Practicode I (1-100) Exam Questions With
Complete Answers
Question 1
CaseID: OPD7064
Primary Diagnosis: S00.03XA
Secondary Diagnosis: S09.90XA, F10.929, Y90.7, W18.30XA, and Y92.009
E/M Level: 99284
Correct Answer
Emergency Department ReportAGE: 86Sex: FDOS: 01/01/2015CHIEF COMPLAINT:
Fall - Struck head at homeHISTORY OF PRESENT ILLNESS: This is a female who was
downtown at a local restaurant and had several drinks and apparently fell over
backwards without injury. The staff at the restaurant drove the patient home where
she again fell over backwards and struck the back of her head. She had no loss of
consciousness. The bar staff called the medics who transported the patient to the
hospital. She was very combative en route. She does arrive in a C collar on a
backboard and refused an IV en route. Patient will not give me any past history and
has no complaints other than that she immediately wants to leave as soon as she
gets here and that we made her come to the hospital just to get money. Patient
states she hurts everywhere and will not cooperate any more than that with her
history, she will not give me any past history.According to the old chart, she has a
past history of previous compression fracture, ectasia of her thoracic aorta, COPD,
hypoalbuminemia. She does not have a physician. She lives by herself. She does
smoke and drink on a regular basis.REVIEW OF SYSTEMS: Negative per the
patient.PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 97.9, blood pressure
148/81, pulse 81, respirations 18, pulse ox 94% on room air.GENERAL: This is an
alert, very foul-mouthed, uncooperative, intoxicated elderly female who is not
cooperative with the exam. Patient is fully alert and is oriented.HEENT: Examination
of the scalp shows a hematoma over the occipital scalp. No sign of any facial
trauma. No tenderness about the face. Pupils are equal and reactive. Extraocular
movements are full with nystagmus. Tympanic membranes are clear. Nose clear.
Throat clear.NECK: Shows some minimal diffuse tenderness.CHEST: Clear,
nontender, no sign of traum
Page 1 of 100
,Question 2
CaseID: OPD7171
Primary Diagnosis: K80.10
CPT: 47563, 74300-26
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSEX: Female AGE: 40DATE OF OPERATION: 1/1/20XXSURGEON:
Dr. Cohen AndrewsFIRST ASSISTANT: Anne Jones, RNFA
PREOPERATIVE DIAGNOSIS: Cholelithiasis and cholecystitis.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE PERFORMED: Laparoscopic cholecystectomy with operative gram.
ANESTHESIA: General.
PATHOLOGY: Gallbladder and stones.
DESCRIPTION OF PROCEDURE: The patient was taken to the operative suite and
placed in the supine position. Her abdomen was prepped with chlorhexidine prep.
Foley was placed as well. The timeout was performed in the room prior to the start
of the procedure. Once that was completed, a 5-mm Optiview port was placed just
above the umbilicus. The remaining two ports were placed with direct visualization.
The gallbladder was grasped and taken in an anterior position. There was a large
amount of bile and a large stone that was apparent in the neck of the gallbladder
that was impacted. The bile within the gallbladder was removed with suction. It had
a pus appearance to it. Once that was completed, the portus of the gallbladder was
cleared and cystic duct was identified. A clip was placed. A ligature clip was placed
proximal to the gallbladder. Cholangiogram was performed. It showed free flow of
contrast into the duodenum. Once completed, the remaining two clips were placed
without any difficulty.The gallbladder was removed with the aid of suction from the
liver bed. The liver bed was then cauterized with cautery irrigator in order to
maintain some modicum of hemostasis. Once that was completed and it was noted
that there was not a lot of bleeding, irrigation was used in order to wash the clot
out of the abdomen. The gallbladder was placed in an Endopouch and then
removed from the abdomen from the upper 10-mm port site that had been slightly
enlarged with cautery. Once that was comp
Page 2 of 100
,Question 3
CaseID: OPD7193
Primary Diagnosis: H66.92, H72.02
CPT: 69631-LT
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSex: FAGE: 36DOS:1/1/20XXPHYSICIAN: J. Kramer,
MDPREOPERATIVE DIAGNOSIS: Chronic otitis media with Central perforation of
Tympanic Membrane.POSTOPERATIVE DIAGNOSIS: Chronic otitis media with Central
perforation of Tympanic Membrane.OPERATIVE PROCEDURE: Left
tympanoplasty.SURGEON: J. Kramer, MDPOSTOP CONDITION: Good.ANESTHESIA:
General endotracheal.ESTIMATED BLOOD LOSS: 30 mL or less.COMPLICATIONS:
None.FINDINGS: The patient had a 35% central tympanic perforation. There was
moderate tympanosclerosis of the remaining tympanic membrane. She also had
attic retraction, but no cholesteatoma. A lot of adhesions were found between
tympanic membrane and promontory. There also were some adhesions between
the long process of incus and long process of malleus. The ossicular chain was a
little stiff, but seemed intact.INDICATIONS FOR SURGERY: This is a female, who has
a history of chronic ear infections. She has had persistent otorrhea with a chronic
tympanic perforation. Ear has been cleaned up with treatment and topical
antibiotics. She has a moderate conductive low frequency hearing loss in her left
ear.DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
and placed on the table in supine position. The patient was induced under general
oral endotracheal anesthesia. After satisfactory induction of anesthesia, a small
amount of hair was shaved from around the left ear. It was prepped with Betadine.
A little alcohol was used to wipe the Betadine away from the skin circumferentially
around the canal. Drapes were placed in the usual sterile fashion. Then, 1% lidocaine
with 1:100,000 epinephrine was injected in the postauricular skin. With microscope
and an ear speculum, the skin of the ear canal was blanched with local anesthetic in
all four quadrants. Incision was made behind the left
Page 3 of 100
, Question 4
CaseID: OPD7223
Primary Diagnosis: R06.00
Secondary Diagnosis: N39.0
E/M Level: 99283
Correct Answer
EMERGENCY DEPARTMENTSEX: FEMALE AGE: 20DOS: 1/1/20XXCHIEF COMPLAINT:
Shortness of breath.HISTORY OF PRESENT ILLNESS: This is a female who states she
was sitting in class at and suddenly started getting short of breath. She was afraid
she was having an allergic reaction so she came to the emergency department. She
states that she had no rash, no nasal discharge, no sore throat, no itchy watery eyes.
She states it felt like sort of acute onset asthma attack. She states she was getting
somewhat panicky. She states that en route here it improved and on arrival here she
is basically asymptomatic. Her past medical history is significant for asthma. She
takes medications p.r.n. She has not had a need for albuterol in a year; in fact, she is
out of her albuterol.She denies fevers, chills, URI symptoms. Denies any chest pain,
nausea, vomiting, diaphoresis. She feels that maybe she is having an allergic
reaction to her Macrodantin, which she started yesterday. She apparently yesterday
was diagnosed with UTI and fungal vaginosis. She denies other symptoms or
problems and at this time she is asymptomatic.MEDICATIONS: She is on
Macrodantin as stated. She has taken 3 doses and she is also on a vaginal
cream.ALLERGIES: NONE.SOCIAL HISTORY: The patient is a local student. She
occasionally drinks alcohol. She does not smoke.PHYSICAL EXAM: VITAL SIGNS:
Normal. GENERAL: The patient is alert and oriented with clear speech and
mentation, a pleasant 18-year-old female resting comfortably on the gurney, alert
and oriented with clear speech and mentation. No evidence of respiratory distress
or other distress. HEENT: Nose without evidence of discharge. Oral is clear. Mucous
membranes are moist. NECK: Supple, nontender. No adenopathy. CHEST: Clear. No
rales, rhonchi or wheezes. CARDIOVASCULAR: Regular rate and rhythm. S1, S2
without a murmur. A
Page 4 of 100
Complete Answers
Question 1
CaseID: OPD7064
Primary Diagnosis: S00.03XA
Secondary Diagnosis: S09.90XA, F10.929, Y90.7, W18.30XA, and Y92.009
E/M Level: 99284
Correct Answer
Emergency Department ReportAGE: 86Sex: FDOS: 01/01/2015CHIEF COMPLAINT:
Fall - Struck head at homeHISTORY OF PRESENT ILLNESS: This is a female who was
downtown at a local restaurant and had several drinks and apparently fell over
backwards without injury. The staff at the restaurant drove the patient home where
she again fell over backwards and struck the back of her head. She had no loss of
consciousness. The bar staff called the medics who transported the patient to the
hospital. She was very combative en route. She does arrive in a C collar on a
backboard and refused an IV en route. Patient will not give me any past history and
has no complaints other than that she immediately wants to leave as soon as she
gets here and that we made her come to the hospital just to get money. Patient
states she hurts everywhere and will not cooperate any more than that with her
history, she will not give me any past history.According to the old chart, she has a
past history of previous compression fracture, ectasia of her thoracic aorta, COPD,
hypoalbuminemia. She does not have a physician. She lives by herself. She does
smoke and drink on a regular basis.REVIEW OF SYSTEMS: Negative per the
patient.PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 97.9, blood pressure
148/81, pulse 81, respirations 18, pulse ox 94% on room air.GENERAL: This is an
alert, very foul-mouthed, uncooperative, intoxicated elderly female who is not
cooperative with the exam. Patient is fully alert and is oriented.HEENT: Examination
of the scalp shows a hematoma over the occipital scalp. No sign of any facial
trauma. No tenderness about the face. Pupils are equal and reactive. Extraocular
movements are full with nystagmus. Tympanic membranes are clear. Nose clear.
Throat clear.NECK: Shows some minimal diffuse tenderness.CHEST: Clear,
nontender, no sign of traum
Page 1 of 100
,Question 2
CaseID: OPD7171
Primary Diagnosis: K80.10
CPT: 47563, 74300-26
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSEX: Female AGE: 40DATE OF OPERATION: 1/1/20XXSURGEON:
Dr. Cohen AndrewsFIRST ASSISTANT: Anne Jones, RNFA
PREOPERATIVE DIAGNOSIS: Cholelithiasis and cholecystitis.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE PERFORMED: Laparoscopic cholecystectomy with operative gram.
ANESTHESIA: General.
PATHOLOGY: Gallbladder and stones.
DESCRIPTION OF PROCEDURE: The patient was taken to the operative suite and
placed in the supine position. Her abdomen was prepped with chlorhexidine prep.
Foley was placed as well. The timeout was performed in the room prior to the start
of the procedure. Once that was completed, a 5-mm Optiview port was placed just
above the umbilicus. The remaining two ports were placed with direct visualization.
The gallbladder was grasped and taken in an anterior position. There was a large
amount of bile and a large stone that was apparent in the neck of the gallbladder
that was impacted. The bile within the gallbladder was removed with suction. It had
a pus appearance to it. Once that was completed, the portus of the gallbladder was
cleared and cystic duct was identified. A clip was placed. A ligature clip was placed
proximal to the gallbladder. Cholangiogram was performed. It showed free flow of
contrast into the duodenum. Once completed, the remaining two clips were placed
without any difficulty.The gallbladder was removed with the aid of suction from the
liver bed. The liver bed was then cauterized with cautery irrigator in order to
maintain some modicum of hemostasis. Once that was completed and it was noted
that there was not a lot of bleeding, irrigation was used in order to wash the clot
out of the abdomen. The gallbladder was placed in an Endopouch and then
removed from the abdomen from the upper 10-mm port site that had been slightly
enlarged with cautery. Once that was comp
Page 2 of 100
,Question 3
CaseID: OPD7193
Primary Diagnosis: H66.92, H72.02
CPT: 69631-LT
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSex: FAGE: 36DOS:1/1/20XXPHYSICIAN: J. Kramer,
MDPREOPERATIVE DIAGNOSIS: Chronic otitis media with Central perforation of
Tympanic Membrane.POSTOPERATIVE DIAGNOSIS: Chronic otitis media with Central
perforation of Tympanic Membrane.OPERATIVE PROCEDURE: Left
tympanoplasty.SURGEON: J. Kramer, MDPOSTOP CONDITION: Good.ANESTHESIA:
General endotracheal.ESTIMATED BLOOD LOSS: 30 mL or less.COMPLICATIONS:
None.FINDINGS: The patient had a 35% central tympanic perforation. There was
moderate tympanosclerosis of the remaining tympanic membrane. She also had
attic retraction, but no cholesteatoma. A lot of adhesions were found between
tympanic membrane and promontory. There also were some adhesions between
the long process of incus and long process of malleus. The ossicular chain was a
little stiff, but seemed intact.INDICATIONS FOR SURGERY: This is a female, who has
a history of chronic ear infections. She has had persistent otorrhea with a chronic
tympanic perforation. Ear has been cleaned up with treatment and topical
antibiotics. She has a moderate conductive low frequency hearing loss in her left
ear.DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
and placed on the table in supine position. The patient was induced under general
oral endotracheal anesthesia. After satisfactory induction of anesthesia, a small
amount of hair was shaved from around the left ear. It was prepped with Betadine.
A little alcohol was used to wipe the Betadine away from the skin circumferentially
around the canal. Drapes were placed in the usual sterile fashion. Then, 1% lidocaine
with 1:100,000 epinephrine was injected in the postauricular skin. With microscope
and an ear speculum, the skin of the ear canal was blanched with local anesthetic in
all four quadrants. Incision was made behind the left
Page 3 of 100
, Question 4
CaseID: OPD7223
Primary Diagnosis: R06.00
Secondary Diagnosis: N39.0
E/M Level: 99283
Correct Answer
EMERGENCY DEPARTMENTSEX: FEMALE AGE: 20DOS: 1/1/20XXCHIEF COMPLAINT:
Shortness of breath.HISTORY OF PRESENT ILLNESS: This is a female who states she
was sitting in class at and suddenly started getting short of breath. She was afraid
she was having an allergic reaction so she came to the emergency department. She
states that she had no rash, no nasal discharge, no sore throat, no itchy watery eyes.
She states it felt like sort of acute onset asthma attack. She states she was getting
somewhat panicky. She states that en route here it improved and on arrival here she
is basically asymptomatic. Her past medical history is significant for asthma. She
takes medications p.r.n. She has not had a need for albuterol in a year; in fact, she is
out of her albuterol.She denies fevers, chills, URI symptoms. Denies any chest pain,
nausea, vomiting, diaphoresis. She feels that maybe she is having an allergic
reaction to her Macrodantin, which she started yesterday. She apparently yesterday
was diagnosed with UTI and fungal vaginosis. She denies other symptoms or
problems and at this time she is asymptomatic.MEDICATIONS: She is on
Macrodantin as stated. She has taken 3 doses and she is also on a vaginal
cream.ALLERGIES: NONE.SOCIAL HISTORY: The patient is a local student. She
occasionally drinks alcohol. She does not smoke.PHYSICAL EXAM: VITAL SIGNS:
Normal. GENERAL: The patient is alert and oriented with clear speech and
mentation, a pleasant 18-year-old female resting comfortably on the gurney, alert
and oriented with clear speech and mentation. No evidence of respiratory distress
or other distress. HEENT: Nose without evidence of discharge. Oral is clear. Mucous
membranes are moist. NECK: Supple, nontender. No adenopathy. CHEST: Clear. No
rales, rhonchi or wheezes. CARDIOVASCULAR: Regular rate and rhythm. S1, S2
without a murmur. A
Page 4 of 100
