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lnfectious Disease ACP Editorial Staff Larry M. Bush, MD, EACP Honorana Linnea Donnarumma, Senior Medical Editor, Assessment Merck Manual and Education Programs Margaret Wells, Ed.M., Director, Assessment and Education Davoren Chick, MD, EACP Programs Other (Owner) Beclqy Krumm, Senior Managing Editor, Assessment and Coding 101, LLC Education Programs Louise M. Dembry MD, MS, MBA, EACP Board Member ACP Principal Staff Society for Healthcare Epidemiologr of America (SHEA) Stock Options / Hold ings Davoren Chick, MD, EACP Advanced Technical Support/ReadyDoc Senior Vice President, Medical Education Rodrigo Hasbun, MD, MPH Tabassum Salam, MD, MBA, EACP Speakers Bureau V ice President, Medical Education Biofire Diagnostics Patrick C. Alguire, MD, EACP MKSAP Senior Deputg Editor Fred A. Lopez, MD, MACP Other Margaret Wells, Ed.M. PriMed Director, Assessment and Education Programs Tabassum Salam, MD, MBA, EACP Becky Krumm Consultantship Senior ManagingEditor Johnson and Johnson Jackie Twomey Jose A. Yazqaez, MD, EACP Associote Managing Editor Speakers Bureau Julia Nawrocki Allergan, Astellas Digital Content Associote /Editor Consultantship Cidara, Amplyx Linnea Donnarumma Senior Medical Editor

lnfectious Disease ACP Editorial Staff Larry M. Bush, MD, EACP Honorana Linnea Donnarumma, Senior Medical Editor, Assessment Merck Manual and Education Programs Margaret Wells, Ed.M., Director, Assessment and Education Davoren Chick, MD, EACP Programs Other (Owner) Beclqy Krumm, Senior Managing Editor, Assessment and Coding 101, LLC Education Programs Louise M. Dembry MD, MS, MBA, EACP Board Member ACP Principal Staff Society for Healthcare Epidemiologr of America (SHEA) Stock Options / Hold ings Davoren Chick, MD, EACP Advanced Technical Support/ReadyDoc Senior Vice President, Medical Education Rodrigo Hasbun, MD, MPH Tabassum Salam, MD, MBA, EACP Speakers Bureau V ice President, Medical Education Biofire Diagnostics Patrick C. Alguire, MD, EACP MKSAP Senior Deputg Editor Fred A. Lopez, MD, MACP Other Margaret Wells, Ed.M. PriMed Director, Assessment and Education Programs Tabassum Salam, MD, MBA, EACP Becky Krumm Consultantship Senior ManagingEditor Johnson and Johnson Jackie Twomey Jose A. Yazqaez, MD, EACP Associote Managing Editor Speakers Bureau Julia Nawrocki Allergan, Astellas Digital Content Associote /Editor Consultantship Cidara, Amplyx Linnea Donnarumma Senior Medical Editor Amanda Cowley Acknowledgments Medical Editor The American College of Physicians (ACP) gratefully acknowledges the special contributions to the develop- Sandy Crump ment and production of the 19th edition of the Medical MedicalEditor Knowledge Self-Assessment Program' (MKSAP- 19) made Georgette Forgione by the following people: Medical Editor Graphic Design: Barry Moshinski (Director, Graphic Beth Goldner Services), Mike Ripca (Technical Administrator, Graphic Medical Editor Services), Raymond DeJohn (Designer, Graphic Services)

Amanda Cowley Acknowledgments Medical Editor The American College of Physicians (ACP) gratefully acknowledges the special contributions to the develop- Sandy Crump ment and production of the 19th edition of the Medical MedicalEditor Knowledge Self-Assessment Program' (MKSAP- 19) made Georgette Forgione by the following people: Medical Editor Graphic Design: Barry Moshinski (Director, Graphic Beth Goldner Services), Mike Ripca (Technical Administrator, Graphic Medical Editor Services), Raymond DeJohn (Designer, Graphic Services) Suzanne Meyers Production / Sy stems: D an H offmann ( Director, I nformation Medical Editor Technology), Scott Hurd (Manager, Content Systems), Neil Kohl (Senior Architect), and Chris Patterson Elise Paxson (Senior Architect). Medical Editor MI(SAP 19 Digital: Under the leadership of Steven Spadt Chuck Graver (Senior Vice President, Technology), the development Finance and Operations Administrator of the digital version of MKSAP 19 was implemented by Kimberly Kerns ACP's Digital Products and Services Department, directed A dministr atiu e Co o r dinat o r and led by Brian Sweigard (Director, Digital Products and Services). Other members of the team included Dan Disclosures of relationships with any entity producing, Barron (Senior Web Application Developer/Architect), marketing, reselling, or distributing health care goods or Callie Cramer (Data Visualization/Web Developer), Chris services consumed by, or used on, patients. Individuals not Forrest (Senior Web Application Developer), Kathleen listed below have nothing to disclose. Hoover (Senior Web Developer), Kara Regis (Manager,

Suzanne Meyers Production / Sy stems: D an H offmann ( Director, I nformation Medical Editor Technology), Scott Hurd (Manager, Content Systems), Neil Kohl (Senior Architect), and Chris Patterson Elise Paxson (Senior Architect). Medical Editor MI(SAP 19 Digital: Under the leadership of Steven Spadt Chuck Graver (Senior Vice President, Technology), the development Finance and Operations Administrator of the digital version of MKSAP 19 was implemented by Kimberly Kerns ACP's Digital Products and Services Department, directed A dministr atiu e Co o r dinat o r and led by Brian Sweigard (Director, Digital Products and Services). Other members of the team included Dan Disclosures of relationships with any entity producing, Barron (Senior Web Application Developer/Architect), marketing, reselling, or distributing health care goods or Callie Cramer (Data Visualization/Web Developer), Chris services consumed by, or used on, patients. Individuals not Forrest (Senior Web Application Developer), Kathleen listed below have nothing to disclose. Hoover (Senior Web Developer), Kara Regis (Manager, tv

User Interface Design and Development), Brad Lord (Senior Web Application Developer/Architect), and John Target Audience . General internal medicine specialists, including primary McKnight (Senior Web Developer). care physicians and hospitalists The College also wishes to acknowledge that many other . Internal medicine subspecialists who desire to remain up persons, too numerous to mention, have contributed to to date in internal medicine the production of this program. Without their dedicated . Residents preparing for the ABIM Internal Medicine efforts, this program would not have been possible. Certification Examination . Physicians engaged in the ABIM Maintenance of Certification Longitudinal Assessment Option, pre- MKSAP Resource Page paring for the ABIM Internal Medicine Maintenance of The MKSAP Resource Page (www.acponline.org/mksap19- Certification Examination, or engaged with the ABIM resources) provides access to MKSAP 19 online answer sheets Focused Practice in Hospital Medicine program for transcribing answers from the print edition; access to MKSAP 19 Digital; Board Basics-; information on Continuing Medical Education (CME), Maintenance of Certification (lttOC), Earn CME Credits or MOC Points Online and intemational Continuing Professional Development (CPD) To earn CME credits or to apply for MOC points, MKSAP and MOC; errata; and other new information. users need to answer at least one of two questions correctly (earning a score of at least 50'/.) and click the Submit CME button. Each single MKSAP 19 self-assessment question lnternational MOC/CPD qualifies for one quarter of a CME credit hour or ABIM Information and instructions on submission of interna- MOC point. tional MOC/CPD is available by accessing the CME/MOC/ MKSAP 19 Subscribers can enter their self-assessment CPD tab on the left navigation menu of MKSAP 19 Digital. question answers and submit for CME/MOC in two wolS:

User Interface Design and Development), Brad Lord (Senior Web Application Developer/Architect), and John Target Audience . General internal medicine specialists, including primary McKnight (Senior Web Developer). care physicians and hospitalists The College also wishes to acknowledge that many other . Internal medicine subspecialists who desire to remain up persons, too numerous to mention, have contributed to to date in internal medicine the production of this program. Without their dedicated . Residents preparing for the ABIM Internal Medicine efforts, this program would not have been possible. Certification Examination . Physicians engaged in the ABIM Maintenance of Certification Longitudinal Assessment Option, pre- MKSAP Resource Page paring for the ABIM Internal Medicine Maintenance of The MKSAP Resource Page (www.acponline.org/mksap19- Certification Examination, or engaged with the ABIM resources) provides access to MKSAP 19 online answer sheets Focused Practice in Hospital Medicine program for transcribing answers from the print edition; access to MKSAP 19 Digital; Board Basics-; information on Continuing Medical Education (CME), Maintenance of Certification (lttOC), Earn CME Credits or MOC Points Online and intemational Continuing Professional Development (CPD) To earn CME credits or to apply for MOC points, MKSAP and MOC; errata; and other new information. users need to answer at least one of two questions correctly (earning a score of at least 50'/.) and click the Submit CME button. Each single MKSAP 19 self-assessment question lnternational MOC/CPD qualifies for one quarter of a CME credit hour or ABIM Information and instructions on submission of interna- MOC point. tional MOC/CPD is available by accessing the CME/MOC/ MKSAP 19 Subscribers can enter their self-assessment CPD tab on the left navigation menu of MKSAP 19 Digital. question answers and submit for CME/MOC in two wolS: 1. Users of MKSAP 19 Complete who prefer to use their print Continuing Medical Education books and a paper answer sheet to study and record their The American College of Physicians is accredited by the answers can use the printed answer sheet at the back Accreditation Council for Continuing Medical Education of this book to record their answers. The corresponding (ACCME) to provide continuing medical education for online answer sheets, which are available on the MKSAP physicians. 19 Resource Page, may be used to transcribe answers onto the online answer sheets. Users may then submit their The American College of Physicians designates this endur- answers to qualiSz for CME credits or MOC points (see ing material, MKSAP 19, for a maximum of 300 AMA PRA below for information on Opting in for MOC). Users who Category 1 CreditsrM. Physicians should claim only the prefer to record their answers on a paper answer sheet credit commensurate with the extent of their participation should save their answer sheet for future use. Users who in the activity. study with MKSAP 19 print can also submit their answers Up to 27 AMA PRA Category l Credit{M are available from directly within MKSAP 19 Digital by accessing the self- August 3t,2O2I, to August 31,2024, for the MKSAP 19 assessment questions dashboard and selecting the pre- Infectious Disease section. ferred subspecialty section to begin answering questions.

1. Users of MKSAP 19 Complete who prefer to use their print Continuing Medical Education books and a paper answer sheet to study and record their The American College of Physicians is accredited by the answers can use the printed answer sheet at the back Accreditation Council for Continuing Medical Education of this book to record their answers. The corresponding (ACCME) to provide continuing medical education for online answer sheets, which are available on the MKSAP physicians. 19 Resource Page, may be used to transcribe answers onto the online answer sheets. Users may then submit their The American College of Physicians designates this endur- answers to qualiSz for CME credits or MOC points (see ing material, MKSAP 19, for a maximum of 300 AMA PRA below for information on Opting in for MOC). Users who Category 1 CreditsrM. Physicians should claim only the prefer to record their answers on a paper answer sheet credit commensurate with the extent of their participation should save their answer sheet for future use. Users who in the activity. study with MKSAP 19 print can also submit their answers Up to 27 AMA PRA Category l Credit{M are available from directly within MKSAP 19 Digital by accessing the self- August 3t,2O2I, to August 31,2024, for the MKSAP 19 assessment questions dashboard and selecting the pre- Infectious Disease section. ferred subspecialty section to begin answering questions. 2. Users of MKSAP 19 Digital can enter their answers within the digital program by accessing the self-assessment Learning Objectives questions dashboard and selecting the preferred sub- The learning objectives of MKSAP 19 are to: specialty section to begin answering questions and . Close gaps between actual care in your practice and clicking the Submit CME button once they qualify for preferred standards ofcare, based on best evidence CME and are ready to submit. Learners should keep in . Diagnose disease states that are less common and some- mind their yearly CME and MOC deadlines when deter- times overlooked or confusing mining the appropriate time to submit. . Improve clinical management decisions that affect Learners' CME/MOC submission progress will be shown patient safety and quality of care on the MKSAP 19 Digital CME/MOC/CPD page. . Determine when to refer patients for care by medical subspecialists, surgeons, and other members of the health care team Opting in for MOC . Pass the ABIM Certification Examination MKSAP 19 users can opt in for simultaneous submission . Pass the ABIM Maintenance of Certification Examination of CME and MOC points as they answer self-assessment

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

questions. To opt in, users will be required to complete those of ACP principal staff listed in the beginning of this a form requesting their name, date of birth, and ABIM book. number. The MOC Opt-in Form will be presented during a user's first CME submission and needs to be completed Language Reflecting Diversity, Equity, only once. and lnclusion Within MKSAP 19 MKSAP 19's Editors and contributors commit to using ABIM Maintenance of Certification language and images that support ACP's commitment to Successful completion of the CME activity, which includes being an anti - racist organ ization that supports diversity, participation in the evaluation component, enables the par- equity, and inclusion throughout health care and health ticipant to earn up to 300 medical knowledge MOC points in education. ACP also continues to ensure diversity among the ABIM's MOC program. It is the CME activity provider's MKSAP's physician-contributors. When appropriate, the responsibility to submit participant completion information MKSAP Editors will also rely on MKSAP 19 Digital's expanded to ACCME for the purpose of granting MOC credit. use of multimedia enhancements, includingvideo and audio, to explore and more fully explain issues surrounding the presentation of MKSAP 19 clinical content as it relates to Disclosure Policy race and ethnicity. MKSAP 19 users are encouraged to It is the policy of the American College of Physicians contact the Editors at mksap-editors6acponline.org to help (ACP) to ensure balance, independence, objectivity, and us identifiz opportunities for improvement in this area. scientific rigor in all of its educational activities. To this end, and consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education Hospital-Based Medieine (ACCME), contributors to all ACP continuing medical For the convenience of subscribers who provide care in education activities are required to disclose all relevant hospital settings, comprehensive hospital-focused con- financial relationships with any entity producing, mar- tent aligned with the ABIM Focused Practice in Hospital keting, re-selling, or distributing health care goods or Medicine blueprint is integrated throughout the syllabus, services consumed by, or used on, patients. Contributors and self-assessment questions that are specific to the are required to use generic names in the discussion of hospital setting are specially designated with the blue therapeutic options and are required to identify any unap- hospitalist icon (EI). proved, off-label, or investigative use of commercial prod- ucts or devices. Where a trade name is used, all available trade names for the same product type are also included. High Value Care Key Points If trade-name products manufactured by companies with Key Points in the text that relate to High Value Care concepts whom contributors have relationships are discussed, con- (that is, concepts that discuss balancing clinical benefit with tributors are asked to provide evidence-based citations in costs and harms) are designated by the HVC icon [lUC]. support of the discussion. The information is reviewed by the committee responsible for producing this content. If Educational Disclaimer necessary, adjustments to topics or contributors' roles in The editors and publisher of MKSAP 19 recognize that the content development are made to balance the discussion. development of new material offers many opportunities Further, all readers of this content are asked to evaluate for error. Despite our best efforts, some errors may persist it for evidence of commercial bias and send any relevant in print. Drug dosage schedules are, we believe, accurate comments to mksap_editors6racponline.org so that future and in accordance with current standards. Readers are decisions about content and contributors can be made in advised, however, to ensure that the recommended dos- light of this information. ages in MKSAP 19 concur with the information provided in the product information material. This is especially Resolution of Conflicts important in cases of new, infrequently used, or highly toxic drugs. Application of the information in MKSAP 19 To resolve all conflicts of interest and influences of vested remains the professional responsibility of the practitioner. interests, ACP's content planners used best evidence and updated clinical care guidelines in developing content, The primary purpose of MKSAP 19 is educational. when such evidence and guidelines were available. All Information presented, as well as publications, technol- content underwent review by external peer reviewers ogies, products, and/or services discussed, is intended to not on the committee to ensure that the material was inform subscribers about the knowledge, techniques, and balanced and unbiased. Contributors' disclosure informa- experiences of the contributors. A diversity of professional tion can be found with the list of contributors' names and opinion exists, and the views of the contributors are their

questions. To opt in, users will be required to complete those of ACP principal staff listed in the beginning of this a form requesting their name, date of birth, and ABIM book. number. The MOC Opt-in Form will be presented during a user's first CME submission and needs to be completed Language Reflecting Diversity, Equity, only once. and lnclusion Within MKSAP 19 MKSAP 19's Editors and contributors commit to using ABIM Maintenance of Certification language and images that support ACP's commitment to Successful completion of the CME activity, which includes being an anti - racist organ ization that supports diversity, participation in the evaluation component, enables the par- equity, and inclusion throughout health care and health ticipant to earn up to 300 medical knowledge MOC points in education. ACP also continues to ensure diversity among the ABIM's MOC program. It is the CME activity provider's MKSAP's physician-contributors. When appropriate, the responsibility to submit participant completion information MKSAP Editors will also rely on MKSAP 19 Digital's expanded to ACCME for the purpose of granting MOC credit. use of multimedia enhancements, includingvideo and audio, to explore and more fully explain issues surrounding the presentation of MKSAP 19 clinical content as it relates to Disclosure Policy race and ethnicity. MKSAP 19 users are encouraged to It is the policy of the American College of Physicians contact the Editors at mksap-editors6acponline.org to help (ACP) to ensure balance, independence, objectivity, and us identifiz opportunities for improvement in this area. scientific rigor in all of its educational activities. To this end, and consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education Hospital-Based Medieine (ACCME), contributors to all ACP continuing medical For the convenience of subscribers who provide care in education activities are required to disclose all relevant hospital settings, comprehensive hospital-focused con- financial relationships with any entity producing, mar- tent aligned with the ABIM Focused Practice in Hospital keting, re-selling, or distributing health care goods or Medicine blueprint is integrated throughout the syllabus, services consumed by, or used on, patients. Contributors and self-assessment questions that are specific to the are required to use generic names in the discussion of hospital setting are specially designated with the blue therapeutic options and are required to identify any unap- hospitalist icon (EI). proved, off-label, or investigative use of commercial prod- ucts or devices. Where a trade name is used, all available trade names for the same product type are also included. High Value Care Key Points If trade-name products manufactured by companies with Key Points in the text that relate to High Value Care concepts whom contributors have relationships are discussed, con- (that is, concepts that discuss balancing clinical benefit with tributors are asked to provide evidence-based citations in costs and harms) are designated by the HVC icon [lUC]. support of the discussion. The information is reviewed by the committee responsible for producing this content. If Educational Disclaimer necessary, adjustments to topics or contributors' roles in The editors and publisher of MKSAP 19 recognize that the content development are made to balance the discussion. development of new material offers many opportunities Further, all readers of this content are asked to evaluate for error. Despite our best efforts, some errors may persist it for evidence of commercial bias and send any relevant in print. Drug dosage schedules are, we believe, accurate comments to mksap_editors6racponline.org so that future and in accordance with current standards. Readers are decisions about content and contributors can be made in advised, however, to ensure that the recommended dos- light of this information. ages in MKSAP 19 concur with the information provided in the product information material. This is especially Resolution of Conflicts important in cases of new, infrequently used, or highly toxic drugs. Application of the information in MKSAP 19 To resolve all conflicts of interest and influences of vested remains the professional responsibility of the practitioner. interests, ACP's content planners used best evidence and updated clinical care guidelines in developing content, The primary purpose of MKSAP 19 is educational. when such evidence and guidelines were available. All Information presented, as well as publications, technol- content underwent review by external peer reviewers ogies, products, and/or services discussed, is intended to not on the committee to ensure that the material was inform subscribers about the knowledge, techniques, and balanced and unbiased. Contributors' disclosure informa- experiences of the contributors. A diversity of professional tion can be found with the list of contributors' names and opinion exists, and the views of the contributors are their vl

own and not those of the ACP. Inclusion of any material points cannot be awarded to those purchasers who have in the program does not constitute endorsement or rec- purchased the program from non-authorized sellers. ommendation by the ACP. The ACP does not warrant the safety, reliability, accuracy, completeness, or usefulness of and disclaims any and all liability for damages and Unauthorized Use of This Book ls claims that may result from the use of information, publi- Against the Law cations, technologies, products, and/or services discussed Unauthorized reproduction of this publication is unlaw- in this program. ful. ACP prohibits reproduction of this publication or any of its parts in any form either for individual use or for distribution. Publisher's I nformation ACP will consider granting an individual permission to Copyright @ 2}2LAmerican College of Physicians. All reproduce only limited portions of this publication for his rights reserved. or her own exclusive use. Send requests in writing to MKSAP This publication is protected by copyright. No part of Permissions, American College of Physicians, 190 N. this publication may be reproduced, stored in a retrieval Independence Mall West, Philadelphia, PA 19106-1572, or system, or transmitted in any form or by any means, elec- email your request to mksap_editors6acponline.org. tronic or mechanical, including photocopy, without the MKSAP 19 ISBN: 978-1-938245-75-6 express consent of the ACP. MKSAP 19 is for individual Infectious Disease ISBN: 978-1-938245-7 6-3 use only. Only one account per subscription will be per- mitted for the purpose of earning CME credits and MOC Printed in the United States of America. points and for other authorized uses of MKSAP 19. For order information in the U.S. or Canada call800-ACP- 1915. All other countries call215-35t-26OO (Monday to Disclaimer Regarding Direct Purchases Friday, 9 arrr - 5 prr,r ET). Fax inquiries to 215-351-2799 or from Online Retailers email to custserv6lacponline.org.

own and not those of the ACP. Inclusion of any material points cannot be awarded to those purchasers who have in the program does not constitute endorsement or rec- purchased the program from non-authorized sellers. ommendation by the ACP. The ACP does not warrant the safety, reliability, accuracy, completeness, or usefulness of and disclaims any and all liability for damages and Unauthorized Use of This Book ls claims that may result from the use of information, publi- Against the Law cations, technologies, products, and/or services discussed Unauthorized reproduction of this publication is unlaw- in this program. ful. ACP prohibits reproduction of this publication or any of its parts in any form either for individual use or for distribution. Publisher's I nformation ACP will consider granting an individual permission to Copyright @ 2}2LAmerican College of Physicians. All reproduce only limited portions of this publication for his rights reserved. or her own exclusive use. Send requests in writing to MKSAP This publication is protected by copyright. No part of Permissions, American College of Physicians, 190 N. this publication may be reproduced, stored in a retrieval Independence Mall West, Philadelphia, PA 19106-1572, or system, or transmitted in any form or by any means, elec- email your request to mksap_editors6acponline.org. tronic or mechanical, including photocopy, without the MKSAP 19 ISBN: 978-1-938245-75-6 express consent of the ACP. MKSAP 19 is for individual Infectious Disease ISBN: 978-1-938245-7 6-3 use only. Only one account per subscription will be per- mitted for the purpose of earning CME credits and MOC Printed in the United States of America. points and for other authorized uses of MKSAP 19. For order information in the U.S. or Canada call800-ACP- 1915. All other countries call215-35t-26OO (Monday to Disclaimer Regarding Direct Purchases Friday, 9 arrr - 5 prr,r ET). Fax inquiries to 215-351-2799 or from Online Retailers email to custserv6lacponline.org. CME and/or MOC for MKSAP 19 is only available to cus- tomers who purchase the program directly from ACP. ACP will not set up MKSAP CME/MOC accounts for Errata and Revisions purchasers of MKSAP sold by unauthorized sellers Errata and Revisions for MKSAP 19 will be available (e.g., Amazon, eBay), with whom ACP has no relationship through MKSAP 19 Digital at mksaplg.acponline.org as We do not honor third party sales. CME credits and MOC new information becomes known to the editors.

CME and/or MOC for MKSAP 19 is only available to cus- tomers who purchase the program directly from ACP. ACP will not set up MKSAP CME/MOC accounts for Errata and Revisions purchasers of MKSAP sold by unauthorized sellers Errata and Revisions for MKSAP 19 will be available (e.g., Amazon, eBay), with whom ACP has no relationship through MKSAP 19 Digital at mksaplg.acponline.org as We do not honor third party sales. CME credits and MOC new information becomes known to the editors. vil