Mastering the cognitive knowledge within a field such as general surgery is a formidable task. 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, guided and instructed by experienced teachers and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education at the 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 general surgery. 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 thought-provoking 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 randomly in order to simulate the way that real patients present to the practitioner. A listing of cases is included in Section III 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.