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Practicode III (Cases
201–300) Practice
Questions and Answers
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Practicode III (Cases 201–300) Practice Questions and Answers
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Practicode III (201-300)
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1. CaseID: MEDICAL RECORD
OPD6918 OPERATION REPORTAGE: 22Sex: FDATE OF OPERATION: 1/1/20XXPREOPERA-
Primary Diagno- TIVE DIAGNOSIS: RECURRENT RIGHT BREAST MASS.PROCEDURES: EXCISION
sis: N63.11 RIGHT BREAST MASS X 2.POSTOPERATIVE DIAGNOSIS: RECURRENT RIGHT BREAST
Secondary Diag- MASS.SURGEON:ANESTHESIA: LMA AND LOCAL INFILTRATION.PROCEDURE: The
nosis: N63.15 patient is a female who has a recurrent mass that was multilobulated in the
CPT: 19120-RT entire right upper outer quadrant and also a separate mass which was further
away from the nipple at a 9 o'clock position. These two were identified. After skin
local infiltration anesthesia was given.A curvilinear incision was made around the
nipple. The skin flaps were raised, so that the entire large mass was exposed. This
was about 2 to 3 cm. The mass was identified below some of the glandula and fat
tissue. It was completely excised using sharp dissection knife and with possible
margin around. The patient had smaller breast and there was active gland tissue
around the area of the excision. Once the entire mass was excised. The superior
margin was marked with a sharp silk suture and lateral with a long Prolene and
the deep margin with staple. Once this was done, on further palpation, there was
discrete separate mass in about 1 cm further lateral at the 9 o'clock position. This
was exposed and then using sharp dissection, this was about 1 cm and removed
in total and sent for pathology separately. The bed was irrigated and inspected.
Hemostasis was achieved. The breast tissue was approximated using 3-0 Vicryl.
The skin was closed using 4-0 Monocryl and sterile dressings were applied.The
patient tolerated the procedure well.Electronically signed by 1/1/20XX
2. CaseID: MEDICAL RECORD
OPD6919 OPERATIVE NOTESex: FAGE: 38DOS: 1/1/20XXPHYSICIAN:PREOPERATIVE DIAG-
Primary Diagno- NOSIS: Bilateral breast hypoplasia.POSTOPERATIVE DIAGNOSIS: Bilateral breast
sis: Z41.1 hypoplasiaOPERATIVE PROCEDURE: Bilateral augmentation using Mentor mod-
Secondary Diag- erate-plus profile silicone-filled implants, volume 375 mL, serial number on the
nosis: N64.82 patient's left is xxx. Serial number on the patient's right is xxx.SURGEON:ANESTHE-
CPT: 19325-50 SIA: General.COMPLICATIONS: None.INDICATIONS: Ms. Smith is a female, who is
interested in bilateral breast augmentation for treatment of breast hypoplasia.
She understood the risks of breast asymmetry, capsular contracture, hematoma,
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode III (201-300)
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Practicode III (201-300)
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seroma, infection, breast pain, nipple anesthesia, and need for further surgery.
Understanding these risks and possible outcomes, she agreed and wished to
proceed with surgery.PROCEDURE: The patient was brought to the operating
room, where she was placed in supine position. She was placed under general
anesthesia without incident. She had been marked for augmentation in the
preoperative holding area. Her chest was sterilely prepped and draped in usual
fashion. I first started on the patient's left. A periareolar incision of 4 cm length
was made along the inferior border. The skin flap was elevated inferiorly towards
the inferior mammary crease. The breast parenchyma in the midline was then
incised and carried down to the chest wall. The inferior border of the pectoralis
major muscle was identified and incised along its border. A submuscular pocket
was developed bluntly. Muscle fiber was released medially to reach the sternal
border. The pectoralis major muscle insertion along the sternum was left intact.
The inferior insertion of the pectoralis major muscle was released. After creation
of a submuscular pocket, I irrigated the pocket out well with saline. With adequate
retraction, I then placed a 375-mL mo
3. CaseID: MEDICAL RECORD
OPD6920 OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. History of left breast
Primary Diagno- cancer, status post-first-stage breast reconstruction with placement of tissue ex-
sis: T85.79XA pander.2. Left breast cellulitis.POSTOPERATIVE DIAGNOSES:1. History of left breast
Secondary Di- cancer, status post-first-stage breast reconstruction with placement of tissue ex-
agnosis: Z85.3, pander.2. Left breast cellulitis, with infected tissue expander.OPERATIVE PROCE-
Z92.21 DURE: Removal of left breast tissue expander with light pocket debridement and
CPT: 11971-LT irrigation.SURGEON:ANESTHESIA: Monitored anesthesia care and IV sedation.IN-
DICATIONS: Ms. Smith is a female who underwent immediate first-stage breast
reconstruction with placement of tissue expander and AlloDerm. Shortly after
surgery, she developed erythema consistent with cellulitis. She was started on oral
antibiotics and after not improving, she was treated with six weeks of IV antibiotics.
Her erythema had resolved and she had no pain or evidence of significant edema
or seroma or abscess. The patient then started chemotherapy and has finished the
chemo. Shortly afterwards she developed some recurrent hyperemia. There was
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode III (201-300)
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Practicode III (Cases
201–300) Practice
Questions and Answers
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Practicode III (Cases 201–300) Practice Questions and Answers
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Practicode III (201-300)
Study online at https://quizlet.com/_gu5gt6
1. CaseID: MEDICAL RECORD
OPD6918 OPERATION REPORTAGE: 22Sex: FDATE OF OPERATION: 1/1/20XXPREOPERA-
Primary Diagno- TIVE DIAGNOSIS: RECURRENT RIGHT BREAST MASS.PROCEDURES: EXCISION
sis: N63.11 RIGHT BREAST MASS X 2.POSTOPERATIVE DIAGNOSIS: RECURRENT RIGHT BREAST
Secondary Diag- MASS.SURGEON:ANESTHESIA: LMA AND LOCAL INFILTRATION.PROCEDURE: The
nosis: N63.15 patient is a female who has a recurrent mass that was multilobulated in the
CPT: 19120-RT entire right upper outer quadrant and also a separate mass which was further
away from the nipple at a 9 o'clock position. These two were identified. After skin
local infiltration anesthesia was given.A curvilinear incision was made around the
nipple. The skin flaps were raised, so that the entire large mass was exposed. This
was about 2 to 3 cm. The mass was identified below some of the glandula and fat
tissue. It was completely excised using sharp dissection knife and with possible
margin around. The patient had smaller breast and there was active gland tissue
around the area of the excision. Once the entire mass was excised. The superior
margin was marked with a sharp silk suture and lateral with a long Prolene and
the deep margin with staple. Once this was done, on further palpation, there was
discrete separate mass in about 1 cm further lateral at the 9 o'clock position. This
was exposed and then using sharp dissection, this was about 1 cm and removed
in total and sent for pathology separately. The bed was irrigated and inspected.
Hemostasis was achieved. The breast tissue was approximated using 3-0 Vicryl.
The skin was closed using 4-0 Monocryl and sterile dressings were applied.The
patient tolerated the procedure well.Electronically signed by 1/1/20XX
2. CaseID: MEDICAL RECORD
OPD6919 OPERATIVE NOTESex: FAGE: 38DOS: 1/1/20XXPHYSICIAN:PREOPERATIVE DIAG-
Primary Diagno- NOSIS: Bilateral breast hypoplasia.POSTOPERATIVE DIAGNOSIS: Bilateral breast
sis: Z41.1 hypoplasiaOPERATIVE PROCEDURE: Bilateral augmentation using Mentor mod-
Secondary Diag- erate-plus profile silicone-filled implants, volume 375 mL, serial number on the
nosis: N64.82 patient's left is xxx. Serial number on the patient's right is xxx.SURGEON:ANESTHE-
CPT: 19325-50 SIA: General.COMPLICATIONS: None.INDICATIONS: Ms. Smith is a female, who is
interested in bilateral breast augmentation for treatment of breast hypoplasia.
She understood the risks of breast asymmetry, capsular contracture, hematoma,
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode III (201-300)
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Practicode III (201-300)
Study online at https://quizlet.com/_gu5gt6
seroma, infection, breast pain, nipple anesthesia, and need for further surgery.
Understanding these risks and possible outcomes, she agreed and wished to
proceed with surgery.PROCEDURE: The patient was brought to the operating
room, where she was placed in supine position. She was placed under general
anesthesia without incident. She had been marked for augmentation in the
preoperative holding area. Her chest was sterilely prepped and draped in usual
fashion. I first started on the patient's left. A periareolar incision of 4 cm length
was made along the inferior border. The skin flap was elevated inferiorly towards
the inferior mammary crease. The breast parenchyma in the midline was then
incised and carried down to the chest wall. The inferior border of the pectoralis
major muscle was identified and incised along its border. A submuscular pocket
was developed bluntly. Muscle fiber was released medially to reach the sternal
border. The pectoralis major muscle insertion along the sternum was left intact.
The inferior insertion of the pectoralis major muscle was released. After creation
of a submuscular pocket, I irrigated the pocket out well with saline. With adequate
retraction, I then placed a 375-mL mo
3. CaseID: MEDICAL RECORD
OPD6920 OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. History of left breast
Primary Diagno- cancer, status post-first-stage breast reconstruction with placement of tissue ex-
sis: T85.79XA pander.2. Left breast cellulitis.POSTOPERATIVE DIAGNOSES:1. History of left breast
Secondary Di- cancer, status post-first-stage breast reconstruction with placement of tissue ex-
agnosis: Z85.3, pander.2. Left breast cellulitis, with infected tissue expander.OPERATIVE PROCE-
Z92.21 DURE: Removal of left breast tissue expander with light pocket debridement and
CPT: 11971-LT irrigation.SURGEON:ANESTHESIA: Monitored anesthesia care and IV sedation.IN-
DICATIONS: Ms. Smith is a female who underwent immediate first-stage breast
reconstruction with placement of tissue expander and AlloDerm. Shortly after
surgery, she developed erythema consistent with cellulitis. She was started on oral
antibiotics and after not improving, she was treated with six weeks of IV antibiotics.
Her erythema had resolved and she had no pain or evidence of significant edema
or seroma or abscess. The patient then started chemotherapy and has finished the
chemo. Shortly afterwards she developed some recurrent hyperemia. There was
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode III (201-300)
