American Board of Internal Medicine Certification (ABIM Board Certification) Endocrinology, Diabetes & Metabolism Syllabus

Endocrinology, Diabetes & Metabolism syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Endocrinology, Diabetes & Metabolism in American Board of Internal Medicine Certification (ABIM Board Certification), not a summary of it.

1. 1

   Diabetes Mellitus

   4 topics

   • Diagnosis and classification of diabetes
   • Glycemic management
     • Oral agents, GLP-1 receptor agonists, insulin regimens
     • Individualized glycemic targets
   • Acute complications
     • DKA and hyperosmolar hyperglycemic state
     • Hypoglycemia management
   • Chronic complications and screening
2. 2

   Thyroid Disorders

   4 topics

   • Hypothyroidism and hyperthyroidism
   • Thyroid nodules and cancer evaluation
   • Thyroiditis and thyroid storm
   • Interpretation of abnormal thyroid function tests
3. 3

   Adrenal & Pituitary Disorders

   4 topics

   • Adrenal insufficiency and Cushing syndrome
   • Pheochromocytoma and primary aldosteronism
   • Pituitary adenomas and hypopituitarism
   • Hyperprolactinemia and acromegaly
4. 4

   Bone, Calcium & Reproductive Endocrinology

   5 topics

   • Osteoporosis screening and treatment
   • Parathyroid disorders and calcium homeostasis
   • Male hypogonadism and gynecomastia
   • PCOS and female reproductive endocrine disorders
   • Lipid disorders and metabolic syndrome

Endocrinology, Diabetes & Metabolism flashcards for American Board of Internal Medicine Certification (ABIM Board Certification)

21 of 59 cards from the Endocrinology, Diabetes & Metabolism deck — real questions with worked answers.

1. What are the four ADA diagnostic criteria for diabetes mellitus (any one, confirmed on repeat)?

   Fasting plasma glucose >=126 mg/dL; 2-hour OGTT (75 g) glucose >=200 mg/dL; HbA1c >=6.5%; or random glucose >=200 mg/dL with classic hyperglycemic symptoms/crisis.

2. What HbA1c and fasting/OGTT ranges define prediabetes?

   HbA1c 5.7-6.4%; impaired fasting glucose (FPG) 100-125 mg/dL; impaired glucose tolerance (2-hr OGTT) 140-199 mg/dL.

3. How are type 1 and type 2 diabetes distinguished pathophysiologically?

   Type 1 is autoimmune beta-cell destruction (GAD-65, IA-2, ZnT8, islet-cell antibodies) causing absolute insulin deficiency with low C-peptide; type 2 is insulin resistance with relative insulin deficiency and normal/high C-peptide.

4. What is latent autoimmune diabetes in adults (LADA)?

   A slowly progressive autoimmune (GAD-antibody positive) diabetes presenting in adults, often initially non-insulin-requiring but progressing to insulin dependence; sometimes called type 1.5 diabetes.

5. What general HbA1c goal does the ADA recommend for most nonpregnant adults, and when is a less stringent goal (<8%) appropriate?

   Goal <7% for most adults; a goal <8% is appropriate for limited life expectancy, severe hypoglycemia history, advanced complications, or extensive comorbidities.

6. Which two glucose-lowering drug classes have proven cardiovascular and renal benefit and are preferred regardless of HbA1c in high-risk patients?

   SGLT2 inhibitors (heart failure and CKD benefit) and GLP-1 receptor agonists (atherosclerotic CVD benefit); preferred in patients with established ASCVD, heart failure, or CKD.

7. What is the first-line oral agent for type 2 diabetes and its main contraindication?

   Metformin; contraindicated when eGFR <30 mL/min/1.73m2 (risk of lactic acidosis), and held around iodinated contrast and acute illness.

8. What is the estimated average glucose (eAG) formula relating HbA1c to mean glucose?

   eAG (mg/dL) = 28.7 x A1c - 46.7. (A 7% A1c ~ 154 mg/dL; each 1% ~ 28-29 mg/dL.)

9. What are the diagnostic criteria for diabetic ketoacidosis (DKA)?

   Glucose >250 mg/dL (can be lower/euglycemic), arterial pH <7.3, serum bicarbonate <18 mEq/L, elevated anion gap, and positive serum/urine ketones (beta-hydroxybutyrate).

10. How does hyperosmolar hyperglycemic state (HHS) differ from DKA?

    HHS has marked hyperglycemia (often >600 mg/dL), serum osmolality >320 mOsm/kg, minimal/absent ketosis, pH >7.3, bicarbonate >18; more profound dehydration and altered mental status, typically in type 2 diabetes.

11. In DKA/HHS management, when should potassium be repleted before insulin and when must insulin be held?

    If serum K+ is 3.3-5.2, add potassium to fluids; if K+ <3.3, hold insulin and replete potassium first to avoid life-threatening hypokalemia; if K+ >5.2, do not add K and recheck.

12. What blood glucose level triggers adding dextrose to fluids during DKA treatment, and why continue insulin?

    When glucose reaches ~200 mg/dL (250 in HHS), add dextrose-containing fluids while continuing insulin to clear ketones/close the anion gap without causing hypoglycemia.

13. What defines the recommended diabetic retinopathy screening schedule for type 1 vs type 2 diabetes?

    Type 1: dilated eye exam within 5 years of diagnosis; type 2: at diagnosis; then annually (or every 1-2 years if no retinopathy), and during pregnancy.

14. How is diabetic kidney disease (albuminuria) screened and what threshold defines moderately increased albuminuria?

    Annual spot urine albumin-to-creatinine ratio (UACR) and eGFR; UACR >=30 mg/g (30-300 = moderately increased/microalbuminuria, >300 = severely increased).

15. Which antihypertensive class is preferred in diabetic patients with albuminuria, and what adjunct lowers CKD progression?

    ACE inhibitor or ARB (not both together); add an SGLT2 inhibitor and consider a nonsteroidal MRA (finerenone) to slow progression.

16. What are the key features distinguishing primary (Hashimoto) hypothyroidism on thyroid function tests?

    High TSH with low free T4; positive anti-TPO (and antithyroglobulin) antibodies indicate autoimmune Hashimoto thyroiditis. Subclinical disease has high TSH with normal free T4.

17. What are the laboratory and clinical features of Graves disease?

    Low TSH, high free T4/T3, positive TSH receptor antibodies (TRAb/TSI); diffuse goiter, orbitopathy, and pretibial myxedema; radioiodine uptake is diffusely increased.

18. How do you distinguish Graves disease from toxic multinodular goiter and toxic adenoma on radioactive iodine uptake scan?

    Graves: diffuse increased uptake; toxic multinodular goiter: patchy/multifocal uptake; toxic adenoma: single focal hot nodule with suppression of surrounding tissue.

19. What distinguishes subacute (de Quervain) thyroiditis and how does its RAIU compare to Graves?

    Painful tender goiter after viral illness, elevated ESR, transient hyperthyroidism from gland destruction; RAIU is LOW (vs high in Graves) because hormone is leaking, not being made.

20. What is the recommended treatment of subclinical hypothyroidism?

    Treat with levothyroxine if TSH >=10 mIU/L; for TSH 4.5-10, consider treatment if symptomatic, positive anti-TPO, pregnant/planning pregnancy, or goiter; otherwise monitor.

21. How should levothyroxine be managed in pregnancy for a woman with hypothyroidism?

    Increase dose ~30% (e.g., two extra tablets/week) as soon as pregnancy confirmed; target trimester-specific TSH (generally <2.5 mIU/L) and recheck TSH every 4 weeks in the first half.

See more Endocrinology, Diabetes & Metabolism flashcards →

Planning Endocrinology, Diabetes & Metabolism for American Board of Internal Medicine Certification (ABIM Board Certification)

Endocrinology, Diabetes & Metabolism (American Board of Internal Medicine Certification (ABIM Board Certification)) FAQ