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Welcome to the General Internal Medicine 1 Section of MKSAP 19! To address the ever-growing role of generalists and the broad and comprehensive spectrum of illnesses they treat, General Internal Medicine has been expanded into two sections for MKSAP 19. In these pages, you will find updated information on clinical decision making and interpreting the medical literature, medical ethics and professionalism, common symptoms, pain, palliative medicine, common musculoskeletal problems, dyslipidemia, mental and behavioral health, geriatric medi- cine, and genetics. The General Internal Medicine 2 section, published in MKSAP 19 Part B, features content on routine care of the healthy patient; patient safety and quality improvement; hospital medicine principles; perioperative medicine; obesity; men’s and women’s health; eye, ear, nose, mouth, and throat disorders; and dermatologic conditions. All of these topics are uniquely focused on the needs of generalists and subspecialists in internal medicine. MKSAP 19 strives to provide the clinical knowledge its learners need to navigate their longitudinal learning paths. MKSAP 19’s core content contains essential, newly researched information in 11 subspecialty areas of internal medicine—created by dozens of expert generalists and subspecialists. Development of MKSAP 19’s syllabus and its 1200 all-new, peer-reviewed, psychomet- rically validated multiple-choice questions (MCQs) has been informed by ABIM Certification and Maintenance of Certification (MOC) requirements, emerging internal medicine knowledge, and our learners’ feedback. MKSAP 19 continues to include High Value Care (HVC) recommendations and MCQs, based on the concept of balancing clinical benefit with costs and harms. Hospital-based internists can continue to trust that MKSAP’s comprehensive hospitalist content, integrated throughout the syllabus, and hospitalist-focused MCQs, specially designated with the blue hospitalist icon (EJ), continue to align with the ABIM’s Focused Practice in Hospital Medicine MOC exam blueprint and enhance learning for hospital-based practitioners.

MKSAP 19 strives to provide the clinical knowledge its learners need to navigate their longitudinal learning paths. MKSAP 19’s core content contains essential, newly researched information in 11 subspecialty areas of internal medicine—created by dozens of expert generalists and subspecialists. Development of MKSAP 19’s syllabus and its 1200 all-new, peer-reviewed, psychomet- rically validated multiple-choice questions (MCQs) has been informed by ABIM Certification and Maintenance of Certification (MOC) requirements, emerging internal medicine knowledge, and our learners’ feedback. MKSAP 19 continues to include High Value Care (HVC) recommendations and MCQs, based on the concept of balancing clinical benefit with costs and harms. Hospital-based internists can continue to trust that MKSAP’s comprehensive hospitalist content, integrated throughout the syllabus, and hospitalist-focused MCQs, specially designated with the blue hospitalist icon (EJ), continue to align with the ABIM’s Focused Practice in Hospital Medicine MOC exam blueprint and enhance learning for hospital-based practitioners. More than ever before, MKSAP 19 Digital focuses on individualized learning and convenience. In addition to custom quizzes and interlinked questions and syllabus sections, MKSAP 19 Digital’s new learning dashboard enables users to create a self- directed learning plan, with topic-specific links to resources within MKSAP and ACP Online. Multimedia formats, including whiteboard animations and clinical videos, will benefit our audiovisual learners, while MKSAP’s Earn-as-You-Go CME/MOC feature now allows subscribers to earn CME/MOC as they answer individual questions. In addition to Extension Questions and New Info Updates, MKSAP 19 Complete and Complete Green continue to offer Virtual Dx and Flashcards and now offer brand- new enhancements: MKSAP Quick Qs, a set of concise questions mapped to high-frequency/high-importance areas of the ABIM blueprint mirroring boards-style MCQs, and an embedded digital version of Board Basics for easy-access exam prep.

More than ever before, MKSAP 19 Digital focuses on individualized learning and convenience. In addition to custom quizzes and interlinked questions and syllabus sections, MKSAP 19 Digital’s new learning dashboard enables users to create a self- directed learning plan, with topic-specific links to resources within MKSAP and ACP Online. Multimedia formats, including whiteboard animations and clinical videos, will benefit our audiovisual learners, while MKSAP’s Earn-as-You-Go CME/MOC feature now allows subscribers to earn CME/MOC as they answer individual questions. In addition to Extension Questions and New Info Updates, MKSAP 19 Complete and Complete Green continue to offer Virtual Dx and Flashcards and now offer brand- new enhancements: MKSAP Quick Qs, a set of concise questions mapped to high-frequency/high-importance areas of the ABIM blueprint mirroring boards-style MCQs, and an embedded digital version of Board Basics for easy-access exam prep. Language can be imprecise and imperfect, but MKSAP 19’s Editors and contributors commit to using language and images that support ACP’s commitment to being an anti-racist organization that supports diversity, equity, and inclusion throughout health care and health education. ACP also continues to ensure diversity among MKSAP’s physician-contributors. When appropriate, the MKSAP Editors also rely on MKSAP 19 Digital’s expanded use of multimedia enhancements, including video and audio, to explore and more fully explain issues surrounding the presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to contact the Editors at mksap_editors@acponline.org to help us identify opportunities for improvement in this area. On behalf of the many internists and editorial staff who have helped us create our new edition, we are honored that you have chosen to use MKSAP 19 to meet your lifelong learning needs. Sincerely, Davoren Chick, MD, FACP Editor-in-Chief Senior Vice President Medical Education Division American College of Physicians

General Internal Medicine 1 Committee Editor-in-Chief Karna K. Sundsted, MD, FACP, Section Editor Davoren Chick, MD, FACP Assistant Professor of Medicine Senior Vice President, Medical Education Co-Director, Medical Grand Rounds American College of Physicians Mayo Clinic Philadelphia, Pennsylvania Rochester, Minnesota Dennis M. Bierle, MD Senior Deputy Editor Consultant Patrick C. Alguire, MD, FACP Assistant Professor of Medicine American College of Physicians Mayo Clinic Philadelphia, Pennsylvania Rochester, Minnesota Elizabeth Ann Gilman, MD Deputy Editor Consultant Robert L. Trowbridge, Jr., MD, FACP Assistant Professor of Medicine Department of Medicine Mayo Clinic Maine Medical Center Rochester, Minnesota Portland, Maine Tufts University School of Medicine Mary Beth Poston, MD, FACP Boston, Massachusetts Associate Professor and Residency Program Director University of South Carolina School of Medicine Prisma Health Midlands General Internal Medicine 1 Reviewers Columbia, South Carolina Sik Kim Ang, MD, FACP Hilary F. Ryder, MD, MS, FACP Anoop Bhagat, MD Associate Professor of Medicine, Medical Education Leslie F Blum, MD, FACP The Dartmouth Institute Lynn Cleary, MD, MACP Geisel Medical School at Dartmouth Molly Cooke, MD, MACP Program Director, Internal Medicine Residency Program Amy Davis, DO, FACP Dartmouth-Hitchcock Medical Center Michael Fingerhood, MD, FACP

Associate Professor of Medicine, Medical Education Leslie F Blum, MD, FACP The Dartmouth Institute Lynn Cleary, MD, MACP Geisel Medical School at Dartmouth Molly Cooke, MD, MACP Program Director, Internal Medicine Residency Program Amy Davis, DO, FACP Dartmouth-Hitchcock Medical Center Michael Fingerhood, MD, FACP Lebanon, New Hampshire Joseph J. Fins, MD, MACP Priscilla A. Furth, MD Jacob J. Strand, MD, FACP Gregory A. Hood, MD, MACP Associate Professor of Medicine Robert H. Hopkins, Jr., MD, MACP Mayo Clinic College of Medicine and Science Constance Lo, MD, FACP Chair, Mayo Clinic Center for Palliative Medicine Teri A. Manolio, MD, PhD, FACP Rochester, Minnesota Richard H. Miranda, MD, FACP Majken Textor Wingo, MD, FACP Aurelio Muyot, MD, FACP Assistant Professor of Medicine Rahat Noor, MD, FACP Director, Advanced Doctoring Preclinical Skills Course Ali R. Rahimi, MD, FACP Firm Chief, Internal Medicine Residency Clinic Vijay Rajput, MD, FACP Mayo Clinic Kristin A. Swedish, MD, MPH Rochester, Minnesota