ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION
ACTUAL EXAM 250+ QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
Question 1
A 45-year-old female presents with a 6-month history of fatigue, weight gain,
cold intolerance, and constipation. Her TSH is 12.5 mIU/L (normal 0.4-4.0),
and free T4 is 0.7 ng/dL (normal 0.8-1.8). The most appropriate initial
treatment is:
A) Methimazole
B) Propylthiouracil (PTU)
C) Levothyroxine
D) Radioactive iodine (RAI)
E) Subtotal thyroidectomy
Correct Answer: C) Levothyroxine
Rationale: The client presents with classic symptoms and laboratory
findings (elevated TSH, low free T4) consistent with primary
hypothyroidism. Levothyroxine is the standard initial replacement
therapy for this condition.
Question 2
A 32-year-old male is found to have a serum calcium of 11.2 mg/dL (normal
8.5-10.2) and a PTH of 85 pg/mL (normal 10-65). He reports no symptoms.
Which of the following is the most likely diagnosis?
A) Malignancy-associated hypercalcemia
B) Vitamin D intoxication
C) Primary hyperparathyroidism
D) Secondary hyperparathyroidism
E) Familial hypocalciuric hypercalcemia (FHH)
Correct Answer: C) Primary hyperparathyroidism
Rationale: The combination of elevated serum calcium and
inappropriately elevated PTH in an asymptomatic patient is
characteristic of primary hyperparathyroidism. Malignancy typically
,causes suppressed PTH. FHH would have low urinary calcium
excretion, which is not given, but the PTH level is higher than
usually seen in FHH where PTH is usually normal to mildly elevated.
Question 3
A 55-year-old male with type 2 diabetes mellitus (T2DM) on metformin and
glargine insulin presents with recurrent hypoglycemia. His C-peptide level is
inappropriately low for his blood glucose, but not absent. Antibodies for
GAD65 and IA-2 are negative. What is the most likely diagnosis?
A) Type 1 diabetes mellitus
B) Latent autoimmune diabetes in adults (LADA)
C) Maturity-onset diabetes of the young (MODY)
D) Insulinoma
E) Factitious hypoglycemia
Correct Answer: C) Maturity-onset diabetes of the young (MODY)
Rationale: MODY is characterized by an autosomal dominant
inheritance, usually diagnosed before age 25, non-insulin-
dependent, and negative for autoimmune markers. While the age of
onset is a bit higher, the clinical picture of recurrent hypoglycemia,
low C-peptide (but not absent), and negative antibodies makes
MODY a strong consideration, especially given other options are less
likely (T1DM/LADA usually antibody positive, insulinoma would have
high C-peptide for hypoglycemia, factitious would have high
insulin/low C-peptide if exogenous insulin or high
C-peptide/sulfonylurea in plasma if sulfonylurea abuse).
Question 4
A 60-year-old female presents with bilateral visual field defects, specifically
bitemporal hemianopsia. Endocrine evaluation reveals elevated IGF-1 and
growth hormone (GH) levels that are not suppressed by an oral glucose
tolerance test. Pituitary MRI shows a macroadenoma. What is the most
appropriate initial treatment?
,A) Transsphenoidal surgery
B) Radiation therapy
C) Octreotide (somatostatin analog)
D) Pegvisomant (GH receptor antagonist)
E) Cabergoline (dopamine agonist)
Correct Answer: A) Transsphenoidal surgery
Rationale: The patient has acromegaly with visual field defects due
to a pituitary macroadenoma compressing the optic chiasm.
Transsphenoidal surgery is the first-line treatment to decompress
the optic chiasm and achieve biochemical control.
Question 5
A 28-year-old woman presents with secondary amenorrhea, galactorrhea,
and a prolactin level of 120 ng/mL (normal < 25). Pituitary MRI shows a 7
mm microadenoma. What is the most appropriate initial treatment?
A) Transsphenoidal surgery
B) Radiation therapy
C) Bromocriptine (dopamine agonist)
D) Estrogen replacement therapy
E) Observation with repeat MRI in 6 months
Correct Answer: C) Bromocriptine (dopamine agonist)
Rationale: Dopamine agonists (like bromocriptine or cabergoline)
are the first-line treatment for prolactinomas, regardless of size, as
they are highly effective in normalizing prolactin levels and
shrinking the tumor.
Question 6
A 38-year-old male with hypertension and resistant hypokalemia is found to
have elevated plasma aldosterone-to-renin ratio. Subsequent adrenal vein
sampling shows unilateral aldosterone hypersecretion from the right adrenal
gland. What is the most appropriate treatment?
A) Spironolactone
, B) Eplerenone
C) Bilateral adrenalectomy
D) Unilateral right adrenalectomy
E) Medical management with ACE inhibitors
Correct Answer: D) Unilateral right adrenalectomy
Rationale: Unilateral aldosterone hypersecretion confirmed by
adrenal vein sampling indicates primary aldosteronism from an
adenoma. Surgical removal of the affected adrenal gland is curative.
Question 7
A 70-year-old female with osteoporosis is considering initiating
bisphosphonate therapy. Her current GFR is 25 mL/min. Which of the
following is the most appropriate action?
A) Initiate alendronate daily.
B) Initiate zoledronic acid IV annually.
C) Prescribe denosumab.
D) Prescribe teriparatide.
E) Bisphosphonates are contraindicated; consider other agents.
Correct Answer: E) Bisphosphonates are contraindicated; consider
other agents.
Rationale: Bisphosphonates are generally contraindicated or used
with extreme caution in patients with a GFR below 30-35 mL/min
due to accumulation and potential renal toxicity. Denosumab or
teriparatide would be more appropriate options for this patient.
Question 8
A 22-year-old male with newly diagnosed Type 1 Diabetes Mellitus (T1DM) is
in Diabetic Ketoacidosis (DKA). Initial management includes intravenous
fluids and insulin. Which electrolyte requires close monitoring and may need
replacement as glucose and insulin levels change?
A) Sodium
B) Chloride
ACTUAL EXAM 250+ QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
Question 1
A 45-year-old female presents with a 6-month history of fatigue, weight gain,
cold intolerance, and constipation. Her TSH is 12.5 mIU/L (normal 0.4-4.0),
and free T4 is 0.7 ng/dL (normal 0.8-1.8). The most appropriate initial
treatment is:
A) Methimazole
B) Propylthiouracil (PTU)
C) Levothyroxine
D) Radioactive iodine (RAI)
E) Subtotal thyroidectomy
Correct Answer: C) Levothyroxine
Rationale: The client presents with classic symptoms and laboratory
findings (elevated TSH, low free T4) consistent with primary
hypothyroidism. Levothyroxine is the standard initial replacement
therapy for this condition.
Question 2
A 32-year-old male is found to have a serum calcium of 11.2 mg/dL (normal
8.5-10.2) and a PTH of 85 pg/mL (normal 10-65). He reports no symptoms.
Which of the following is the most likely diagnosis?
A) Malignancy-associated hypercalcemia
B) Vitamin D intoxication
C) Primary hyperparathyroidism
D) Secondary hyperparathyroidism
E) Familial hypocalciuric hypercalcemia (FHH)
Correct Answer: C) Primary hyperparathyroidism
Rationale: The combination of elevated serum calcium and
inappropriately elevated PTH in an asymptomatic patient is
characteristic of primary hyperparathyroidism. Malignancy typically
,causes suppressed PTH. FHH would have low urinary calcium
excretion, which is not given, but the PTH level is higher than
usually seen in FHH where PTH is usually normal to mildly elevated.
Question 3
A 55-year-old male with type 2 diabetes mellitus (T2DM) on metformin and
glargine insulin presents with recurrent hypoglycemia. His C-peptide level is
inappropriately low for his blood glucose, but not absent. Antibodies for
GAD65 and IA-2 are negative. What is the most likely diagnosis?
A) Type 1 diabetes mellitus
B) Latent autoimmune diabetes in adults (LADA)
C) Maturity-onset diabetes of the young (MODY)
D) Insulinoma
E) Factitious hypoglycemia
Correct Answer: C) Maturity-onset diabetes of the young (MODY)
Rationale: MODY is characterized by an autosomal dominant
inheritance, usually diagnosed before age 25, non-insulin-
dependent, and negative for autoimmune markers. While the age of
onset is a bit higher, the clinical picture of recurrent hypoglycemia,
low C-peptide (but not absent), and negative antibodies makes
MODY a strong consideration, especially given other options are less
likely (T1DM/LADA usually antibody positive, insulinoma would have
high C-peptide for hypoglycemia, factitious would have high
insulin/low C-peptide if exogenous insulin or high
C-peptide/sulfonylurea in plasma if sulfonylurea abuse).
Question 4
A 60-year-old female presents with bilateral visual field defects, specifically
bitemporal hemianopsia. Endocrine evaluation reveals elevated IGF-1 and
growth hormone (GH) levels that are not suppressed by an oral glucose
tolerance test. Pituitary MRI shows a macroadenoma. What is the most
appropriate initial treatment?
,A) Transsphenoidal surgery
B) Radiation therapy
C) Octreotide (somatostatin analog)
D) Pegvisomant (GH receptor antagonist)
E) Cabergoline (dopamine agonist)
Correct Answer: A) Transsphenoidal surgery
Rationale: The patient has acromegaly with visual field defects due
to a pituitary macroadenoma compressing the optic chiasm.
Transsphenoidal surgery is the first-line treatment to decompress
the optic chiasm and achieve biochemical control.
Question 5
A 28-year-old woman presents with secondary amenorrhea, galactorrhea,
and a prolactin level of 120 ng/mL (normal < 25). Pituitary MRI shows a 7
mm microadenoma. What is the most appropriate initial treatment?
A) Transsphenoidal surgery
B) Radiation therapy
C) Bromocriptine (dopamine agonist)
D) Estrogen replacement therapy
E) Observation with repeat MRI in 6 months
Correct Answer: C) Bromocriptine (dopamine agonist)
Rationale: Dopamine agonists (like bromocriptine or cabergoline)
are the first-line treatment for prolactinomas, regardless of size, as
they are highly effective in normalizing prolactin levels and
shrinking the tumor.
Question 6
A 38-year-old male with hypertension and resistant hypokalemia is found to
have elevated plasma aldosterone-to-renin ratio. Subsequent adrenal vein
sampling shows unilateral aldosterone hypersecretion from the right adrenal
gland. What is the most appropriate treatment?
A) Spironolactone
, B) Eplerenone
C) Bilateral adrenalectomy
D) Unilateral right adrenalectomy
E) Medical management with ACE inhibitors
Correct Answer: D) Unilateral right adrenalectomy
Rationale: Unilateral aldosterone hypersecretion confirmed by
adrenal vein sampling indicates primary aldosteronism from an
adenoma. Surgical removal of the affected adrenal gland is curative.
Question 7
A 70-year-old female with osteoporosis is considering initiating
bisphosphonate therapy. Her current GFR is 25 mL/min. Which of the
following is the most appropriate action?
A) Initiate alendronate daily.
B) Initiate zoledronic acid IV annually.
C) Prescribe denosumab.
D) Prescribe teriparatide.
E) Bisphosphonates are contraindicated; consider other agents.
Correct Answer: E) Bisphosphonates are contraindicated; consider
other agents.
Rationale: Bisphosphonates are generally contraindicated or used
with extreme caution in patients with a GFR below 30-35 mL/min
due to accumulation and potential renal toxicity. Denosumab or
teriparatide would be more appropriate options for this patient.
Question 8
A 22-year-old male with newly diagnosed Type 1 Diabetes Mellitus (T1DM) is
in Diabetic Ketoacidosis (DKA). Initial management includes intravenous
fluids and insulin. Which electrolyte requires close monitoring and may need
replacement as glucose and insulin levels change?
A) Sodium
B) Chloride
