Nr511 Final Study Guide 2023/2024

NR511 FINAL STUDY GUIDE 2023/2024 Define diagnostic reasoning - CORRECT ANSWER-A list of possible diagnoses based on historical and clinical presentation listed in order of priority Identify subjective and objective data - CORRECT ANSWER-Subjective data is what the patient tells you (SAYS) objective data is what you see: labs, etc. (OBSERVE) Identify the components of the HPI - CORRECT ANSWER-OLDCARTS onset location duration characteristics aggravating factors relieving factors timing and severity Develop an appropriate differential: - CORRECT ANSWER-Confirm or rule out hypotheses screen for conditions monitor progress of the current condition Accurately describe why every procedure code must have a corresponding diagnosis code - CORRECT ANSWER-To Be able to bill correctly Identify the three components required in determining an out patient office visit E and M code - CORRECT ANSWER-Number one) history number two) physical examination number three) MDM - medical decision-making Describe the differences between medical billing and medical coding - CORRECT ANSWER-Medical coding is use of codes to communicate with payers about which procedures were performed and why billing is the process of submitting and follow-up on claims made to a payor in order to receive payment for medical services rendered by health care provider Compare and contrast the two coding classification systems that are currently used in the US healthcare system - CORRECT ANSWER-CPT: common procedural terminology: official procedural coding rules and guidelines required when reporting medical services and procedures performed by M.D. and non-MD providers; recognized universally; logical means to track healthcare data, trends, and outcomes; five digit code presenting: E and M, anesthesia, surgery, radiology, and pathology ICD: ICD - 10 as current, shorthand for diagnosis - provides the payer info on the necessity of the visit or procedures performed Discuss how specificity, sensitivity, and predictive value contribute to the usefulness of diagnostic data - CORRECT ANSWER-Specificity is the extent to which diagnostic test is specific for a condition/trait sensitivity is the ability of a test to correctly ID those with the disease predictive value: probability that the patient actually has the condition, truly and with the disease Discuss the elements that need to be considered when developing a plan - CORRECT ANSWER-Patient preferences and actions insurance family willingness clinical state and circumstances practice setting research evidence Describe the components of medical decision-making in E and M coding risk - CORRECT ANSWER-History, exam, and medical decision-making Correctly order that E and M office visit codes based on complexity from least to most complex - CORRECT ANSWER-99201 office outpatient new 10 minutes 99202 office outpatient new 20 minutes 99203 office outpatient new 30 minutes 99204 office outpatient new 45 minutes 99205 office outpatient new 60 minutes 99211 office outpatient visit 5 minutes 99212 office outpatient visit 10 minutes 99213 office outpatient visit 15 minutes 99214 office outpatient visit 25 minutes 99215 office outpatient visit 40 minutes Define the components of a SOAP note - CORRECT ANSWER-subjective objective assessment plan Discuss a minimum of three purposes of the written history and physical in relation to the importance of documentation - CORRECT ANSWER-Document that gives concise information about the patient outlines plan for addressing reasons for visit means of communicating information to other providers medical - legal document essential to accurately code and bill for services Quickly identify a patient as new or established given the historical information - CORRECT ANSWER-Established: may be seen by any provider in the practice of must of been seen within the past three years new: patients not seen within the practice or have not been seen within three years Explain what a "well rounded" clinical experience means - CORRECT ANSWER-15% pediatrics/women's health variety of patients Discuss the max number of hours that time can be spent "rounding" in a facility - CORRECT ANSWER-25% Discussed nine things that must be documented when inputting data into clinical encounter logs - CORRECT ANSWER-Date of service age gender ethnicity E and M complexity diagnosis procedures and test performed/ordered RX given level of preceptor involvement Explain each part of the acronym of the SNAPPS presentation - CORRECT ANSWERSummarize narrow the differential analyze the differential probe the preceptor plan self-directed learning Identify the most common type of pathogens responsible for acute gastroenteritis - CORRECT ANSWER-Adults: Norovirus peds: rotavirus (although becoming less prevalent due to vaccines) Identify when stools studies are warranted - CORRECT ANSWER-Patient has severe or prolonged diarrhea. There still should be checked for consistency, blood, and fecal leukocytes. Do cultures for severe diarrhea, of fever of greater than 38.5 centigrade, bloody stools, or stools that test positive or leukocytes or occult blood because these symptoms are indicative of diffuse colonic inflammation, likely from a bacterial pathogen Correctly identify the most specific ICD - 10 code with the information given - CORRECT ANSWERThe difference between irritable bowel disease(IBS) and inflammatory bowel disorder (IBD) - CORRECT ANSWER-IBS: disordered sensation or abnormal function of the small and large bowel 1) patients with abdominal pain and altered bowel habits, diarrhea/constipation or 2) painless diarrhea, may have slight tenderness in some areas of the colon. Labs: CBC, ESR. Diagnose based on H&P exam that reveals an increased bowel symptoms with pain, relief of pain after defecation, increase sensation and bowel activity, sense of incomplete defecation. Does not present with fever or bleeding. IBD: more severe, symptoms from the inflammation results and bleeding, fever, and increased wbc's. Leads to ulcerative colitis and Crohn's disease Discussed two common inflammatory bowel diseases - CORRECT ANSWER-UC: the mucosal surface of the colon is inflamed and results and fry ability, erosions, and bleeding. Crohn's: inflammation is deeper in the intestinal wall and can involve all or any layer of the bowel wall in any part of the G.I. tract, the left lower quadrant pain Describe the characteristics of acute diverticulitis - CORRECT ANSWER-Causes characteristic LOQ abdominal pain and tenderness; often diagnosed clinically and then get abdominal x-ray to rule out perforation or obstruction and treat empirically; for definitive diagnosis of milder symptoms, CT scan with oral and I contrast Discuss how the diagnosis of diverticulitis is made - CORRECT ANSWER-CBC: mild to moderate leukocytes, H&H may be decreased if the patient has rectal bleed. Abdominal x-ray to look for free air (perf), ileus, or obstruction. Definitive diagnosis with CT with oral AND IV contrast. S/S include LL Q abdominal pain, tenderness, fever, changes in bowel or bladder habits, diarrhea is common, N/V, may be able to palpate a firm fixed mass (diverticuli), peritonitis may or may not be present, rebound tenderness with an voluntary guarding/rigidity, rectal exam reveals + a cold blood in stool Discuss colon cancer screening recommendations relative to certain populations - CORRECT ANSWER-Recommendations for African-American start at age 45 as they have a higher risk. All individuals screen at age 50 Identify at least one effective treatment for irritable bowel syndrome(IBS) - CORRECT ANSWER-Diet: avoid triggers(caffeine, artificial sweetener, lactose); modification of stress; treat symptoms; diarrhea: Imodium/Lomotil/Const: high-fiber, hydration, include activity, stimulant laxatives short-term/intermittent: lactulose(MiraLAX), MOM; ABD pain: anti-spasmodic's: Bentyl/Levisn (outfield elderly patient, BPD, or both,) or TCA or SSRI for the ABD pain Identify at least one prescription medication for the treatment of chronic constipation - CORRECT ANSWER-Lactulose(Enulose,Kristalose and generic); Linaclotide (Linzess), Lubiprostone (Amitza) and Plecanatide (Trulance) Describe the component of the H&P that should be done for a patient with abdominal pain: - CORRECT ANSWER-HPI/OLDCARTS: vital signs, include heart rate, include respiratory rate, include BP, will all tell intensity of pain: ABD exam: rebound tenderness, guarding, bowel sounds; rectal exam; genital and pelvic exams Discuss the difference between sensorineural and conductive hearing loss - CORRECT ANSWER-Sensorineural: deterioration of the cochlea, I frequency hearing loss with the aging(presbycusis) conductive: hearing loss due to obstruction between middle ear and outer ear Identify the triad of symptoms associated with Ménière's disease - CORRECT ANSWER-Vertigo tinnitus hearing loss Identify at least two disorders that are considered to be disorders related to conductive hearing loss - CORRECT ANSWER-Cerumen impaction otitis media foreign body Describe an intervention for a patient with gastroenteritis - CORRECT ANSWER-Almost always viral, self-limiting, and resolves in a week. No antibiotics - increases risk of C Diff. TX: supportive and includes fluid replacement and nutrition. Pedialyte.NO evidence to support BRAT diet speeds recovery but can be useful if tolerated better. Severe dehydration(tachy, low BP, pallor, decreased skin turgor) requires IVF and ED/admit Discuss an appropriate treatment for prophylaxis or treatment of travelers diarrhea - CORRECT ANSWER-Empiric antibiotic is recommended for patient with severe diarrhea. Trimethoprim - sulfamethoxazole or Bactrim DS at one tab BID times three days. Other antibiotics: Cipro 500 mg, norfloxacin or hundred milligrams or ofloxacin 300 mg Discuss treatment options for Ménière's disease i - CORRECT ANSWER-We been geared toward relief of symptoms. It occurs rarely longer than four hours. Diuretics(Chlorthiazide, diurel) to reduce lymphatic pressure and volume. Vesticular suppressants(meclizine, promethazine,metoclopramide, diphenhydramine) Identify which conditions warrant an ENT referral - CORRECT ANSWER-Surgical removal of the tonsils/adenoids is absolutely indicated if tonsillar inflammation leads to airway obstruction or is active flares recur more than three per year. Also, insects in the ear canal but does not come out easily with manual remov