Browse the corpus

ABIM Maintenance of Certification being an anti-racist organization that supports diversity, equity, and inclusion throughout health care and health Successful completion of the CME activity, which includes education. ACP also continues to ensure diversity among participation in the evaluation component, enables the MKSAP’s physician-contributors. When appropriate, the participant to earn up to 300 medical knowledge MOC points MKSAP Editors will also rely on MKSAP 19 Digital’s expanded in the ABIM’s MOC program. It is the CME activity provider’s use of multimedia enhancements, including video and responsibility to submit participant completion information audio, to explore and more fully explain issues surrounding to ACCME for the purpose of granting MOC credit. the presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to Disclosure Policy contact the Editors at mksap_editors@acponline.org It is the policy of the American College of Physicians (ACP) to help us identify opportunities for improvement in to ensure balance, independence, objectivity, and scientific this area.

ABIM Maintenance of Certification being an anti-racist organization that supports diversity, equity, and inclusion throughout health care and health Successful completion of the CME activity, which includes education. ACP also continues to ensure diversity among participation in the evaluation component, enables the MKSAP’s physician-contributors. When appropriate, the participant to earn up to 300 medical knowledge MOC points MKSAP Editors will also rely on MKSAP 19 Digital’s expanded in the ABIM’s MOC program. It is the CME activity provider’s use of multimedia enhancements, including video and responsibility to submit participant completion information audio, to explore and more fully explain issues surrounding to ACCME for the purpose of granting MOC credit. the presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to Disclosure Policy contact the Editors at mksap_editors@acponline.org It is the policy of the American College of Physicians (ACP) to help us identify opportunities for improvement in to ensure balance, independence, objectivity, and scientific this area. rigor in all of its educational activities. To this end, and consistent with the policies of the ACP and the Accreditation Hospital-Based Medicine Council for Continuing Medical Education (ACCME), con- For the convenience of subscribers who provide care in tributors to all ACP continuing medical education activities hospital settings, comprehensive hospital-focused content are required to disclose all relevant financial relationships aligned with the ABIM Focused Practice in Hospital Medicine with any entity producing, marketing, re-selling, or distribut- blueprint is integrated throughout the syllabus, and self- ing health care goods or services consumed by, or used on, assessment questions that are specific to the hospital setting patients. Contributors are required to use generic names are specially designated with the blue hospitalist icon (EJ). in the discussion of therapeutic options and are required to identify any unapproved, off-label, or investigative use of commercial products or devices. Where a trade name is High Value Care Key Points used, all available trade names for the same product type Key Points in the text that relate to High Value Care are also included. If trade-name products manufactured by concepts (that is, concepts that discuss balancing clinical companies with whom contributors have relationships are benefit with costs and harms) are designated by the HVC discussed, contributors are asked to provide evidence-based icon [HVC]. citations in support of the discussion. The information is reviewed by the committee responsible for producing this content. If necessary, adjustments to topics or contributors’ Educational Disclaimer roles in content development are made to balance the dis- The editors and publisher of MKSAP 19 recognize that cussion. Further, all readers of this content are asked to the development of new material offers many opportu- evaluate it for evidence of commercial bias and send any nities for error. Despite our best efforts, some errors may relevant comments to mksap_editors@acponline.org so persist in print. Drug dosage schedules are, we believe, that future decisions about content and contributors can be accurate and in accordance with current standards. made in light of this information. Readers are advised, however, to ensure that the recom- mended dosages in MKSAP 19 concur with the informa-

rigor in all of its educational activities. To this end, and consistent with the policies of the ACP and the Accreditation Hospital-Based Medicine Council for Continuing Medical Education (ACCME), con- For the convenience of subscribers who provide care in tributors to all ACP continuing medical education activities hospital settings, comprehensive hospital-focused content are required to disclose all relevant financial relationships aligned with the ABIM Focused Practice in Hospital Medicine with any entity producing, marketing, re-selling, or distribut- blueprint is integrated throughout the syllabus, and self- ing health care goods or services consumed by, or used on, assessment questions that are specific to the hospital setting patients. Contributors are required to use generic names are specially designated with the blue hospitalist icon (EJ). in the discussion of therapeutic options and are required to identify any unapproved, off-label, or investigative use of commercial products or devices. Where a trade name is High Value Care Key Points used, all available trade names for the same product type Key Points in the text that relate to High Value Care are also included. If trade-name products manufactured by concepts (that is, concepts that discuss balancing clinical companies with whom contributors have relationships are benefit with costs and harms) are designated by the HVC discussed, contributors are asked to provide evidence-based icon [HVC]. citations in support of the discussion. The information is reviewed by the committee responsible for producing this content. If necessary, adjustments to topics or contributors’ Educational Disclaimer roles in content development are made to balance the dis- The editors and publisher of MKSAP 19 recognize that cussion. Further, all readers of this content are asked to the development of new material offers many opportu- evaluate it for evidence of commercial bias and send any nities for error. Despite our best efforts, some errors may relevant comments to mksap_editors@acponline.org so persist in print. Drug dosage schedules are, we believe, that future decisions about content and contributors can be accurate and in accordance with current standards. made in light of this information. Readers are advised, however, to ensure that the recom- mended dosages in MKSAP 19 concur with the informa- Resolution of Conflicts tion provided in the product information material. This is especially important in cases of new, infrequently used, To resolve all conflicts of interest and influences of vested or highly toxic drugs. Application of the information in interests, ACP’s content planners used best evidence and MKSAP 19 remains the professional responsibility of the updated clinical care guidelines in developing content, practitioner. when such evidence and guidelines were available. All content underwent review by external peer reviewers not The primary purpose of MKSAP 19 is educational. on the committee to ensure that the material was bal- Information presented, as well as publications, technol- anced and unbiased. Contributors’ disclosure information ogies, products, and/or services discussed, is intended to can be found with the list of contributors’ names and inform subscribers about the knowledge, techniques, and those of ACP principal staff listed in the beginning of experiences of the contributors. A diversity of professional this book. opinion exists, and the views of the contributors are their own and not those of the ACP. Inclusion of any material in the program does not constitute endorsement or rec- Language Reflecting Diversity, Equity, ommendation by the ACP. The ACP does not warrant the and Inclusion Within MKSAP 19 safety, reliability, accuracy, completeness, or usefulness MKSAP 19’s Editors and contributors commit to using of and disclaims any and all liability for damages and language and images that support ACP’s commitment to claims that may result from the use of information,

Resolution of Conflicts tion provided in the product information material. This is especially important in cases of new, infrequently used, To resolve all conflicts of interest and influences of vested or highly toxic drugs. Application of the information in interests, ACP’s content planners used best evidence and MKSAP 19 remains the professional responsibility of the updated clinical care guidelines in developing content, practitioner. when such evidence and guidelines were available. All content underwent review by external peer reviewers not The primary purpose of MKSAP 19 is educational. on the committee to ensure that the material was bal- Information presented, as well as publications, technol- anced and unbiased. Contributors’ disclosure information ogies, products, and/or services discussed, is intended to can be found with the list of contributors’ names and inform subscribers about the knowledge, techniques, and those of ACP principal staff listed in the beginning of experiences of the contributors. A diversity of professional this book. opinion exists, and the views of the contributors are their own and not those of the ACP. Inclusion of any material in the program does not constitute endorsement or rec- Language Reflecting Diversity, Equity, ommendation by the ACP. The ACP does not warrant the and Inclusion Within MKSAP 19 safety, reliability, accuracy, completeness, or usefulness MKSAP 19’s Editors and contributors commit to using of and disclaims any and all liability for damages and language and images that support ACP’s commitment to claims that may result from the use of information, vi

publications, technologies, products, and/or services dis- Unauthorized Use of This Book cussed in this program. Is Against the Law Unauthorized reproduction of this publication is unlaw- Publisher's Information ful. ACP prohibits reproduction of this publication or any of its parts in any form either for individual use or for Copyright © 2021 American College of Physicians. All rights reserved. distribution. This publication is protected by copyright. No part of this ACP will consider granting an individual permission to reproduce only limited portions of this publication for publication may be reproduced, stored in a retrieval system, his or her own exclusive use. Send requests in writing to or transmitted in any form or by any means, electronic or MKSAP* Permissions, American College of Physicians, 190 N. mechanical, including photocopy, without the express Independence Mall West, Philadelphia, PA 19106-1572, or consent of the ACP. MKSAP 19 is for individual use only. email your request to mksap_editors@acponline.org. Only one account per subscription will be permitted for the purpose of earning CME credits and MOC points and for MKSAP 19 ISBN: 978-1-938245-75-6 other authorized uses of MKSAP 19. General Internal Medicine 1 ISBN: 978-1-938245-77-0

This publication is protected by copyright. No part of this ACP will consider granting an individual permission to reproduce only limited portions of this publication for publication may be reproduced, stored in a retrieval system, his or her own exclusive use. Send requests in writing to or transmitted in any form or by any means, electronic or MKSAP* Permissions, American College of Physicians, 190 N. mechanical, including photocopy, without the express Independence Mall West, Philadelphia, PA 19106-1572, or consent of the ACP. MKSAP 19 is for individual use only. email your request to mksap_editors@acponline.org. Only one account per subscription will be permitted for the purpose of earning CME credits and MOC points and for MKSAP 19 ISBN: 978-1-938245-75-6 other authorized uses of MKSAP 19. General Internal Medicine 1 ISBN: 978-1-938245-77-0 Printed in the United States of America. Disclaimer Regarding Direct Purchases For order information in the U.S. or Canada call 800-ACP- from Online Retailers 1915. All other countries call 215-351-2600 (Monday to CME and/or MOC for MKSAP 19 is available only to custom- Friday, 9 AM - 5 pM ET). Fax inquiries to 215-351-2799 or ers who purchase the program directly from ACP. ACP will email to custserv@acponline.org. not set up MKSAP CME/MOC accounts for purchasers of MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), with whom ACP has no relationship. We do not honor third Errata and Revisions party sales. CME credits and MOC points cannot be awarded Errata and Revisions for MKSAP 19 will be available to those purchasers who have purchased the program from through MKSAP 19 Digital at mksap19.acponline.org as non-authorized sellers. new information becomes known to the editors.

Printed in the United States of America. Disclaimer Regarding Direct Purchases For order information in the U.S. or Canada call 800-ACP- from Online Retailers 1915. All other countries call 215-351-2600 (Monday to CME and/or MOC for MKSAP 19 is available only to custom- Friday, 9 AM - 5 pM ET). Fax inquiries to 215-351-2799 or ers who purchase the program directly from ACP. ACP will email to custserv@acponline.org. not set up MKSAP CME/MOC accounts for purchasers of MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), with whom ACP has no relationship. We do not honor third Errata and Revisions party sales. CME credits and MOC points cannot be awarded Errata and Revisions for MKSAP 19 will be available to those purchasers who have purchased the program from through MKSAP 19 Digital at mksap19.acponline.org as non-authorized sellers. new information becomes known to the editors. vii