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This is the fifth edition of Harrison's Self-Assessment and Board Review prepared by the Johns Hopkins team. We thank the editors of the 20th edition of Harrison's Principles of Internal Medicine for their continued confidence in our ability to produce a worthwhile companion to their exceptional textbook. It is truly inspirational to remind ourselves why we love medicine broadly, and internal medicine specifically.

The care of patients is a privilege. As physicians, we owe it to our patients to be intelligent, knowledgeable, contemporary, and curious. Continuing education takes many forms; many of us enjoy the intellectual stimulation and active learning challenge of the question-and-answer format. It is in that spirit that we offer the 20th edition of the Self-Assessment and Board Review to students, house staff, and practitioners. We hope that from it you will learn, read, investigate, and question. The questions and answers are particularly conducive to collaboration and discussion with colleagues.

This edition contains over 1000 questions and comprehensive explanations. The questions, whenever possible, use realistic patient scenarios, including radiographic or pathologic images. Our answers attempt to explain the correct or best choice, often supported with outstanding figures from Harrison's Principles of Internal Medicine to stimulate learning.

We have replaced more than 60% of questions from the prior edition, thus hundreds of brand new questions and explanations are included herein. We continue to try to use interesting and clinically relevant images throughout the book.

The content of this book is available in a variety of delivery formats. In addition to the print edition, an “app” will be available that offers adaptive learning features so that users can focus their studies on areas of greatest need. Several eBook formats are available, and as before the content is available on the widely used www.accessmedicine.com resource, where users can easily toggle over the Harrison's content for greater explanation and context of all the Q&A in this book. We also note that the Q&A in this book has served as the source of the Harrison's Podclass podcast for the past two years. The podcast is also available on AccessMedicine and in all the usual podcast outlets.

Although one of the authors (B.H.) has transitioned to another institution, and carries his knowledge and experience with him, he will never leave the Osler Medical Service at Johns Hopkins Hospital spiritually. Our experiences with colleagues and patients at Johns Hopkins have defined our professional lives. In the words of William Osler, “We are here to add what we can to life, not to get what we can from life.” We hope this addition to your life stimulates your mind, challenges your thinking, and translates benefit to your patients. We also thank our families who cooked, minded children, and drove carpools while we toiled over this labor of love.

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