Mastering the cognitive knowledge within a field such as emergency medicine 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 to 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 simulate the clinical approach and decision-making. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches relevant to emergency medicine. 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: it benefits the student “in a rush” to go quickly through the scenarios and check the corresponding answers, as well as 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 placed in a systematic order to allow students to compare and contrast like cases. Review questions are included in Section III to aid the students to integrate their knowledge. Finally, we intentionally did not primarily use a multiple-choice question (MCQ) format because clues (or distractions) are not available in the real world. Nevertheless, several MCQs 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 with open-ended questions. At times, the patient’s complaint is different from the most concerning issue, and sometimes extraneous information is given. The answers are organized with four different parts.

PART I

1. Summary: The salient aspects of the case are identified, filtering out the extraneous information. Student should formulate their summaries from the case before looking at the answers. A comparison to the summation in the answer will help to improve one’s ability to focus on the important data while appropriately discarding the irrelevant information, a fundamental skill in clinical problem solving.

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

3. The Analysis of the Case, which is comprised of two parts:

   1. Objectives of the Case: A listing of the two or three main principles that are crucial for a practitioner to manage the patient. Again, the student is challenged to make educated “guesses” about the objectives of the case upon initial review of the case scenario, which will help to sharpen clinical and analytical skills.

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

PART II

Approach to the Disease Process, which has two distinct parts:

1. Definitions or pathophysiology: Terminology or basic science correlates 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 contains several multiple-choice questions that reinforce the material or introduce new and related concepts. Questions about material not found in the text will have explanations in the answers.

PART IV

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