0.4 Building a Blueprint-Weighted Study Plan

ABIM Internal Medicine Exam

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1 Chapter 0: The ABIM Exam, Blueprint & Study Strategy

0.1 Exam Format, Question Types & the 2026 Blueprint 0.2 Eligibility, Registration, Fees & Exam-Day Logistics 0.3 Scoring, the Passing Standard & Score Reports 0.4 Building a Blueprint-Weighted Study Plan

2 Chapter 1: Cardiovascular Disease (14% of Exam)

1.1 Ischemic Heart Disease & Acute Coronary Syndromes 1.2 Antithrombotic Therapy, Secondary Prevention & Mechanical Complications of MI 1.3 Atrial Fibrillation, Atrial Flutter & Stroke Prevention 1.4 Supraventricular Tachycardias, Ventricular Arrhythmias & Bradycardias 1.5 Heart Failure: Classification, Staging & Guideline-Directed Medical Therapy 1.6 Device Therapy, HFpEF & the Cardiomyopathies 1.7 Valvular Heart Disease & Endocarditis Prophylaxis 1.8 Pericardial Disease & Acute Aortic Syndromes 1.9 Hypertension: Classification, Diagnosis & Secondary Causes 1.10 Hypertensive Crises & Dyslipidemia 1.11 Adult Congenital Heart Disease & Coarctation of the Aorta 1.12 Syncope: Reflex, Orthostatic & Cardiac Causes 1.13 Cardiac Physical Examination, Murmurs & Antithrombotic Selection

3 Chapter 2: Endocrinology, Diabetes & Metabolism (9% of Exam)

2.1 Diabetes Mellitus: Diagnosis, Glycemic Targets & Pharmacotherapy 2.2 Insulin Therapy, Hyperglycemic Emergencies & Chronic Complications 2.3 Thyroid Function Testing & Hypothyroidism 2.4 Thyrotoxicosis, Thyroid Storm & Thyroid Nodules 2.5 Adrenal & Pituitary Disorders 2.6 Hypercalcemia, Hypocalcemia & Disorders of Mineral Metabolism 2.7 Osteoporosis & Paget Disease of Bone 2.8 Ovarian, Testicular & Reproductive Endocrine Disorders 2.9 Hypoglycemia, Endocrine Tumors, Polyglandular Syndromes & Severe Hypertriglyceridemia

4 Chapter 3: Gastroenterology & Hepatology (9% of Exam)

3.1 Esophageal Disease 3.2 Stomach & Duodenal Disease and Gastrointestinal Hemorrhage 3.3 Inflammatory Bowel Disease 3.4 Celiac Disease & Irritable Bowel Syndrome 3.5 Diverticular Disease & Colorectal Cancer Screening 3.6 Viral Hepatitis, Steatotic & Alcohol-Associated Liver Disease 3.7 Cirrhosis & the Complications of Portal Hypertension 3.8 Acute Pancreatitis 3.9 Chronic Pancreatitis & Biliary Tract Disease 3.10 Inherited, Autoimmune & Drug-Induced Liver Disease 3.11 Small Intestinal Disease, Ischemia & Gastrointestinal Complications of HIV

5 Chapter 4: Infectious Disease (9% of Exam)

4.1 Lower Respiratory Tract Infections & Sepsis Syndromes 4.2 Viral Respiratory Pathogens & Tuberculosis 4.3 Central Nervous System Infections 4.4 Skin, Soft Tissue, Bone & Joint Infections 4.5 Infective Endocarditis & Cardiovascular Infection 4.6 Clostridioides difficile & Catheter-Related Bloodstream Infection 4.7 HIV Diagnosis, Antiretroviral Therapy & Prevention 4.8 Opportunistic Infections & Sexually Transmitted Infections 4.9 Fever of Unknown Origin, Neutropenic Fever & Toxic Shock 4.10 Travel-Related Illness, Vector-Borne Disease & Outbreaks 4.11 Infection Prevention, Nosocomial Infection & Postexposure Prophylaxis 4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections

6 Chapter 5: Pulmonary Disease (9% of Exam)

5.1 COPD: Diagnosis, GOLD Classification & Initial Pharmacotherapy 5.2 Interventions That Reduce COPD Mortality & Exacerbation Management 5.3 Asthma: Diagnosis, Stepwise Therapy & Status Asthmaticus 5.4 Interstitial Lung Disease & Idiopathic Pulmonary Fibrosis 5.5 Sarcoidosis, Hypersensitivity Pneumonitis & Occupational Lung Disease 5.6 Pulmonary Embolism: Diagnosis, Risk Stratification & Anticoagulation 5.7 Pulmonary Hypertension & Sleep-Disordered Breathing 5.8 Acute Respiratory Distress Syndrome & Mechanical Ventilation 5.9 Pleural Disease, Empyema & Pneumothorax 5.10 Bronchiectasis, Cystic Fibrosis & Restrictive Lung Disease 5.11 Evaluation of Cough, Dyspnea, Hemoptysis & the Solitary Pulmonary Nodule

7 Chapter 6: Rheumatology & Orthopedics (9% of Exam)

6.1 Rheumatoid Arthritis: Diagnosis & Systemic Manifestations 6.2 Antirheumatic Pharmacotherapy & the Spondyloarthropathies 6.3 Gout: Pathophysiology & Acute Management 6.4 Urate-Lowering Therapy & Calcium Pyrophosphate Deposition Disease 6.5 Osteoarthritis 6.6 Systemic Lupus Erythematosus 6.7 Systemic Sclerosis, Sjogren Syndrome & Inflammatory Myopathies 6.8 The Vasculitides 6.9 Regional Musculoskeletal Syndromes, Back Pain & Sports Injuries 6.10 Other Primary Rheumatic Disorders & Mixed Connective Tissue Disease 6.11 Osteonecrosis & Metabolic Bone Disease

8 Chapter 7: Hematology (6% of Exam)

7.1 Approach to Anemia & the Microcytic Anemias 7.2 Macrocytic, Normocytic & Hemolytic Anemias 7.3 Hemoglobinopathies, Thalassemias & Paroxysmal Nocturnal Hemoglobinuria 7.4 Platelet Disorders, Thrombocytopenia & the Bleeding Patient 7.5 Coagulation Factor Disorders, Thrombophilia & Anticoagulant Reversal 7.6 Acute Leukemias, Chronic Leukemias & Myeloproliferative Neoplasms 7.7 Lymphomas & Plasma Cell Disorders 7.8 Myelodysplastic Syndrome, Myeloproliferative Neoplasms & Porphyria 7.9 Transfusion Medicine & Late Complications of Transplantation

9 Chapter 8: Medical Oncology (6% of Exam)

8.1 Breast, Lung, Colorectal & Prostate Cancer 8.2 Oncologic Emergencies 8.3 Genitourinary & Gynecologic Malignancies 8.4 Head and Neck, Bone & Soft Tissue Cancer and Cancer of Unknown Primary 8.5 Complications of Cancer & Its Treatment 8.6 Cancer Prevention, Survivorship & Psychosocial Care

10 Chapter 9: Nephrology & Urology (6% of Exam)

9.1 Acute Kidney Injury: Staging, Etiology & Urine Microscopy 9.2 Glomerular Disorders & Nephrotic Syndrome 9.3 Nephritic Syndromes, RPGN & Indications for Renal Replacement Therapy 9.4 Chronic Kidney Disease: Staging & Progression Retardation 9.5 Complications of Chronic Kidney Disease: Anemia, CKD-MBD & Acidosis 9.6 Hyponatremia, Hypernatremia & Water Balance 9.7 Potassium Disorders & Systematic Acid-Base Analysis 9.8 Renal Tubular Acidosis & Nephrolithiasis 9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions 9.10 Cystic Kidney Disease, Obstructive Uropathy, Tubulointerstitial Disease & Hematuria

11 Chapter 10: Neurology (4% of Exam)

10.1 Acute Ischemic Stroke: Syndromes & Reperfusion 10.2 Transient Ischemic Attack, Secondary Prevention & Hemorrhagic Stroke 10.3 Headache & Facial Pain 10.4 Seizures, Epilepsy & Movement Disorders 10.5 Multiple Sclerosis & Neuromuscular Junction Disorders 10.6 Motor Neuron Disease & Acute Peripheral Neuropathy 10.7 Cranial Neuropathies & Neuro-Ophthalmology 10.8 Peripheral Neuropathies, CNS Tumors & Other Neurologic Disorders

12 Chapter 11: Psychiatry & Behavioral Health (4% of Exam)

11.1 Major Depressive Disorder & Medical Mimics 11.2 Antidepressant Pharmacotherapy & Treatment-Resistant Depression 11.3 Bipolar Disorder, Mood Stabilizers & Lithium Toxicity 11.4 Anxiety, Stress-Related & Obsessive-Compulsive Disorders 11.5 Alcohol Use Disorder & Withdrawal 11.6 Pharmacotherapy for Alcohol & Opioid Use Disorder 11.7 Toxidromes, Psychiatric Emergencies & Suicide Risk Assessment 11.8 Psychotic, Somatic Symptom, Factitious & Personality Disorders 11.9 Eating Disorders, Sleep Disorders & Sexual Health

13 Chapter 12: Dermatology (3% of Exam)

12.1 Dermatitis, Papulosquamous & Inflammatory Dermatoses 12.2 Acne, Rosacea & Cutaneous Infections 12.3 Herpes Zoster & Autoimmune Blistering Diseases 12.4 Nodules, Tumors & Cutaneous Oncology 12.5 Dermatologic Emergencies & Severe Cutaneous Adverse Reactions 12.6 Pigment Disorders, Alopecia, Nail Disease & Photosensitivity 12.7 Vascular Dermatoses, Environmental Injury & Cutaneous Signs of Systemic Disease

14 Chapter 13: Obstetrics & Gynecology / Women's Health (3% of Exam)

13.1 Contraception, Preconception Care & Teratogenicity 13.2 Hypertensive Disorders of Pregnancy & Gestational Diabetes 13.3 Thyroid Disease & Venous Thromboembolism in Pregnancy 13.4 Menopause & Menopausal Hormone Therapy 13.5 Abnormal Uterine Bleeding, Endometrial Disease & Gynecologic Cancer Screening 13.6 Breast Disorders & Diseases of the Vulva and Vagina 13.7 Menstrual Disorders, Fibroids, Endometriosis & Early Pregnancy Complications

15 Chapter 14: Geriatric Syndromes (3% of Exam)

14.1 Comprehensive Geriatric Assessment & Frailty 14.2 Falls, Gait Assessment & Polypharmacy 14.3 Urinary Incontinence & Pressure Injuries in Older Adults 14.4 Mild Cognitive Impairment, Dementia & Its Subtypes 14.5 Delirium & the Pharmacotherapy of Cognitive Disorders 14.6 Palliative Care, Hospice & Advance Care Planning 14.7 Chronic Wounds, Nutrition, Swallowing, Constipation & Hip Fracture 14.8 Sensory Impairment, Dizziness, Elder Mistreatment & Care Settings

16 Chapter 15: Allergy & Immunology (2% of Exam)

15.1 Anaphylaxis: Recognition & Emergency Management 15.2 Urticaria & Angioedema 15.3 Drug Allergy, Desensitization & Adult Immunodeficiency 15.4 Food Allergy, Insect Venom Hypersensitivity, Serum Sickness & Contrast Reactions 15.5 Rhinitis, Conjunctivitis, Eosinophilic & Mast Cell Disorders

17 Chapter 16: Preventive Medicine, Immunization & Clinical Epidemiology

16.1 The USPSTF Framework & Evidence-Based Cancer Screening 16.2 Cardiovascular & Metabolic Screening and Primary Prevention 16.3 Adult Immunization & Vaccines in Special Populations 16.4 Clinical Epidemiology, Biostatistics & Study Design

18 Chapter 17: Miscellaneous - Ethics, Patient Safety & Quality Improvement (2% of Exam)

17.1 Principles of Bioethics & Decisional Capacity 17.2 Informed Consent, Treatment Refusal & Special Scenarios 17.3 Surrogate Decision-Making, Advance Directives & Confidentiality 17.4 Patient Safety Science, Medical Error & Diagnostic Reasoning 17.5 Quality Improvement Methods, Health Disparities & Health Equity

19 Chapter 18: Perioperative Medicine & Medical Consultation

18.1 Preoperative Cardiovascular Risk Assessment 18.2 Preoperative Pulmonary Risk & Perioperative Medication Management 18.3 Perioperative Anticoagulation, Bridging & Postoperative Complications

20 Chapter 19: Ophthalmology (1% of Exam)

19.1 The Acute Red Eye & Ophthalmic Emergencies 19.2 Painless Vision Loss & Chronic Ophthalmic Disease 19.3 Uveitis, Scleritis & Orbital Disease

21 Chapter 20: Otolaryngology & Dental Medicine (1% of Exam)

20.1 Dizziness, Vertigo & Epistaxis 20.2 Ear Disorders, Hearing Loss & Upper Respiratory Infections 20.3 Oral Cavity, Salivary Gland, Laryngeal & Taste and Smell Disorders

0.4 Building a Blueprint-Weighted Study Plan

Key Takeaways Explain This Topic AI

Cardiovascular disease, endocrinology, gastroenterology, infectious disease and pulmonary disease together account for 50% of the exam and should be scheduled first.

The nine categories weighted 3% or below sum to 16% of the exam, which is more than cardiovascular disease alone, so they cannot be skipped entirely.

Mixed-topic question blocks that force diagnostic discrimination outperform sequential single-topic review for an exam built on undifferentiated vignettes.

Because roughly two minutes are available per question, timed practice should train a three-minute flag-and-move rule rather than overall speed.

A written error log sorted by blueprint subsection converts wrong answers into a targeted second-pass review list.

Last updated: August 2026

Allocate by Weight, Not by Interest

The most common study-plan failure is spending time in proportion to comfort rather than to blueprint weight . Cardiology enthusiasts over-study cardiology; the exam does not reward the marginal hour once typical cardiology items are already secure.

Start from the arithmetic. On a form with roughly 205 scored items:

Tier Categories Combined weight Approx. scored items

Tier 1 (9–14%) Cardiovascular, Endocrinology, Gastroenterology, Infectious Disease, Pulmonary, Rheumatology/Orthopedics 59% ~121

Tier 2 (4–6%) Hematology, Medical Oncology, Nephrology/Urology, Neurology, Psychiatry 26% ~53

Tier 3 (1–3%) Dermatology, Geriatric Syndromes, OB/GYN, Allergy/Immunology, Miscellaneous, Ophthalmology, Otolaryngology 15% ~31

Two observations drive the plan:

Tier 1 alone is nearly six of every ten questions. If your preparation time collapses, this is the irreducible core.

Tier 3 is not negligible. Fifteen percent is more than the entire cardiovascular category. Skipping dermatology, ophthalmology and otolaryngology because they are "only 1–3%" forfeits roughly 31 questions — far more than the margin by which most borderline candidates fail.

A Three-Pass Structure

Pass 1 — Content, weighted (months 1–3). Work through Tier 1 chapters first, then Tier 2, then Tier 3. Read for the decision rules : which drug is contraindicated, what the next step is, which finding changes management. ABIM vignettes rarely ask you to name a disease in isolation.

Pass 2 — Mixed retrieval (months 3–5). Switch to mixed-topic question blocks . This matters more than it sounds. Single-topic review gives you the diagnosis for free — when every question in a block is about anemia, you never practice the actual exam task of deciding whether a fatigued patient has anemia, hypothyroidism, depression or obstructive sleep apnea. Undifferentiated blocks force that discrimination.

Pass 3 — Error-log consolidation and endurance (final month). Re-study only what you got wrong, and complete at least one full four-block simulation.

The Error Log

Keep a written log with one line per missed question:

• Blueprint subsection (e.g. "Nephrology → Glomerular disorders")
• What the correct answer was

Why you missed it , classified as one of: knowledge gap , misread stem , right diagnosis wrong next step , or guessed

The classification is the valuable part. A log dominated by "misread stem" is a pacing and attention problem that more content review will not fix. A log dominated by "right diagnosis wrong next step" means you are learning diseases rather than management algorithms — the exact failure mode ABIM's task list is designed to detect.

Sort the log by blueprint subsection at the end of each week. Subsections with three or more misses become the next week's targeted review.

Timing Practice

At up to 60 questions in 120 minutes, you have two minutes per question . Most candidates do not fail on total time; they fail on allocation . The two habits worth drilling are:

The three-minute rule. If you have not converged by three minutes, choose the best remaining option, flag it, and move. You can return with leftover time; you cannot un-spend eight minutes.

Read the last sentence first. ABIM stems are long and laboratory-dense. Knowing whether you are being asked for a diagnosis, a next test, or a treatment tells you which parts of the vignette matter and prevents you from memorizing a table of labs you will not need.

Guideline Currency

ABIM reviews the blueprint annually and writes items to current standards of care. Several high-yield areas move frequently, and studying from an outdated source is a silent source of wrong answers:

• Heart failure GDMT and SGLT2 inhibitor indications
• Diabetes pharmacotherapy sequencing and cardiorenal indications
• COPD (GOLD) and asthma (GINA) treatment groups
• Hepatitis C and HIV antiretroviral regimens
• USPSTF screening ages and intervals
• ACIP adult immunization schedule
• CKD progression retardation and anemia management

When a review resource and a current society guideline disagree, the guideline wins — but check the guideline's publication date, because organizations frequently leave superseded PDFs online.

What Not to Do

Do not study to a percentage-correct target on a commercial question bank. Bank percentages do not map onto the scaled 366 standard, and bank difficulty is calibrated differently from the real form.

Do not skip the small categories. See the Tier 3 arithmetic above.

Do not defer the exam to feel more ready. Board eligibility runs seven years, the exam is offered only in August, and knowledge decays fastest immediately after residency.

Do not neglect image and audio practice. Photographs, radiographs, ECGs and auscultation recordings appear in stems and cannot be prepared for through prose alone.

A Worked Six-Month Allocation

For a candidate with roughly 10 hours per week (about 260 hours total):

• Block Weeks Focus Hours
• 1 1–8 Tier 1 content: cardiovascular, pulmonary, infectious disease 80
• 2 9–13 Tier 1 content: endocrine, GI, rheumatology 50
• 3 14–17 Tier 2 content: heme, onc, nephrology, neurology, psychiatry 40
• 4 18–20 Tier 3 sweep: derm, geriatrics, OB/GYN, allergy, ophtho, ENT, miscellaneous 30
• 5 21–24 Mixed timed blocks + error-log consolidation + one full simulation 60

The Tier 3 sweep is deliberately short and deliberately not optional . Three focused weeks across seven small categories is enough to convert 31 unreachable questions into mostly reachable ones.