ABIM Endocrinology

Question 1

A 45-year-old woman presents with weight gain, fatigue, constipation, and cold intolerance. TSH is 12 mIU/L and free T4 is low. What is the most appropriate treatment?

Accepted Answer

Levothyroxine (T4)

Answer

Levothyroxine is the standard treatment for primary hypothyroidism and is titrated to normalize TSH levels.

Question 2

A 32-year-old woman with type 1 diabetes presents with recurrent hypoglycemia, nausea, and weight loss. Morning cortisol is undetectable. What additional test should be performed?

Accepted Answer

ACTH stimulation test

Answer

The ACTH (cosyntropin) stimulation test is the gold standard for diagnosing primary adrenal insufficiency (Addison disease) by assessing adrenal cortisol response.

Question 3

A 60-year-old man with type 2 diabetes has HbA1c of 8.9% on metformin monotherapy. He has CKD stage 3a (GFR 48 mL/min) and no cardiovascular disease. What is the best add-on therapy?

Accepted Answer

GLP-1 receptor agonist

Answer

GLP-1 receptor agonists have cardiovascular and renal benefits, are effective at all GFR levels (most agents), and reduce HbA1c significantly, making them preferred add-on therapy.

Question 4

A 35-year-old woman develops hypercalcemia with a PTH of 120 pg/mL (normal 10–65). She is asymptomatic. Which statement is correct about management?

Accepted Answer

Surgery is indicated if age <50 or serum calcium >1 mg/dL above upper limit

Answer

According to guidelines, parathyroidectomy is indicated in asymptomatic primary hyperparathyroidism if age <50, calcium >1 mg/dL above normal, T-score <−2.5, or GFR <60 mL/min.

Question 5

A patient with type 2 diabetes has a foot ulcer that probes to bone. X-ray shows periosteal reaction and bone erosion. What is the most appropriate next step?

Accepted Answer

MRI of the foot

Answer

MRI is the gold standard for diagnosing diabetic osteomyelitis, offering high sensitivity and specificity for bone marrow involvement when plain X-rays are inconclusive.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Endocrinology