintain my ABIM Endocrinology certification after passing?

ABIM offers continuous MOC via the Longitudinal Knowledge Assessment (LKA) — roughly 30 questions per quarter, open-book — or a traditional 10-year recertification exam. You must also keep your underlying Internal Medicine certification active and meet ABIM professional standing requirements.

Is ABIM Endocrinology certification worth it career-wise?

Yes. Board certification is required by most academic and hospital-based endocrinology positions, and insurance credentialing. Demand for endocrinologists is high given the diabetes and obesity epidemic. Board-certified endocrinologists earn median compensation of $250K-$325K, with particularly strong demand in obesity medicine, transgender health, and diabetes technology.