GC SF Sp WH BV YL BT CP SA CB CC Back to puzzle



by Justin Graham

The intent of this puzzle was to expose puzzlers to the wonderful world of controlled medical vocabularies. It also allowed me to create a puzzle that used the actual meaning of “pneumonoultramicroscopicsilicovolcanoconiosis”—a word that was originally invented by the National Puzzlers’ League!

Cavity Sam (yes, he has a canonical name) is suffering from a number of real medical disorders, each clued with a cutesy sounding nickname (usually derived from a medical term or outdated medical jargon). So “Web in the Eye” actually refers to a cataract; “Swollen Head” refers to cerebral edema, etc.

Each disorder is shown along with (all but one digit of) its SNOMED CT Core code (from the flavortext “..snow. Med Core...”) SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) is the most comprehensive clinical terminology system. [If you are an aspiring medical informaticist (the world needs more of them!) you can read up about it here.] [If you’re a real geek, you’ll notice we’re using the pre-coordinated SNOMED code set, even though SNOMED was intended as a post-coordinated terminology with multiple axes of flexibility.]

If you have enough medical knowledge to identify the disorder, you can look up the SNOMED code directly. Otherwise you can cycle through the various options for the missing digit to make the match. Order the conditions sequentially by missing digit.

CT Squeeze 57406009 Carpal tunnel syndrome G-5 = B
Mortified 195303005 Gangrene of foot U-9 = L
Swollen Head 2032001 Cerebral edema R-3 = O
Web in the Eye 193570009 Cataract H-5 = C
NASH stash 442685003 Nonalcoholic steatohepatitis S-8 = K
Pneumonoultramicroscopicsilicovolcanoconiosis 805002 Pneumoconiosis caused by silica C-2 = A
MR Murmur 48724000 Mitral valve regurgitation G-0 = G
Outie 396347007 Umbilical hernia E-0 = E

Once you have each correct SNOMED disorder code, you can take the letter substitution and subtract the number that the letter is hiding. Reading diagonally left to right gives you the cute name for Cavity Sam’s final disorder: BLOCKAGE. But BLOCKAGE of what? And what procedure will cure him? (This was changed many times in testing because test solvers were able to short circuit the last bit of the puzzle when the cute disorder name was CHOKED UP or even PIPE CLOG).

Each of these medical disorders (in their most severe forms) can be treated with an actual operation. These operations are clued through the short video snippets below the image. (All snippets were pulled from public YouTube videos—apologies for the poor video quality on some of them.) Each snippet contains enough anatomical information (usually the surgeon’s narration) to identify a specific procedure.

Each medical procedure also has an associated SNOMED Procedure code. Finding this code is a little more tricky, since you aren’t given any numbers. But if you have a little anatomical and medical knowledge, and if you study the video and its associated disorder, you can probably make a guess as to what the procedure is. The limitation of 8 digits (not all SNOMED codes have 8 digits) and the checksum should further constrain the space of possible answers.

Decompression of median nerve 47534009
Amputation of leg through tibia and fibula 88312006
Craniotomy 25353009
Extraction of cataract 54885007
Transplantation of liver 18027006
Transplant of lung 88039007
Replacement of mitral valve 53059001
Repair of umbilical hernia 44946007

Identify all the procedure codes and then read diagonally left to right, like before, to get the numerical sequence 48387007. This is the procedure code for “Incision of trachea,” which might be performed if, say, there was a BLOCKAGE of your airway. An 11 letter synonym is TRACHEOSTOMY, which is your answer.

(This puzzle was crafted prior to the Misktaonic University Game, which coincidentally also featured a puzzle based on Operation.)