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Hospital Medicine General Internal Chuck Graver Medicine 1 Reviewers Finance and Operations Administrator Fyad Al-hihi, MD, MBA, FACP Kimberly Kerns Alexander Diaz de Villalvilla, MD Administrative Coordinator Jonathan Doroshow, MD, FACP Rahulkumar Singh, MD, FACP Disclosures of relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients. Individuals not General Internal Medicine 1 ACP listed below have nothing to disclose. Editorial Staff Jackie Twomey, Associate Managing Editor, Assessment Davoren Chick, MD, FACP and Education Programs Other (Owner) Georgette Forgione, Medical Editor, Assessment and Coding 101, LLC Education Programs Tabassum Salam, MD, MBA, FACP Margaret Wells, EdM, Director, Assessment and Education Consultantship Programs Johnson & Johnson Becky Krumm, Senior Managing Editor, Assessment and Education Programs Majken Textor Wingo, MD, FACP Research Grants/Contracts Pfizer ACP Principal Staff Davoren Chick, MD, FACP Senior Vice President, Medical Education Acknowledgments The American College of Physicians (ACP) gratefully Tabassum Salam, MD, MBA, FACP acknowledges the special contributions to the develop- Vice President, Medical Education ment and production of the 19th edition of the Medical Patrick C. Alguire, MD, FACP Knowledge Self-Assessment Program" (MKSAP* 19) made MKSAP Senior Deputy Editor by the following people:

Education Programs Tabassum Salam, MD, MBA, FACP Margaret Wells, EdM, Director, Assessment and Education Consultantship Programs Johnson & Johnson Becky Krumm, Senior Managing Editor, Assessment and Education Programs Majken Textor Wingo, MD, FACP Research Grants/Contracts Pfizer ACP Principal Staff Davoren Chick, MD, FACP Senior Vice President, Medical Education Acknowledgments The American College of Physicians (ACP) gratefully Tabassum Salam, MD, MBA, FACP acknowledges the special contributions to the develop- Vice President, Medical Education ment and production of the 19th edition of the Medical Patrick C. Alguire, MD, FACP Knowledge Self-Assessment Program" (MKSAP* 19) made MKSAP Senior Deputy Editor by the following people: Margaret Wells, EdM Graphic Design: Barry Moshinski (Director, Graphic Director, Assessment and Education Programs Services), Mike Ripca (Technical Administrator, Graphic Services), Raymond DeJohn (Designer, Graphic Services) Becky Krumm Senior Managing Editor Production/Systems: Dan Hoffmann (Director, Information Technology), Scott Hurd (Manager, Content Systems), Jackie Twomey Neil Kohl (Senior Architect), and Chris Patterson (Senior Associate Managing Editor Architect). Julia Nawrocki MKSAP 19 Digital: Under the leadership of Steven Spadt Digital Content Associate/Editor (Senior Vice President, Technology), the development Linnea Donnarumma of the digital version of MKSAP 19 was implemented by Senior Medical Editor ACP’s Digital Products and Services Department, directed and led by Brian Sweigard (Director, Digital Products Amanda Cowley and Services). Other members of the team included Dan Medical Editor Barron (Senior Web Application Developer/Architect), Sandy Crump Callie Cramer (Data Visualization/Web Developer), Chris Medical Editor Forrest (Senior Web Application Developer), Kathleen Hoover (Senior Web Developer), Kara Regis (Manager, Georgette Forgione User Interface Design and Development), Brad Lord Medical Editor (Senior Web Application Developer/Architect), and Beth Goldner John McKnight (Senior Web Developer). Medical Editor The College also wishes to acknowledge that many Suzanne Meyers other persons, too numerous to mention, have contrib- Medical Editor uted to the production of this program. Without their dedicated efforts, this program would not have been Elise Paxson possible. Medical Editor

Margaret Wells, EdM Graphic Design: Barry Moshinski (Director, Graphic Director, Assessment and Education Programs Services), Mike Ripca (Technical Administrator, Graphic Services), Raymond DeJohn (Designer, Graphic Services) Becky Krumm Senior Managing Editor Production/Systems: Dan Hoffmann (Director, Information Technology), Scott Hurd (Manager, Content Systems), Jackie Twomey Neil Kohl (Senior Architect), and Chris Patterson (Senior Associate Managing Editor Architect). Julia Nawrocki MKSAP 19 Digital: Under the leadership of Steven Spadt Digital Content Associate/Editor (Senior Vice President, Technology), the development Linnea Donnarumma of the digital version of MKSAP 19 was implemented by Senior Medical Editor ACP’s Digital Products and Services Department, directed and led by Brian Sweigard (Director, Digital Products Amanda Cowley and Services). Other members of the team included Dan Medical Editor Barron (Senior Web Application Developer/Architect), Sandy Crump Callie Cramer (Data Visualization/Web Developer), Chris Medical Editor Forrest (Senior Web Application Developer), Kathleen Hoover (Senior Web Developer), Kara Regis (Manager, Georgette Forgione User Interface Design and Development), Brad Lord Medical Editor (Senior Web Application Developer/Architect), and Beth Goldner John McKnight (Senior Web Developer). Medical Editor The College also wishes to acknowledge that many Suzanne Meyers other persons, too numerous to mention, have contrib- Medical Editor uted to the production of this program. Without their dedicated efforts, this program would not have been Elise Paxson possible. Medical Editor iv

MKSAP Resource Page e Physicians engaged in the ABIM Maintenance of Certification Longitudinal Assessment Option, pre- The MKSAP Resource Page (www.acponline.org/mksap19- paring for the ABIM Internal Medicine Maintenance of resources) provides access to MKSAP 19 online answer sheets Certification Examination, or engaged with the ABIM for transcribing answers from the print edition; access to Focused Practice in Hospital Medicine program MKSAP 19 Digital; Board Basics"; information on Continuing Medical Education (CME), Maintenance of Certification (MOC), and international Continuing Professional Development (CPD) Earn CME Credits or MOC Points Online and MOC; errata; and other new information. To earn CME credits or to apply for MOC points, MKSAP users need to answer at least one of two questions

Medical Education (CME), Maintenance of Certification (MOC), and international Continuing Professional Development (CPD) Earn CME Credits or MOC Points Online and MOC; errata; and other new information. To earn CME credits or to apply for MOC points, MKSAP users need to answer at least one of two questions International MOC/CPD correctly (earning a score of at least 50%) and click the Submit CME button. Each single MKSAP 19 self-assessment Information and instructions on submission of international question qualifies for one quarter of a CME credit hour or MOC/CPD is available by accessing the CME/MOC/CPD tab ABIM MOC point. on the left navigation menu of MKSAP 19 Digital. MKSAP 19 Subscribers can enter their self-assessment question answers and submit for CME/MOC in two ways: Continuing Medical Education 1. Users of MKSAP 19 Complete who prefer to use their The American College of Physicians is accredited by the print books and a paper answer sheet to study and Accreditation Council for Continuing Medical Education record their answers can use the printed answer sheet (ACCME) to provide continuing medical education for at the back of this book to record their answers. The physicians. corresponding online answer sheets, which are avail- The American College of Physicians designates this endur- able on the MKSAP 19 Resource Page, may be used to ing material, MKSAP 19, for a maximum of 300 AMA PRA transcribe answers onto the online answer sheets. Users Category 1 CreditsTM. Physicians should claim only the may then submit their answers to qualify for CME cred- credit commensurate with the extent of their participation its or MOC points (see below for information on Opting in the activity. in for MOC). Users who prefer to record their answers on a paper answer sheet should save their answer sheet Up to 28.5 AMA PRA Category 1 CreditsTM are available for future use. Users who study with MKSAP 19 print from August 31, 2021, to August 31, 2024, for the MKSAP 19 can also submit their answers directly within MKSAP 19 General Internal Medicine 1 section. Digital by accessing the self-assessment questions dash- board and selecting the preferred subspecialty section Learning Objectives to begin answering questions.

International MOC/CPD correctly (earning a score of at least 50%) and click the Submit CME button. Each single MKSAP 19 self-assessment Information and instructions on submission of international question qualifies for one quarter of a CME credit hour or MOC/CPD is available by accessing the CME/MOC/CPD tab ABIM MOC point. on the left navigation menu of MKSAP 19 Digital. MKSAP 19 Subscribers can enter their self-assessment question answers and submit for CME/MOC in two ways: Continuing Medical Education 1. Users of MKSAP 19 Complete who prefer to use their The American College of Physicians is accredited by the print books and a paper answer sheet to study and Accreditation Council for Continuing Medical Education record their answers can use the printed answer sheet (ACCME) to provide continuing medical education for at the back of this book to record their answers. The physicians. corresponding online answer sheets, which are avail- The American College of Physicians designates this endur- able on the MKSAP 19 Resource Page, may be used to ing material, MKSAP 19, for a maximum of 300 AMA PRA transcribe answers onto the online answer sheets. Users Category 1 CreditsTM. Physicians should claim only the may then submit their answers to qualify for CME cred- credit commensurate with the extent of their participation its or MOC points (see below for information on Opting in the activity. in for MOC). Users who prefer to record their answers on a paper answer sheet should save their answer sheet Up to 28.5 AMA PRA Category 1 CreditsTM are available for future use. Users who study with MKSAP 19 print from August 31, 2021, to August 31, 2024, for the MKSAP 19 can also submit their answers directly within MKSAP 19 General Internal Medicine 1 section. Digital by accessing the self-assessment questions dash- board and selecting the preferred subspecialty section Learning Objectives to begin answering questions. The learning objectives of MKSAP 19 are to: 2. Users of MKSAP 19 Digital can enter their answers within the digital program by accessing the self- ¢ Close gaps between actual care in your practice and preferred standards of care, based on best evidence assessment questions dashboard and selecting the

The learning objectives of MKSAP 19 are to: 2. Users of MKSAP 19 Digital can enter their answers within the digital program by accessing the self- ¢ Close gaps between actual care in your practice and preferred standards of care, based on best evidence assessment questions dashboard and selecting the e Diagnose disease states that are less common and preferred subspecialty section to begin answer- ing questions and clicking the Submit CME button sometimes overlooked or confusing once they qualify for CME and are ready to submit. ¢ Improve clinical management decisions that affect patient Learners should keep in mind their yearly CME and safety and quality of care MOC deadlines when determining the appropriate e Determine when to refer patients for care by medical time to submit. subspecialists, surgeons, and other members of the health care team Learners’ CME/MOC submission progress will be shown on e Pass the ABIM Certification Examination the MKSAP 19 Digital CME/MOC/CPD page. e Pass the ABIM Maintenance of Certification Examination

e Diagnose disease states that are less common and preferred subspecialty section to begin answer- ing questions and clicking the Submit CME button sometimes overlooked or confusing once they qualify for CME and are ready to submit. ¢ Improve clinical management decisions that affect patient Learners should keep in mind their yearly CME and safety and quality of care MOC deadlines when determining the appropriate e Determine when to refer patients for care by medical time to submit. subspecialists, surgeons, and other members of the health care team Learners’ CME/MOC submission progress will be shown on e Pass the ABIM Certification Examination the MKSAP 19 Digital CME/MOC/CPD page. e Pass the ABIM Maintenance of Certification Examination Opting in for MOC Target Audience MKSAP 19 users can opt in for simultaneous submission of ¢ General internal medicine specialists, including primary CME and MOC points as they answer self-assessment care physicians and hospitalists questions. To opt in, users will be required to complete e Internal medicine subspecialists who desire to remain up a form requesting their name, date of birth, and ABIM to date in internal medicine number. The MOC Opt-in Form will be presented during e Residents preparing for the ABIM Internal Medicine a user’s first CME submission and needs to be completed Certification Examination only once.