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The College also wishes to acknowledge that many other persons, too numerous to mention, have contributed to Target Audience the production of this program. Without their dedicated . General internal medicine specialists, including primary efforts, this program would not have been possible. care physicians and hospitalists o Internal medicine subspecialists who desire to remain up to date in internal medicine o Residents preparing fbr the ABIM Internal Medicine MKSAP Resource Page Certification Examination The M KSAP Resource Page (www.acpon line.org/mksapl 9 . Physicians engaged in the ABIM Maintenance of resources) provides access to MKSAP 19 online answer Certification Longitudinal Assessment Option, pre- sheets for transcribing answers from the print edition; paring fbr the ABIM lnternal Medicine Maintenance of access to MKSAP 19 Digital; Board Basics-; information Certification Examination, or engaged with the ABIM on Continuing Medical Education (CME), Maintenance Focused Practice in Hospital Medicine program of Certification (MOC), and international Continuing Prof'essional Development (CPD) and MOC; errata; and other new information. Earn CME Credits or MOC Points Online To earn CME credits or to apply fbr MOC points, MKSAP users need to answer at least one of two questions cor lnternational MOC/CPD rectly (earning a score of at least 50'X,) and click the Submit Infbrmation and instructions on submission of interna CME button. Each single MKSAP 19 self assessment ques tional MOC/CPD is available by accessing the CME/MOC/ tion qualifies for one quarter of'a CME credit hour or ABIM CPD tab on the left navigation menu of'MKSAP 19 Digital. MOC point.

The College also wishes to acknowledge that many other persons, too numerous to mention, have contributed to Target Audience the production of this program. Without their dedicated . General internal medicine specialists, including primary efforts, this program would not have been possible. care physicians and hospitalists o Internal medicine subspecialists who desire to remain up to date in internal medicine o Residents preparing fbr the ABIM Internal Medicine MKSAP Resource Page Certification Examination The M KSAP Resource Page (www.acpon line.org/mksapl 9 . Physicians engaged in the ABIM Maintenance of resources) provides access to MKSAP 19 online answer Certification Longitudinal Assessment Option, pre- sheets for transcribing answers from the print edition; paring fbr the ABIM lnternal Medicine Maintenance of access to MKSAP 19 Digital; Board Basics-; information Certification Examination, or engaged with the ABIM on Continuing Medical Education (CME), Maintenance Focused Practice in Hospital Medicine program of Certification (MOC), and international Continuing Prof'essional Development (CPD) and MOC; errata; and other new information. Earn CME Credits or MOC Points Online To earn CME credits or to apply fbr MOC points, MKSAP users need to answer at least one of two questions cor lnternational MOC/CPD rectly (earning a score of at least 50'X,) and click the Submit Infbrmation and instructions on submission of interna CME button. Each single MKSAP 19 self assessment ques tional MOC/CPD is available by accessing the CME/MOC/ tion qualifies for one quarter of'a CME credit hour or ABIM CPD tab on the left navigation menu of'MKSAP 19 Digital. MOC point. MKSAP 19 Subscribers can enter their self-assessment Continuing Medical Education question answers and submit for CME/MOC in two The American College of Physicians is accredited by the ways: Accreditation Council lbr Continuing Medical Education 1. Users of M KSAP 19 Complete who prefer to use their (ACCME) to provide continuing medical education for print books and a paper answer sheet to study and physicians. record their answers can use the printed answer The American College of Physicians designates this endur sheet at the back olthis book to record their answers. ing material, MKSAP 19, for a maximum of 300 AMA PRA The corresponding online answer sheets, which are Category 1 CreditsrM. Physicians should claim only the available on the MKSAP 19 Resource Page, may be credit commensurate with the extent of their participation used to transcribe answers onto the online answer in the activity. sheets. Users may then submit their answers to qualify for CME credits or MOC points (see below fbr Up to 25.75 AMA PRA Category I Credifsr M are available fiom information on Opting in for MOC). Users who pre January 31,2022, to January 31, 2025, for the MKSAP 19 fer to record their answers on a paper answer sheet Pulmonary and Critical Care Medicine section. should save their answer sheet for future use. Users who study with MKSAP 19 print can also submit their Learning Objectives answers directly within MKSAP 19 Digital by access- ing the sell assessment questions dashboard and The learning objectives of MKSAP 19 are to: selecting the preferred subspecialty section to begin . Close gaps between actual care in your practice and answering questions. preferred standards of'care, based on best evidence 2. Users of MKSAP 19 Digital can enter their answers within . Diagnose disease states that are less commoll and some the digital program by accessing the self-assessment times overlcloked or confusing questions dashboard and selecting the pref'erred sub r Improve clinical management decisions that alfect patient specialty section to begin answering questions and saf'ety and quality ol care clicking the Submit CME button once they qualiflz fbr o Determine when to refer patients fbr care by medical CME and are ready to submit. Learners should keep in subspecialists, surgeons, and other members of the health mind their yearly CME and MOC deadlines when deter- care team mining the appropriate time to submit. o Pass the ABIM Certification Examination . Pass the ABIM Maintenance of Certilication Learners' CME/MOC submission progress will be shown Examination on the MKSAP 19 Digital CME/MOC/CPD page.

MKSAP 19 Subscribers can enter their self-assessment Continuing Medical Education question answers and submit for CME/MOC in two The American College of Physicians is accredited by the ways: Accreditation Council lbr Continuing Medical Education 1. Users of M KSAP 19 Complete who prefer to use their (ACCME) to provide continuing medical education for print books and a paper answer sheet to study and physicians. record their answers can use the printed answer The American College of Physicians designates this endur sheet at the back olthis book to record their answers. ing material, MKSAP 19, for a maximum of 300 AMA PRA The corresponding online answer sheets, which are Category 1 CreditsrM. Physicians should claim only the available on the MKSAP 19 Resource Page, may be credit commensurate with the extent of their participation used to transcribe answers onto the online answer in the activity. sheets. Users may then submit their answers to qualify for CME credits or MOC points (see below fbr Up to 25.75 AMA PRA Category I Credifsr M are available fiom information on Opting in for MOC). Users who pre January 31,2022, to January 31, 2025, for the MKSAP 19 fer to record their answers on a paper answer sheet Pulmonary and Critical Care Medicine section. should save their answer sheet for future use. Users who study with MKSAP 19 print can also submit their Learning Objectives answers directly within MKSAP 19 Digital by access- ing the sell assessment questions dashboard and The learning objectives of MKSAP 19 are to: selecting the preferred subspecialty section to begin . Close gaps between actual care in your practice and answering questions. preferred standards of'care, based on best evidence 2. Users of MKSAP 19 Digital can enter their answers within . Diagnose disease states that are less commoll and some the digital program by accessing the self-assessment times overlcloked or confusing questions dashboard and selecting the pref'erred sub r Improve clinical management decisions that alfect patient specialty section to begin answering questions and saf'ety and quality ol care clicking the Submit CME button once they qualiflz fbr o Determine when to refer patients fbr care by medical CME and are ready to submit. Learners should keep in subspecialists, surgeons, and other members of the health mind their yearly CME and MOC deadlines when deter- care team mining the appropriate time to submit. o Pass the ABIM Certification Examination . Pass the ABIM Maintenance of Certilication Learners' CME/MOC submission progress will be shown Examination on the MKSAP 19 Digital CME/MOC/CPD page. v

on the committee to ensure that the material was balanced Opting in for MOC and unbiased. Contributors' disclosure information can MKSAP 19 users can opt in for simultaneous submission be found with the list of contributors' names and those of of CME and MOC points as they answer self assessment ACP principal staff listed in the beginning of this book' questions. To opt in, users will be required to complete a form requesting their name, date of birth, and ABIM number. The MOC Opt in Form will be presented during Language Reflecting Diversity,_Eq uity, a user's first CME submission and needs to be completed andlnclusion Within MKSAP 19 only once. MKSAP 19's Editors and contributors commit to using language and images that support ACP's commitment to ABtM 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 par MKSAP's physician contributors. When appropriate, ticipant to earn up to 300 medical knowledge MOC points the MKSAP Editors will also rely on MKSAP 19 Digital's in the ABIM's MOC program. It is the CME activity provider's expanded use of multimedia enhancements. including video responsibility to submit participant completion information and audio, to explore and more fully explain issues sur- to ACCME for the purpose of granting MOC credit. rounding the presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged Disclosure Policy to contact the Editors at mksap-editors6:acponline.org to It is the policy of the American College of Physicians (ACP) help us identiflz opporhrnities for improvement in this area. to ensure balance, independence, objectivity, and scientillc rigor in all ofits educational activities. To this end, and con- Hospital-Based Medicine sistent with the policies of the ACP and the Accreditation For the convenience of subscribers who provide care in Council for Continuing Medical Education (ACCME), con hospital settings, comprehensive hospital fbcused content tributors to all ACP continuing medical education activities aligned with the ABIM Focused Practice in tlospital are required to disclose all relevant financial relationships Medicine blueprint is integrated throughout the syllabus. with any entity producing, marketing, re-selling, or dis and self assessment questions that are specific to the tributing health care goods or services consumed by, or hospital setting are specially designated with the blue used on, patients. Contributors are required to use generic hospitalist icon (El). names in the discussion of therapeutic options and are required to identi$r any unapproved, off label, or investiga tive use of commercial products or devices. Where a trade High Value Care Key Points name is used, all available trade names for the same product Key Points in the text that relate to High Value Care con type are also included. If trade name products manufac cepts (that is, concepts that discuss balancing clinical tured by companies with whom contributors have rela- benefit with costs and harms) are designated by the HVC tionships are discussed, contributors are asked to provide icon [HVCI. evidence based citations in support of the discussion. The information is reviewed by the committee responsible for producing this content. If necessary adjustments to topics Educational Disclaimer or contributors' roles in content development are made to The editors and publisher of MKSAP 19 recognize that the balance the discussion. All relevant relationships are miti development of new material offers many opportunities gated. Readers of this content are asked to evaluate it for evi for error. Despite our best efforts, some errors may persist dence of commercial bias and send any relevant comments in print. Drug dosage schedules are, we believe, accurate to mksap_editorspacponline.org so that future decisions and in accordance with current standards. Readers are about content and contributors can be made in light of this advised. however. to ensure that the recommended dos- information. ages in MKSAP 19 concur with the information provided in the product information material. This is especially Mitigation of Conflicts important in cases of new, inlrequently used, or highly toxic drugs. Application of the information in MKSAP 19 To mitigate 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 not ogies, products, and/or services discussed, is intended to

on the committee to ensure that the material was balanced Opting in for MOC and unbiased. Contributors' disclosure information can MKSAP 19 users can opt in for simultaneous submission be found with the list of contributors' names and those of of CME and MOC points as they answer self assessment ACP principal staff listed in the beginning of this book' questions. To opt in, users will be required to complete a form requesting their name, date of birth, and ABIM number. The MOC Opt in Form will be presented during Language Reflecting Diversity,_Eq uity, a user's first CME submission and needs to be completed andlnclusion Within MKSAP 19 only once. MKSAP 19's Editors and contributors commit to using language and images that support ACP's commitment to ABtM 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 par MKSAP's physician contributors. When appropriate, ticipant to earn up to 300 medical knowledge MOC points the MKSAP Editors will also rely on MKSAP 19 Digital's in the ABIM's MOC program. It is the CME activity provider's expanded use of multimedia enhancements. including video responsibility to submit participant completion information and audio, to explore and more fully explain issues sur- to ACCME for the purpose of granting MOC credit. rounding the presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged Disclosure Policy to contact the Editors at mksap-editors6:acponline.org to It is the policy of the American College of Physicians (ACP) help us identiflz opporhrnities for improvement in this area. to ensure balance, independence, objectivity, and scientillc rigor in all ofits educational activities. To this end, and con- Hospital-Based Medicine sistent with the policies of the ACP and the Accreditation For the convenience of subscribers who provide care in Council for Continuing Medical Education (ACCME), con hospital settings, comprehensive hospital fbcused content tributors to all ACP continuing medical education activities aligned with the ABIM Focused Practice in tlospital are required to disclose all relevant financial relationships Medicine blueprint is integrated throughout the syllabus. with any entity producing, marketing, re-selling, or dis and self assessment questions that are specific to the tributing health care goods or services consumed by, or hospital setting are specially designated with the blue used on, patients. Contributors are required to use generic hospitalist icon (El). names in the discussion of therapeutic options and are required to identi$r any unapproved, off label, or investiga tive use of commercial products or devices. Where a trade High Value Care Key Points name is used, all available trade names for the same product Key Points in the text that relate to High Value Care con type are also included. If trade name products manufac cepts (that is, concepts that discuss balancing clinical tured by companies with whom contributors have rela- benefit with costs and harms) are designated by the HVC tionships are discussed, contributors are asked to provide icon [HVCI. evidence based citations in support of the discussion. The information is reviewed by the committee responsible for producing this content. If necessary adjustments to topics Educational Disclaimer or contributors' roles in content development are made to The editors and publisher of MKSAP 19 recognize that the balance the discussion. All relevant relationships are miti development of new material offers many opportunities gated. Readers of this content are asked to evaluate it for evi for error. Despite our best efforts, some errors may persist dence of commercial bias and send any relevant comments in print. Drug dosage schedules are, we believe, accurate to mksap_editorspacponline.org so that future decisions and in accordance with current standards. Readers are about content and contributors can be made in light of this advised. however. to ensure that the recommended dos- information. ages in MKSAP 19 concur with the information provided in the product information material. This is especially Mitigation of Conflicts important in cases of new, inlrequently used, or highly toxic drugs. Application of the information in MKSAP 19 To mitigate 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 not ogies, products, and/or services discussed, is intended to vl

inform subscribers about the knowledge, techniques, and We do not honor third party sales. CME credits and MOC experiences of the contributors. A diversity of professional points cannot be awarded to those purchasers who have opinion exists, and the views of the contributors are their purchased the program from non-authorized sellers. own and not those of the ACP. Inclusion of any material in the program does not constitute endorsement or rec ommendation by the ACP. The ACP does not warrant the Unauthorized Use of This Book ls safety, reliability, accuracy, completeness, or usefulness of Against the Law and disclaims any and all liability for damages and claims Unauthorized reproduction of this publication is unlaw that may result from the use of information, publications, ful. ACP prohibits reproduction of this publication or any technologies, products, and/or services discussed in this of its parts in any form either for individual use or for program. distribution. ACP will consider granting an individual permission to Publisher's lnformation reproduce only limited portions of this publication for his Copyright c 2022 American College of Physicians. AII or her or,rm exclusive use. Send requests in writing to MKSAP' rights reserved. Permissions, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106 1572, or This publication is protected by copyright. No part of email your request to mksap editors6racponline.org. this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, elec MKSAP 19ISBN: 978-r-938245 75-6 tronic or mechanical, including photocopy, without the Pulmonary and Critical Care Medicine ISBN: 978'l 938245 express consent of the ACP. MKSAP 19 is for individual 86-2 use only. Only one account per subscription will be per- Printed in the United States of America. mitted for the purpose of earning CME credits and MOC points and for other authorized uses of MKSAP 19. For order information in the U.S. or Canada, call B0o ACP 1915. In all other countries, call 215-351 2600 (Monday to Friday, 9 au-S prlt ET). Fax inquiries to Disclaimer Regarding Direct Purchases 215-351 2799 or email to custserv@acponline'org. from Online Retailers \ :

inform subscribers about the knowledge, techniques, and We do not honor third party sales. CME credits and MOC experiences of the contributors. A diversity of professional points cannot be awarded to those purchasers who have opinion exists, and the views of the contributors are their purchased the program from non-authorized sellers. own and not those of the ACP. Inclusion of any material in the program does not constitute endorsement or rec ommendation by the ACP. The ACP does not warrant the Unauthorized Use of This Book ls safety, reliability, accuracy, completeness, or usefulness of Against the Law and disclaims any and all liability for damages and claims Unauthorized reproduction of this publication is unlaw that may result from the use of information, publications, ful. ACP prohibits reproduction of this publication or any technologies, products, and/or services discussed in this of its parts in any form either for individual use or for program. distribution. ACP will consider granting an individual permission to Publisher's lnformation reproduce only limited portions of this publication for his Copyright c 2022 American College of Physicians. AII or her or,rm exclusive use. Send requests in writing to MKSAP' rights reserved. Permissions, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106 1572, or This publication is protected by copyright. No part of email your request to mksap editors6racponline.org. this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, elec MKSAP 19ISBN: 978-r-938245 75-6 tronic or mechanical, including photocopy, without the Pulmonary and Critical Care Medicine ISBN: 978'l 938245 express consent of the ACP. MKSAP 19 is for individual 86-2 use only. Only one account per subscription will be per- Printed in the United States of America. mitted for the purpose of earning CME credits and MOC points and for other authorized uses of MKSAP 19. For order information in the U.S. or Canada, call B0o ACP 1915. In all other countries, call 215-351 2600 (Monday to Friday, 9 au-S prlt ET). Fax inquiries to Disclaimer Regarding Direct Purchases 215-351 2799 or email to custserv@acponline'org. from Online Retailers \ : CME and/or MOC for MKSAP 19 is available only to cus tomers who purchase the program directly from ACP. Errata and Revisions \ Errata and Revisions for MKSAP 19 will be available ACP will not set up MKSAP CME/MOC accounts for i purchasers of MKSAP sold by unauthorized sellers (e.g., through MKSAP 19 Digital at mksaplg.acponline.org as I Amazon, eBay), with whom ACP has no relationship' new information becomes known to the editors. I t t I

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