What is MKSAP 19 Pulmonary and Critical Care Medicine?
MKSAP 19 Pulmonary and Critical Care Medicine is a comprehensive educational section for internists, residents, hospitalists, and other clinicians who need practical knowledge of pulmonary and critical care medicine. It covers diagnostic testing, airway disease, lung disorders, pulmonary vascular disease, sleep medicine, respiratory failure, ICU care, and critical care emergencies.
Introduction
Pulmonary and critical care medicine requires clinicians to move comfortably between diagnostic reasoning, chronic disease management, acute respiratory deterioration, and intensive care. MKSAP 19 Pulmonary and Critical Care Medicine is designed to support that broad clinical knowledge base, particularly for generalists, hospitalists, residents, and subspecialists who practice outside pulmonary and critical care medicine.
The book is a dedicated section of MKSAP 19 (Medical Knowledge Self-Assessment Program), 19th edition, published by the American College of Physicians (ACP).
Its stated purpose is educational, with an emphasis on developing clinical knowledge, improving management decisions, recognizing less common or confusing disease states, and preparing physicians for internal medicine certification and maintenance of certification examinations.
What makes this section particularly useful is its breadth. Rather than concentrating exclusively on one pulmonary subspecialty, it moves from pulmonary function testing and imaging through asthma, COPD, diffuse parenchymal lung disease, occupational lung disease, pleural and pulmonary vascular disorders, lung tumors, sleep medicine, high-altitude illness, and critical care.
The material is therefore relevant not only to pulmonologists but also to clinicians who encounter respiratory problems in outpatient medicine, hospital wards, emergency settings, and intensive care units.
Book Overview
|
Detail |
Information |
|
Full
title |
MKSAP 19 Pulmonary and Critical Care
Medicine |
|
Edition |
19th edition / MKSAP 19 |
|
Publisher |
American College of Physicians (ACP) |
|
Publication
year |
2022 |
|
Medical
specialty |
Pulmonary and Critical Care Medicine |
|
Format |
Educational/self-assessment program
section with print and digital components described in the book |
|
Primary
audience |
General internists, hospitalists,
internal medicine subspecialists, and residents |
|
Section
editor |
Rendell W. Ashton, MD, FACE |
|
Editor-in-Chief |
Davoren Chick, MD, FACP |
|
Senior
Deputy Editor |
Patrick C. Alguire, MD, FACP |
|
Deputy
Editor |
Janet A. Jokela, MD, MPH, FACP |
The Pulmonary and Critical Care Medicine committee includes physicians associated with institutions such as Cleveland Clinic, Mayo Clinic, HealthPartners, and the University of Alabama at Birmingham. The section editor is Rendell W. Ashton, MD, FACE.
The publication information identifies 2022 as the copyright year and provides a separate ISBN for the Pulmonary and Critical Care Medicine section.
What This Book Covers
Pulmonary Diagnostic Testing
The book begins with the practical foundation of pulmonary medicine: understanding diagnostic tests and interpreting their results.
The pulmonary function testing material includes:
- Spirometry
- Bronchial challenge testing
- Lung-volume measurement
- Diffusing capacity for carbon monoxide (DLCO)
- Interpretation of pulmonary function tests
- Six-minute walk testing
- Pulse oximetry
- Fractional exhaled nitric oxide (FeNO)
The section explains how pulmonary function tests can be interpreted in terms of obstructive, restrictive, and mixed patterns and discusses the role of measurements such as FEV1/FVC, total lung capacity, and DLCO.
Imaging is also addressed, including chest radiography, CT, ultrasonography, and PET/CT. Bronchoscopy and endobronchial ultrasonography are included as both diagnostic and therapeutic tools.
Airways Disease
A substantial portion of the book focuses on common and clinically important airway disorders.
Asthma
The asthma section covers epidemiology and natural history, pathogenesis, risk factors, symptoms and clinical evaluation, asthma syndromes, chronic management, exacerbations, severe refractory asthma, and asthma in pregnancy.
Chronic Obstructive Pulmonary Disease
COPD is addressed through its definition, epidemiology, pathophysiology, risk factors, heterogeneity, comorbid conditions, diagnosis, disease assessment, management, and acute exacerbations.
The section also covers bronchiectasis and cystic fibrosis, including diagnosis and treatment.
Diffuse Parenchymal Lung Disease
The book provides a structured approach to diffuse parenchymal lung disease. Topics include classification and epidemiology, diagnostic evaluation, high-resolution CT, serologic testing, and lung biopsy.
It distinguishes diffuse parenchymal lung diseases with known causes—including smoking-related disease, connective tissue disease, hypersensitivity pneumonitis, drug-induced disease, and radiation pneumonitis—from diseases with an unknown cause.
Specific disorders include:
- Idiopathic pulmonary fibrosis
- Nonspecific interstitial pneumonia
- Cryptogenic organizing pneumonia
- Acute interstitial pneumonia
- Combined pulmonary fibrosis and emphysema
- Sarcoidosis
Occupational Lung Disease
Occupational respiratory disease receives its own section, emphasizing when clinicians should suspect an occupational cause and how to obtain an appropriate exposure history.
The material addresses work-related asthma, occupational COPD, pneumoconioses, asbestos-related disease, metal-induced lung disease, occupational hypersensitivity pneumonitis, chronic beryllium disease, and occupationally associated malignancies.
Pleural Disease
Pleural medicine includes evaluation and management of:
- Pleural effusion
- Pneumothorax
The table of contents organizes these topics around practical evaluation and management rather than presenting them simply as descriptive pathology.
Pulmonary Vascular Disease
The pulmonary vascular section focuses heavily on pulmonary hypertension. It covers evaluation of suspected pulmonary hypertension, pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, and other pulmonary hypertension groups.
Lung Tumors
The lung tumor material includes evaluation of pulmonary nodules according to their characteristics and size, followed by lung cancer types, risk factors, screening, diagnosis, and staging.
Other thoracic neoplasms addressed include mesothelioma and mediastinal masses, with separate consideration of anterior, middle, and posterior mediastinal disease.
Sleep Medicine
Sleep medicine is another major component. Topics include excessive daytime sleepiness, circadian rhythm disorders, jet lag, shift-work sleep disorder, obstructive sleep apnea, central sleep apnea syndromes, and sleep-related hypoventilation.
The book also addresses sleep-related hypoventilation associated with COPD, obesity hypoventilation syndrome, and neuromuscular disease.
High-Altitude-Related Illnesses
The high-altitude section covers the pathogenesis of altitude illness, acute mountain sickness, high-altitude cerebral edema, high-altitude pulmonary edema, and considerations surrounding air travel in patients with pulmonary disease.
Critical Care Medicine
The critical care component broadens the book from pulmonary disease to the management of critically ill patients.
Topics include:
- Recognition of the critically ill patient
- Organization of critical care
- Principles of critical care
- Comprehensive support
- Sedation and analgesia
- Nutritional support
- Early mobilization
- ICU care bundles
- High-value care in the ICU
- Mechanical ventilatory support
- Hemodynamic support
- Intravenous access
- Blood pressure support
- ICU complications
- ICU-acquired weakness
- Long-term cognitive impairment
- Post-intensive care syndrome
The common ICU conditions section covers acute respiratory failure, acute upper-airway management, hypoxemic respiratory failure, acute inhalational injuries, ARDS, heart failure, atelectasis, pneumonia, diffuse parenchymal lung disease, pulmonary embolism, hypercapnic respiratory failure, shock, and sepsis.
Specific critical care topics extend to anaphylaxis, hyperthermic emergencies, heat stroke, malignant hyperthermia, neuroleptic malignant syndrome, serotonin syndrome, accidental hypothermia, toxicology, poisoning, abdominal surgical emergencies, fat embolism, critical illness in pregnancy, encephalopathy, coma, and anoxic brain injury.
Key Features
Several features distinguish the educational approach of MKSAP 19 Pulmonary and Critical Care Medicine:- Broad pulmonary and critical care coverage spanning outpatient and ICU medicine.
- Practical diagnostic emphasis, including pulmonary function testing, imaging, bronchoscopy, and ultrasonography.
- Coverage of both common and less frequently encountered conditions.
- Dedicated critical care content addressing respiratory failure, shock, sepsis, mechanical ventilation, and ICU complications.
- High Value Care recommendations emphasizing the balance between clinical benefit, cost, and potential harm.
- Self-assessment questions designed around clinical decision-making.
- ABIM-oriented educational structure, including board-style questions and content aligned with certification and maintenance-of-certification objectives.
- Digital learning features described in the book, including custom quizzes, linked content, a learning dashboard, multimedia resources, Virtual Dx, Flashcards, Quick Qs, and Board Basics in applicable MKSAP 19 digital products.
Who Should Read This Book?
Medical Students
Medical students interested in internal medicine, pulmonary medicine, or critical care can use the book to become familiar with clinically oriented respiratory topics. However, the stated target audience is primarily postgraduate internal medicine learners and practicing physicians rather than beginning medical students.
Residents
Residents are among the clearest intended users. The stated target audience specifically includes internal medicine residents preparing for the ABIM Internal Medicine Certification Examination.
Specialists
Pulmonary and critical care specialists may find the section useful for maintaining broader internal medicine knowledge, although the book specifically describes its pulmonary and critical care content as being focused on the needs of generalists and subspecialists outside these fields.
Exam Candidates
Exam candidates are an especially important audience. The stated learning objectives include passing the ABIM Certification Examination and Maintenance of Certification Examination.
Why This Book Is Useful
Clinical Relevance
One of the strongest aspects of the book is its clinical breadth. Respiratory complaints rarely remain confined to one diagnostic category. A patient with dyspnea may require pulmonary function testing, imaging, evaluation for pulmonary vascular disease, assessment for sleep-related disorders, or escalation to respiratory support.
The organization of the book reflects this reality by moving from diagnostic methods to specific pulmonary diseases and then into critical illness.
Evidence-Based Educational Framework
The book states that its learning objectives include closing gaps between actual practice and preferred standards of care based on the best available evidence, improving clinical management decisions, recognizing overlooked or confusing disease states, and determining when referral is appropriate.
It also describes an editorial process involving external peer review and the use of best evidence and updated clinical care guidelines when available.
High-Value Care
High-Value Care is deliberately integrated into the pulmonary and critical care section. The book defines this approach around balancing clinical benefit against costs and harms, intending to improve outcomes while conserving finite healthcare resources.
Examples listed in the book include avoiding unnecessary testing and interventions and selecting diagnostic or management strategies according to their expected clinical value.
Board Examination Preparation
The self-assessment component is central to the MKSAP educational model. The book states that its multiple-choice questions were developed with consideration of ABIM Certification and Maintenance of Certification requirements.
The digital program also includes features specifically designed around high-frequency and high-importance areas of the ABIM blueprint.
Learning Efficiency
The combination of concise clinical topics, key points, self-assessment questions, and structured disease categories supports focused study. Rather than requiring learners to search across an enormous general reference, the section concentrates on clinically important pulmonary and critical care knowledge.
Table of Contents Overview
The major structure of the book is:
Pulmonary Diagnostic Tests
- Pulmonary function testing
- Spirometry
- Bronchial challenge testing
- Lung volumes and DLCO
- Six-minute walk test
- Pulse oximetry
- FeNO
- Imaging
- Bronchoscopy and endobronchial ultrasonography
Airways Disease
- Asthma
- COPD
- Bronchiectasis
- Cystic fibrosis
Diffuse Parenchymal Lung Disease
- Diagnostic approach
- HRCT
- Serologic testing
- Lung biopsy
- Diseases with known causes
- Idiopathic pulmonary fibrosis
- NSIP
- Cryptogenic organizing pneumonia
- Acute interstitial pneumonia
- Sarcoidosis
Occupational Lung Disease
Pleural Disease
- Pleural effusion
- Pneumothorax
Pulmonary Vascular Disease
- Pulmonary hypertension
- Pulmonary arterial hypertension
- Chronic thromboembolic pulmonary hypertension
- Other pulmonary hypertension groups
Lung Tumors
- Pulmonary nodules
- Lung cancer
- Other pulmonary neoplasms
- Mesothelioma
- Mediastinal masses
Sleep Medicine
High-Altitude-Related Illnesses
Critical Care Medicine: ICU Utilization
Common ICU Conditions
Specific Critical Care Topics
Bibliography
Self-Assessment Test
Index
This structure is directly reflected in the book's contents pages.
Strengths of the Book
The principal strength of MKSAP 19 Pulmonary and Critical Care Medicine is its integration of pulmonary medicine with critical care. The reader is not limited to chronic respiratory disorders; the same section progresses into acute respiratory failure, mechanical ventilation, shock, sepsis, toxicologic emergencies, and other ICU problems.
Another strength is its diagnostic orientation. Pulmonary medicine depends heavily on interpreting physiologic and imaging data, and the book explicitly addresses spirometry, lung volumes, DLCO, bronchial challenge testing, pulse oximetry, FeNO, CT, ultrasonography, PET/CT, bronchoscopy, and endobronchial ultrasonography.
The educational structure is also strongly assessment-oriented. The book includes self-assessment questions, and MKSAP 19's broader question bank is described as peer-reviewed and psychometrically validated.
Finally, the High Value Care framework adds an important dimension to clinical decision-making by emphasizing not only whether an intervention can be performed, but whether its expected benefits justify its costs and potential harms.
Limitations
The book itself identifies an important limitation: its primary purpose is educational, and the editors acknowledge that errors may persist despite efforts to prevent them. They specifically advise clinicians to verify drug dosing against current product information, particularly for newer, infrequently used, or highly toxic drugs.
A second limitation is temporal. The publication information dates the material to 2022, and the stated CME availability for this section ran from January 31, 2022, through January 31, 2025. Therefore, readers using the book today should recognize that subsequent evidence, guidelines, terminology, and clinical recommendations may not be reflected.
The book also states that application of its information remains the professional responsibility of the practitioner.
Comparison With Similar Books
It is not presented simply as a comprehensive pulmonary textbook. Instead, it is part of a broader internal medicine self-assessment program, with explicit attention to clinical decision-making, ABIM examination objectives, High Value Care, and self-assessment.
MKSAP 19 Pulmonary and Critical Care Medicine
FAQs
MKSAP 19 Pulmonary and Critical Care Medicine is a pulmonary and critical care medicine section of the 19th edition of the Medical Knowledge Self-Assessment Program. It provides clinically focused educational material and self-assessment content for internal medicine learners and practicing physicians.
The stated target audience includes general internal medicine specialists, primary care physicians, hospitalists, internal medicine subspecialists, and residents preparing for the ABIM Internal Medicine Certification Examination.
The section covers pulmonary diagnostic testing, asthma, COPD, bronchiectasis, cystic fibrosis, diffuse parenchymal lung disease, occupational lung disease, pleural disease, pulmonary vascular disease, lung tumors, sleep medicine, high-altitude illness, ICU utilization, respiratory failure, shock, sepsis, and other critical care emergencies.
Yes. The book explicitly identifies passing the ABIM Certification Examination and Maintenance of Certification Examination among its learning objectives.
Yes. Critical care is a major component, including ICU organization, supportive care, sedation and analgesia, nutrition, early mobilization, mechanical ventilation, hemodynamic support, ICU complications, acute respiratory failure, ARDS, shock, sepsis, toxicology, and other critical care topics.
Yes. The diagnostic section includes spirometry, bronchial challenge testing, lung volumes, DLCO, six-minute walk testing, pulse oximetry, FeNO, chest imaging, CT, ultrasonography, PET/CT, bronchoscopy, and endobronchial ultrasonography.
Yes. High Value Care recommendations are explicitly incorporated into the Pulmonary and Critical Care Medicine section and focus on balancing clinical benefit, cost, and potential harms.
The book was published in 2022, and its own educational disclaimer advises clinicians to verify information such as medication dosing against current product information. Because medical evidence and guidelines evolve, the book should be considered an educational reference rather than a substitute for current clinical guidance.
Conclusion
MKSAP 19 Pulmonary and Critical Care Medicine provides a broad, clinically oriented review of respiratory and critical care medicine within the larger MKSAP educational framework. Its scope extends from fundamental pulmonary diagnostic testing to airway disease, interstitial and occupational lung disease, pleural and pulmonary vascular disorders, lung tumors, sleep medicine, altitude-related illness, and complex ICU conditions.
Its greatest educational value lies in the combination of clinical coverage and assessment. The material is structured around the needs of internal medicine clinicians, while the self-assessment framework and ABIM-oriented objectives make it particularly relevant to residents and physicians preparing for certification or continuing professional development.
For learners, the book can function as a focused pulmonary and critical care review resource rather than an encyclopedic subspecialty reference. Its diagnostic emphasis, critical care coverage, High Value Care recommendations, and question-based learning approach make it particularly suitable for structured study and reinforcement of clinical reasoning.
At the same time, readers should recognize its 2022 publication date and consult current clinical guidance when making patient-care decisions. Within those boundaries, MKSAP 19 Pulmonary and Critical Care Medicine represents a substantial educational resource for physicians seeking to strengthen their knowledge of pulmonary and critical care medicine.
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