0.1 Exam Format, Question Types & the 2026 Blueprint

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

0.1 Exam Format, Question Types & the 2026 Blueprint

Key Takeaways Explain This Topic AI

The exam contains up to 240 single-best-answer multiple-choice questions, of which approximately 35 are unscored pretest items that do not count toward the score.

The January 2026 blueprint lists 18 medical content categories; cardiovascular disease is the largest at 14% and ophthalmology and otolaryngology/dental medicine are the smallest at 1% each.

Hypertension is a 5% blueprint line item that is deliberately cross-listed under both Cardiovascular Disease and Nephrology and Urology, so it is not double-counted in the 100% total.

Questions are written around five physician tasks: making a diagnosis, ordering and interpreting tests, recommending treatment, assessing risk and prognosis, and applying underlying pathophysiology.

Ten cross-content areas (including critical care, prevention, clinical epidemiology, ethics, nutrition, palliative care and patient safety) are embedded inside the 18 primary categories rather than tested as separate sections.

Last updated: August 2026

Why the Blueprint Is the Only Study Plan That Matters

The American Board of Internal Medicine (ABIM) publishes a blueprint — a table of specifications — for the Internal Medicine Certification Examination, and it revises that blueprint annually. The version in force for the current cycle is dated January 2026 . Every scored question on your exam form is written to a blueprint cell, so the blueprint is not a study aid; it is the literal specification the item writers work from.

Two consequences follow, and both are frequently missed by candidates who study from a review course syllabus instead:

Category weight predicts question volume. A 14% category on a 205-scored-item form is roughly 29 questions. A 1% category is roughly two. Time spent must be proportional or you are optimizing the wrong thing.

Breadth beats depth at the margins. ABIM states that the exam "may require recognition of common as well as rare clinical problems for which patients may consult a certified internist." The blueprint enumerates hundreds of named subsection topics. A candidate who knows cardiology to fellowship depth but has never reviewed pigment disorders or factitious disorder will lose points that were cheap to protect.

The 18 Medical Content Categories (January 2026)

• Medical Content Category % of Exam
• Cardiovascular Disease 14%
• Endocrinology, Diabetes, and Metabolism 9%
• Gastroenterology 9%
• Infectious Disease 9%
• Pulmonary Disease 9%
• Rheumatology and Orthopedics 9%
• Hematology 6%
• Medical Oncology 6%
• Nephrology and Urology 6%
• Neurology 4%
• Psychiatry 4%
• Dermatology 3%
• Geriatric Syndromes 3%
• Obstetrics and Gynecology 3%
• Allergy and Immunology 2%
• Miscellaneous 2%
• Ophthalmology 1%
• Otolaryngology and Dental Medicine 1%
• Total 100%
• The hypertension cross-listing trap

Inside the blueprint, Hypertension carries a 5% weight — the single largest subsection on the entire exam, larger than all of dermatology. ABIM prints it twice, once under Cardiovascular Disease and once under Nephrology and Urology, with an explicit note on each that the total includes the content listed under the other. It is one 5% block, not two. Treat hypertension as a top-priority topic in its own right: essential hypertension, renal and renovascular causes, primary aldosteronism, coarctation, hypertensive urgency versus emergency, and the undifferentiated presentation.

Categories where weight and topic count diverge

Weight and breadth are not the same thing. Geriatric Syndromes is only 3% of the exam but enumerates 19 named subsections, from pressure injuries to elder mistreatment to common foot problems. Medical Oncology is 6% but lists 18 subsections. Conversely Cardiovascular Disease packs 14% into 14 subsections, so each carries far more expected questions. When you allocate review time, weight tells you how many questions are at stake; subsection count tells you how thinly those questions are spread and therefore how shallow the required knowledge is.

The Five Physician Tasks

ABIM writes most items as patient vignettes and asks about the work internists actually do. The published task list is:

• Making a diagnosis
• Ordering and interpreting results of tests
• Recommending treatment or other patient care
• Assessing risk, determining prognosis, and applying principles from epidemiologic studies
• Understanding the underlying pathophysiology of disease and basic science knowledge applicable to patient care

Notice what is absent: pure recall of isolated facts. A well-written ABIM item gives you a patient in whom the diagnosis is already strongly implied and then asks for the next step . The discriminating knowledge is usually sequencing — what you do first, what you do only after something else, and what you must not do at all.

Media in the Item Stem

Clinical information in the stem may include patient photographs, radiographs, electrocardiograms, and recordings of heart or lung sounds , among other media. Two practical implications:

Practice with images and audio, not just text. Morphologic dermatology, peripheral smears, chest radiographs and ECGs are all fair game and cannot be learned from prose alone.

Use headphones deliberately. Auscultation items require you to actually listen; budget the extra 20–30 seconds rather than guessing from the vignette.

Cross-Content Areas

ABIM states that questions in the 18 categories above may also include topics in:

• Critical Care Medicine
• Prevention
• Clinical Epidemiology
• Ethics
• Nutrition
• Palliative and End-of-Life Care
• Adolescent Medicine
• Occupational Medicine
• Patient Safety
• Substance Abuse

These are not separate blueprint sections with their own percentages. They are lenses applied inside the primary categories: a sepsis question is critical care and infectious disease; a question about whether to offer lung cancer screening is prevention and pulmonary disease. The one exception is the Miscellaneous category (2%), which does carve out three explicit subsections — primarily epidemiology, primarily ethics, and primarily safety and quality improvement — for items that do not fit a clinical discipline at all.

ABIM also states that health equity content that is clinically important to each discipline will be included in assessments, and that the use of gender, race and ethnicity identifiers is being re-evaluated. Expect items in which the correct answer depends on recognizing a disparity or a social determinant rather than a laboratory value.

What This Means for the Rest of This Guide

Every chapter that follows maps to a blueprint category, and the section count within each chapter is proportional to that category's weight and subsection breadth. Chapters 1–5 (cardiovascular, endocrine, gastroenterology, infectious disease, pulmonary) together account for 50% of the exam . If your study time is short, that is where it goes first.