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Practicode I (Cases 1–
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Practicode I (Cases 1–100) Practice Questions and Answers
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1. CaseID: MEDICAL RECORD
OPD6921 OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. Localized abdominal
Primary Diagno- adiposity2. Left axillary glandular tissue.3. Bilateral breast ptosis.POSTOPERATIVE
sis: Z41.1 DIAGNOSES:1. Localized abdominal adiposity.2. Left axillary glandular tissue.3.
Secondary Diag- Bilateral breast ptosis.4. Left breast lump upper inner quadrantOPERATIVE PRO-
nosis: N64.81, CEDURE:1. Bilateral mastopexy.2. Bilateral axillary and chest wall suction-assisted
N63.22, Q83.1, lipectomy.3. Excision of left breast lump upper inner quadrant.4. Abdomino-
E65, L98.7 plasty with upper abdomen and flank liposuction.SURGEON:ANESTHESIA: Gen-
CPT: 15830, eral.COMPLICATIONS: None.INDICATIONS: Ms. Smith is a female, who presented
19316-50, to clinic with significant abdominal dermatolipodystrophy, breast ptosis, and re-
19120-LT, 15877 dundant left axillary tissue. She desired body contouring surgery. I recommended
mastopexy with abdominoplasty, as well as liposuction of her bilateral axilla, and
upper abdomen, as well as flanks. She also had redundant left axillary tissue,
which was significant with ectopic or accessory breast glandular tissue, which I
recommended direct excision. The patient agreed and wished to proceed with
the above-mentioned procedures.DESCRIPTION OF PROCEDURE: The patient was
brought to the operating room, where she was placed in the supine position.
She was placed under general anesthesia. The patient's breasts and abdomen
were sterilely prepped and draped in the usual fashion. She was marked in the
preoperative holding area for bilateral mastopexy and abdominoplasty. I first
started with mastopexy. On the patient's right, I traced out the patient's nipple
areolar margin with a 42-mm cookie cutter. This was incised partial-thickness
through the skin with a 10-blade scalpel. The skin incisions, which had been
planned in the preoperative holding area, were then incised partially through the
skin thickness with a 10-blade scalpel.
2. CaseID: DATE OF OPERATION: 1/01/20XXPREOPERATIVE DIAGNOSIS: NONHEALING VE-
OPD6922 NOUS STASIS ULCERS, BILATERAL LOWER EXTREMITY.PROCEDURES: BILATER-
Primary Diagno- AL LOWER EXTREMITY SPLIT-THICKNESS SKIN GRAFTINGPOSTOPERATIVE DI-
sis: I87.2 AGNOSIS: CHRONIC, VENOUS STASIS ULCERS BILATERAL LOWER EXTREMI-
Secondary Diag- TY.SURGEON:ANESTHESIA: SPINAL.ESTIMATED BLOOD LOSS: MINIMAL.COMPLI-
nosis: L97.411, CATIONS: NONE.INDICATIONS: The patient is a male with chronic venous insuf-
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L97.421 ficiency and bilateral lower extremity venous stasis ulcers limited to breakdown
CPT: 15120 of skin.PROCEDURE: The patient was brought to the operating room and placed
on the OR table in the sitting position. Spinal anesthesia was administered by
anesthesiologist. The patient was placed supine and both lower extremities were
prepped and draped for sterile procedure.We directed our attention to the left
upper thigh where split-thickness graft was harvested with 0.0020-inch thickness.
At this point, graft was meshed with the ratio of 1:1.5 and placed on both venous
stasis ulcers on the medial aspect of the left heel and plantar midfoot and lateral
aspect of the right heel and plantar midfoot and held in place using surgical
staple device.Xeroform was placed on both wounds. VAC sponges were applied
on both wounds. No leakage noted from the sponge site of VAC device and tubing
was connected to the suction machine.The patient tolerated the procedure well.
He was wide-awake at the end of the procedure and safely transported to the
recovery room for further management.Electronically signed by 1/1/20XX
3. CaseID: MEDICAL RECORD
OPD6924 PREOPERATIVE DIAGNOSIS: REMOVAL OF HARDWARE DUE TO PAIN STATUS
Primary Diagno- POST-OP-KNOWLES PIN (X 3) FIXATION OF RIGHT HIPPROCEDURES: REMOVAL
sis: T84.84XA OF KNOWLES PIN X 3; RIGHT HIP.POSTOPERATIVE DIAGNOSIS: REMOVAL OF
CPT: 20680 HARDWARE DUE TO PAIN/ STATUS POST-OP-KNOWLES PIN (X 3) FIXATION OF
RIGHT HIPSURGEON:ANESTHESIA: GENERAL.ANESTHESIOLOGIST:PROCEDURE:
After adequate induction with general anesthesia and the patient on the fracture
table, the right lower extremity was stabilized in neutral rotation. Preliminary views
were taken with the image intensifier and the AP and lateral plains demonstrating
the presence of three Knowles pins in the right hip. The right hip was scrubbed,
prepped with Betadine and draped in the usual manner for lateral approach
surgery.The location of the Knowles pins was determined with the C-arm and a
3-inch incision was made through previously healed surgical scar. The incision
was brought down through subcutaneous tissue, fascia lata and proximal vastus
lateralis. As determined by the image intensifier views, a considerable amount
of bone had grown over and covered the heads of the Knowles ends. Thus, after
appropriate soft tissue dissection and hemostasis, a curved osteotome and mallet
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Practicode I (1-100)
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was utilized to unroof and expose the squared heads of the Knowles pins.The
Knowles pins screw heads were found to be straight alignment with impingement
of the distal two (2) pins upon one another. Bony in growth was removed from
the periphery of the pin heads utilizing a small straight osteotome and mallet. The
screws were removed in their entirety utilizing a vice grip. After complete hardware
removal, the bone site was examined and there was no evidence of bone defect
propagation nor fracture. The operative site was repeatedly irrigated with saline
solution.The vastus lateralis and fascia lata were repaired with figure
4. CaseID: MEDICAL RECORD
OPD6929 SEX: MALE Age: 62DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
Primary Diag- RIGHT LOWER END TIBIA STATUS POST ORIF WITH RETAINED SYNDESMOTIC
nosis: S82.301D, SCREW, LEFT LOWER END TIBIA STATUS POST EXTERNAL FIXATION WITH RETAINED
S82.302D HARDWARE.PROCEDURES: RIGHT LOWER END TIBIA REMOVAL OF SYNDESMOTIC
E/M Lev- SCREWS, LEFT LOWER END TIBIA REMOVAL OF EXTERNAL FIXATOR.POSTOPERA-
el: 20680-RT, TIVE DIAGNOSIS: RIGHT LOWER END TIBIA STATUS POST ORIF WITH RETAINED
20694-RT SYNDESMOTIC SCREW AND LEFT LOWER END TIBIA STATUS POST EXTERNAL
FIXATION WITH RETAINED HARDWARE.SURGEON: Stephanie Andrews MDANES-
THESIA: LOCAL WITH IV SEDATION. (MAC)ESTIMATE BLOOD LOSS: 20 CC.TOURNI-
QUET TIME: NONE.ANTIBIOTICS: 1 GM OF ANCEF.COMPLICATIONS: NONE.IN-
DICATIONS: The patient is a male who sustained a left lower end tibia fracture
and had external fixation and a right lower end tibia ORIF with syndesmotic
screws. He had healed the syndesmotic area and was complaining of the external
fixator and requesting removal.Options, risks and benefits were discussed with
the patient. He agreed with removal of the external fixator and of the syndesmotic
screws.PROCEDURE: The patient was brought to the operating room and the right
lower extremity was prepped and draped in sterile fashion and he was injected
with a 50:50 mixture of 1% lidocaine with epinephrine and 0.25% Marcaine along
the area where the syndesmotic screws were located.A longitudinal incision was
made through the previous incision and the screws were viewed and removed
without difficulty. The wound was irrigated out with sterile saline and the skin
was closed with interrupted 3-0 nylon sutures. The left tibia external fixator pins
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Practicode I (Cases 1–
100) Practice Questions
and Answers
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Practicode I (Cases 1–100) Practice Questions and Answers
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1. CaseID: MEDICAL RECORD
OPD6921 OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. Localized abdominal
Primary Diagno- adiposity2. Left axillary glandular tissue.3. Bilateral breast ptosis.POSTOPERATIVE
sis: Z41.1 DIAGNOSES:1. Localized abdominal adiposity.2. Left axillary glandular tissue.3.
Secondary Diag- Bilateral breast ptosis.4. Left breast lump upper inner quadrantOPERATIVE PRO-
nosis: N64.81, CEDURE:1. Bilateral mastopexy.2. Bilateral axillary and chest wall suction-assisted
N63.22, Q83.1, lipectomy.3. Excision of left breast lump upper inner quadrant.4. Abdomino-
E65, L98.7 plasty with upper abdomen and flank liposuction.SURGEON:ANESTHESIA: Gen-
CPT: 15830, eral.COMPLICATIONS: None.INDICATIONS: Ms. Smith is a female, who presented
19316-50, to clinic with significant abdominal dermatolipodystrophy, breast ptosis, and re-
19120-LT, 15877 dundant left axillary tissue. She desired body contouring surgery. I recommended
mastopexy with abdominoplasty, as well as liposuction of her bilateral axilla, and
upper abdomen, as well as flanks. She also had redundant left axillary tissue,
which was significant with ectopic or accessory breast glandular tissue, which I
recommended direct excision. The patient agreed and wished to proceed with
the above-mentioned procedures.DESCRIPTION OF PROCEDURE: The patient was
brought to the operating room, where she was placed in the supine position.
She was placed under general anesthesia. The patient's breasts and abdomen
were sterilely prepped and draped in the usual fashion. She was marked in the
preoperative holding area for bilateral mastopexy and abdominoplasty. I first
started with mastopexy. On the patient's right, I traced out the patient's nipple
areolar margin with a 42-mm cookie cutter. This was incised partial-thickness
through the skin with a 10-blade scalpel. The skin incisions, which had been
planned in the preoperative holding area, were then incised partially through the
skin thickness with a 10-blade scalpel.
2. CaseID: DATE OF OPERATION: 1/01/20XXPREOPERATIVE DIAGNOSIS: NONHEALING VE-
OPD6922 NOUS STASIS ULCERS, BILATERAL LOWER EXTREMITY.PROCEDURES: BILATER-
Primary Diagno- AL LOWER EXTREMITY SPLIT-THICKNESS SKIN GRAFTINGPOSTOPERATIVE DI-
sis: I87.2 AGNOSIS: CHRONIC, VENOUS STASIS ULCERS BILATERAL LOWER EXTREMI-
Secondary Diag- TY.SURGEON:ANESTHESIA: SPINAL.ESTIMATED BLOOD LOSS: MINIMAL.COMPLI-
nosis: L97.411, CATIONS: NONE.INDICATIONS: The patient is a male with chronic venous insuf-
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L97.421 ficiency and bilateral lower extremity venous stasis ulcers limited to breakdown
CPT: 15120 of skin.PROCEDURE: The patient was brought to the operating room and placed
on the OR table in the sitting position. Spinal anesthesia was administered by
anesthesiologist. The patient was placed supine and both lower extremities were
prepped and draped for sterile procedure.We directed our attention to the left
upper thigh where split-thickness graft was harvested with 0.0020-inch thickness.
At this point, graft was meshed with the ratio of 1:1.5 and placed on both venous
stasis ulcers on the medial aspect of the left heel and plantar midfoot and lateral
aspect of the right heel and plantar midfoot and held in place using surgical
staple device.Xeroform was placed on both wounds. VAC sponges were applied
on both wounds. No leakage noted from the sponge site of VAC device and tubing
was connected to the suction machine.The patient tolerated the procedure well.
He was wide-awake at the end of the procedure and safely transported to the
recovery room for further management.Electronically signed by 1/1/20XX
3. CaseID: MEDICAL RECORD
OPD6924 PREOPERATIVE DIAGNOSIS: REMOVAL OF HARDWARE DUE TO PAIN STATUS
Primary Diagno- POST-OP-KNOWLES PIN (X 3) FIXATION OF RIGHT HIPPROCEDURES: REMOVAL
sis: T84.84XA OF KNOWLES PIN X 3; RIGHT HIP.POSTOPERATIVE DIAGNOSIS: REMOVAL OF
CPT: 20680 HARDWARE DUE TO PAIN/ STATUS POST-OP-KNOWLES PIN (X 3) FIXATION OF
RIGHT HIPSURGEON:ANESTHESIA: GENERAL.ANESTHESIOLOGIST:PROCEDURE:
After adequate induction with general anesthesia and the patient on the fracture
table, the right lower extremity was stabilized in neutral rotation. Preliminary views
were taken with the image intensifier and the AP and lateral plains demonstrating
the presence of three Knowles pins in the right hip. The right hip was scrubbed,
prepped with Betadine and draped in the usual manner for lateral approach
surgery.The location of the Knowles pins was determined with the C-arm and a
3-inch incision was made through previously healed surgical scar. The incision
was brought down through subcutaneous tissue, fascia lata and proximal vastus
lateralis. As determined by the image intensifier views, a considerable amount
of bone had grown over and covered the heads of the Knowles ends. Thus, after
appropriate soft tissue dissection and hemostasis, a curved osteotome and mallet
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode I (1-100)
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was utilized to unroof and expose the squared heads of the Knowles pins.The
Knowles pins screw heads were found to be straight alignment with impingement
of the distal two (2) pins upon one another. Bony in growth was removed from
the periphery of the pin heads utilizing a small straight osteotome and mallet. The
screws were removed in their entirety utilizing a vice grip. After complete hardware
removal, the bone site was examined and there was no evidence of bone defect
propagation nor fracture. The operative site was repeatedly irrigated with saline
solution.The vastus lateralis and fascia lata were repaired with figure
4. CaseID: MEDICAL RECORD
OPD6929 SEX: MALE Age: 62DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
Primary Diag- RIGHT LOWER END TIBIA STATUS POST ORIF WITH RETAINED SYNDESMOTIC
nosis: S82.301D, SCREW, LEFT LOWER END TIBIA STATUS POST EXTERNAL FIXATION WITH RETAINED
S82.302D HARDWARE.PROCEDURES: RIGHT LOWER END TIBIA REMOVAL OF SYNDESMOTIC
E/M Lev- SCREWS, LEFT LOWER END TIBIA REMOVAL OF EXTERNAL FIXATOR.POSTOPERA-
el: 20680-RT, TIVE DIAGNOSIS: RIGHT LOWER END TIBIA STATUS POST ORIF WITH RETAINED
20694-RT SYNDESMOTIC SCREW AND LEFT LOWER END TIBIA STATUS POST EXTERNAL
FIXATION WITH RETAINED HARDWARE.SURGEON: Stephanie Andrews MDANES-
THESIA: LOCAL WITH IV SEDATION. (MAC)ESTIMATE BLOOD LOSS: 20 CC.TOURNI-
QUET TIME: NONE.ANTIBIOTICS: 1 GM OF ANCEF.COMPLICATIONS: NONE.IN-
DICATIONS: The patient is a male who sustained a left lower end tibia fracture
and had external fixation and a right lower end tibia ORIF with syndesmotic
screws. He had healed the syndesmotic area and was complaining of the external
fixator and requesting removal.Options, risks and benefits were discussed with
the patient. He agreed with removal of the external fixator and of the syndesmotic
screws.PROCEDURE: The patient was brought to the operating room and the right
lower extremity was prepped and draped in sterile fashion and he was injected
with a 50:50 mixture of 1% lidocaine with epinephrine and 0.25% Marcaine along
the area where the syndesmotic screws were located.A longitudinal incision was
made through the previous incision and the screws were viewed and removed
without difficulty. The wound was irrigated out with sterile saline and the skin
was closed with interrupted 3-0 nylon sutures. The left tibia external fixator pins
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