ABIM Endocrinology, Diabetes, and Metabolism Initial Certification Examination Practice Test
Endocrinology, diabetes, and metabolism spans hormone disorders, diabetes care, metabolic bone disease, and conditions affecting the thyroid, adrenal glands, pituitary, and reproductive system. Clinical decisions often depend on connecting symptoms and examination findings with biochemical testing, imaging, and treatment risks. Practice questions on this page include cases involving acromegaly, adrenal masses, thyroid nodules, osteoporosis, diabetes complications, and metabolic liver disease.
Exam overview
About the ABIM Endocrinology, Diabetes, and Metabolism Initial Certification… Exam
Questions exercise the interpretation of endocrine test results and the selection of safe next steps. You may need to distinguish a functioning thyroid nodule from a nonfunctioning one, identify warning signs that warrant urgent evaluation of androgen excess, or recognize why adrenal hormone excess must be assessed before biopsy. Diabetes cases call for choices about kidney and cardiovascular risk reduction, hypoglycemia treatment, neuropathy assessment, and persistent albuminuria. Other scenarios test counseling about fracture risk after denosumab discontinuation and management of metabolic contributors to fatty liver disease. These decisions reflect clinical tasks such as matching a test to the suspected disorder, weighing medication benefits against risks, and applying comorbidities and laboratory findings to an individual treatment plan.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A 42-year-old man has progressive enlargement of his hands and feet, coarse facial features, and obstructive sleep apnea. Which test is the preferred initial biochemical screening test for acromegaly?
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Correct answer: ASerum IGF-1 is the preferred initial biochemical test because it reflects integrated growth hormone secretion and is less variable than a random growth hormone measurement. If elevated or equivocal, biochemical confirmation commonly uses an oral glucose suppression test with growth hormone measurement.
A 68-year-old woman with osteoporosis has been taking denosumab every six months for several years. She plans to stop treatment because she is moving and does not want further injections. Which counseling point is most important?
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Correct answer: CAfter denosumab is discontinued, bone turnover can rise rapidly, bone density can fall, and vertebral fracture risk may increase. Discontinuation should be planned with the treating clinician, often using a subsequent antiresorptive medication rather than simply stopping or substantially delaying doses.
A 50-year-old man with obesity and type 2 diabetes has elevated aminotransferases. Ultrasound shows hepatic steatosis. He drinks alcohol rarely, and testing for viral hepatitis is negative. Which intervention is most likely to improve the underlying metabolic liver disease?
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Correct answer: AWeight loss through sustainable dietary changes and physical activity is a key intervention for metabolic dysfunction-associated steatotic liver disease and can improve steatosis and steatohepatitis. Management also includes treating cardiometabolic risk factors; corticosteroids and prophylactic antibiotics are not routine therapy.
A 39-year-old woman with autoimmune thyroid disease is found to have a 2.5-cm adrenal mass on imaging. She has no symptoms of catecholamine excess. Before adrenal biopsy is considered, which safety principle is most important?
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Correct answer: APheochromocytoma must be excluded before adrenal biopsy or other invasive manipulation because a catecholamine-secreting tumor can cause a dangerous hypertensive crisis. Lack of classic symptoms does not reliably exclude the diagnosis, so appropriate biochemical testing is important when evaluating an adrenal mass before biopsy.
A 52-year-old woman with type 2 diabetes and chronic kidney disease (estimated GFR 38 mL/min/1.73 m²) has persistent albuminuria despite maximally tolerated lisinopril. Potassium is 4.4 mmol/L. Which medication has evidence for reducing cardiovascular and kidney events in this setting, with appropriate potassium monitoring?
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Correct answer: AFinerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces kidney and cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease receiving renin-angiotensin system blockade. Serum potassium and kidney function should be monitored because hyperkalemia can occur.
A 32-year-old woman has irregular menses, acne, and increasing facial hair. She also reports rapid progression of these symptoms over several months and a noticeably deepening voice. Which next step is most appropriate?
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Correct answer: BRapidly progressive androgenic symptoms and virilization are atypical for routine polycystic ovary syndrome and warrant evaluation for an androgen-secreting ovarian or adrenal tumor. Initial assessment commonly includes androgen measurements, with further testing and imaging guided by the results and clinical findings.
A 61-year-old woman with type 2 diabetes reports burning pain and reduced sensation in both feet. Examination shows diminished vibration at the toes and intact pedal pulses. Which screening test is most appropriate to assess loss of protective sensation?
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Correct answer: AA 10-g monofilament is a standard bedside method for identifying loss of protective sensation and elevated risk of diabetic foot ulceration. Vibration testing can complement the examination, while vascular tests do not assess sensory loss.
How to use this practice test
Access is free. The practice bank contains 50 questions; each session presents up to 20 random questions. Complete a session to see your results, then use missed or uncertain items to identify which clinical decisions and concepts need further review.
Preparation tips
- For suspected acromegaly, review how IGF-1 testing is used for initial biochemical assessment and how confirmatory evaluation differs from screening.
- Practice diabetes kidney-risk decisions using eGFR, urine albumin-to-creatinine ratio, potassium, and blood pressure; connect these findings to medication selection and monitoring.
- Review urgent evaluation of rapidly progressive virilization and the safety principle of excluding pheochromocytoma before adrenal biopsy.
- Compare thyroid nodule workups when TSH is suppressed with evaluation when TSH is normal or elevated.
- Know the risks of stopping denosumab without follow-on antiresorptive treatment and how to assess diabetic loss of protective sensation.