Mastering the cognitive knowledge within a field such as anesthesia is a formidable task, especially for the new learner. It is even more difficult to draw on that knowledge, procure and filter through the clinical and laboratory data, develop a differential diagnosis, and finally form a rational treatment plan. To gain these skills, the student often learns best at the bedside (or for anesthesia, most often the operating table), guided and instructed by experienced teachers and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education in the operating room or bedside. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical approach and decision making. In an attempt to achieve this goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches relevant to the field of anesthesia. Most importantly, the explanations for the cases emphasize the mechanisms and underlying principles rather than merely rote questions and answers.

This book is organized for versatility: to allow the student "in a rush" to go quickly through the scenarios and check the corresponding answers, and to provide more detailed information for the student who wants thoughtprovoking explanations. The answers are arranged from simple to complex: a summary of the pertinent points, the bare answers, an analysis of the case, an approach to the topic, a comprehension test at the end for reinforcement and emphasis, and a list of resources for further reading. The clinical vignettes are purposely arranged in a systematic manner to more easily allow the student to learn and integrate the mechanisms. A listing of cases is included in Section IV to aid the student who desires to test his or her knowledge of a certain area or to review a topic, including basic definitions. Finally, we intentionally did not primarily use a multiple-choice question format because clues (or distractions) are not available in the real world. Nevertheless, several multiple-choice questions are included at the end of each scenario to reinforce concepts or introduce related topics.

HOW TO GET THE MOST OUT OF THIS BOOK

Each case is designed to simulate a patient encounter and includes openended questions. At times, the patient’s complaint differs from the issue of most concern, and sometimes extraneous information is given. The answers are organized into four different parts:

PART I

1. Summary: The salient aspects of the case are identified, filtering out the extraneous information. The student should formulate his or her summary from the case before looking at the answers. A comparison with the summation in the answer helps to improve one's ability to focus on the important data while appropriately discarding irrelevant information, a fundamental skill required in clinical problem solving.

2. A straightforward answer is given to each open-ended question.

3. An analysis of the case, which consists of two parts:

   1. Objectives: A listing of the two or three main principles that are crucial for a practitioner in treating a patient. Again, the student is challenged to make educated "guesses" about the objectives of the case after an initial review of the case scenario, which helps to sharpen his or her clinical and analytical skills.

   2. Considerations: A discussion of the relevant points and a brief approach to a specific patient.

PART II

An approach to the disease process, consisting of two distinct parts:

1. Definitions: Terminology pertinent to the disease process.

2. Clinical approach: A discussion of the approach to the clinical problem in general, including tables, figures, and algorithms.

PART III

Comprehension questions: Each case includes several multiple-choice questions that reinforce the material or introduce new and related concepts. Questions about material not found in the text are explained in the answers.

PART IV

Clinical pearls: A listing of several clinically important points, which are reiterated as a summation of the text and to allow for easy review, such as before an examination.