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Welcome to the Pulmonary and Critical Care Medicine Section of MKSAP 191 In these pages, you will find updated information on pulmonary diagnostic testing, airways disease, diffuse parenchymal lung disease, occupational lung disease, pleural disease, pulmonary vascular disease, lung tumors, sleep medicine' high- altitude-related illnesses, critical care principles and utilization issues, common ICU conditions, and other specific critical care topics. All of these topics are uniquely focused on the needs of generalists and subspecialists outside of pulmonary and critical care 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. psychometrically 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 contin- ues to include High Value Core (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 fbcused MCQs, specially designated with the blue hospitalist icon (E), 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. psychometrically 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 contin- ues to include High Value Core (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 fbcused MCQs, specially designated with the blue hospitalist icon (E), 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, equify, and inclusion through- out 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 editors6racponline.org to help us identiff 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 ol Physicians

Pulmonary and Critical Care Medicine Committee Gretchen Renae Winter, MD Rendell W Ashton, MD, FACE Section Editor Assistant Professor Associate Professor of Medicine Department of Medicine Cleveland Clinic Lerner College of Medicine of the Case Division of Pulmonary AIlergz, and Critical Western Reserve Universily Care Medicine Associate Designated Institutional Official/Associate Director. University of Alabama at Birmingham Graduate Medical Education Birmingham, Alabama Program Director, Pulmonary and Critical Care Fellowship Cleveland Clinic Editor-in-Chief Cleveland, Ohio Davoren Chick, MD, FACP Sean M. Caples, DO, MS Senior Vice President. Medical Education Prof'essor of Medicine American College ol Physicians Division of Pulmonary and Critical Care Mledicine Philadelphia. Pennsylvaniir Mayo Clinic College of Medicine Rochester. Minnesota Senior Deputy Editor Neal F. Chaisson, MD Patrick C. Alguire, MD, FACP Program Director, Critical Care Medicine Program American College of Physicians Cleveland Clinic Philadelphia. Pennsylvan ia Cleveland. Ohio

Committee Gretchen Renae Winter, MD Rendell W Ashton, MD, FACE Section Editor Assistant Professor Associate Professor of Medicine Department of Medicine Cleveland Clinic Lerner College of Medicine of the Case Division of Pulmonary AIlergz, and Critical Western Reserve Universily Care Medicine Associate Designated Institutional Official/Associate Director. University of Alabama at Birmingham Graduate Medical Education Birmingham, Alabama Program Director, Pulmonary and Critical Care Fellowship Cleveland Clinic Editor-in-Chief Cleveland, Ohio Davoren Chick, MD, FACP Sean M. Caples, DO, MS Senior Vice President. Medical Education Prof'essor of Medicine American College ol Physicians Division of Pulmonary and Critical Care Mledicine Philadelphia. Pennsylvaniir Mayo Clinic College of Medicine Rochester. Minnesota Senior Deputy Editor Neal F. Chaisson, MD Patrick C. Alguire, MD, FACP Program Director, Critical Care Medicine Program American College of Physicians Cleveland Clinic Philadelphia. Pennsylvan ia Cleveland. Ohio Melissa King-Biggs, MD Deputy Editor Department Chair Pulmonary and Sleep Medicine Janet A. Jokela, MD, MPH, FACP HealthPartners Medical Group Professor & Head, Department of Medicine Assistant Professor University of Minnesota School of Medicine Acting Regional Dean St. Paul. Minnesota University of lllinois College of Medicine Urbana, Illinois Eduardo Mireles-Cabodevila, MD Director, Medical lntensive Care Unit Medical Director. Simulation and Advanced Skills Center Pulmonary and Critical Care Cleveland Clinic Medicine Reviewers Cleveland. Ohio Hugh Cassiere, MD, FACP Janaki Deepak, MBBS, FACP Tathagat Narula, MD Joel Deitz. MD Consultant, Lung Transplant Glenn Eiger, MD, I.ACP Division ol Transplant Medicine David Hostler, MD, MPH, FACP Medical Director, Adult Cardiopulmonary Rehabilitation Unit Jordanna Mae Hostlet MD, FACP Assistant Professor of Medicine William R. Hunt, MD, FACP Mayo Clinic College of Medicine Marshaleen N. Henriques King, MD, MSc, FACP Jacksonville, Florida Laura Meinke, MD, FACP Darlene R. Nelson, MD, MHPE Bhupinder Natt, MD, FACP Program Director, Pulmonary and Critical Care Medicine, Jody C. Olson, MD, FACP Critical Care Internal Medicine, and Pulmonary Disease Iqbal Ratnani, MD Fellowships Alexander Sy, MD, MBA, FACP Assistant Professor of \4edicine Tammy Wichman, MD, FACP Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine Rochester, Minnesota