Practicode I (1-100) Exam Questions
With Complete Answers
CaseID: OPD6921
Primary Diagnosis: Z41.1
Secondary Diagnosis: N64.81, N63.22, Q83.1, E65, L98.7
CPT: 15830, 19316-50, 19120-LT, 15877 - ANSWER MEDICAL RECORD
OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. Localized
abdominal adiposity2. Left axillary glandular tissue.3. Bilateral breast
ptosis.POSTOPERATIVE DIAGNOSES:1. Localized abdominal adiposity.2. Left
axillary glandular tissue.3. Bilateral breast ptosis.4. Left breast lump upper inner
quadrantOPERATIVE PROCEDURE:1. Bilateral mastopexy.2. Bilateral axillary
and chest wall suction-assisted lipectomy.3. Excision of left breast lump upper
inner quadrant.4. Abdominoplasty with upper abdomen and flank
liposuction.SURGEON:ANESTHESIA: General.COMPLICATIONS:
None.INDICATIONS: Ms. Smith is a female, who presented to clinic with
significant abdominal dermatolipodystrophy, breast ptosis, and redundant 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.
CaseID: OPD6922
Primary Diagnosis: I87.2
Secondary Diagnosis: L97.411, L97.421
CPT: 15120 - ANSWER DATE OF OPERATION: 1/01/20XXPREOPERATIVE
DIAGNOSIS: NONHEALING VENOUS STASIS ULCERS, BILATERAL LOWER
EXTREMITY.PROCEDURES: BILATERAL LOWER EXTREMITY SPLIT-THICKNESS
SKIN GRAFTINGPOSTOPERATIVE DIAGNOSIS: CHRONIC, VENOUS STASIS
ULCERS BILATERAL LOWER EXTREMITY.SURGEON:ANESTHESIA:
,SPINAL.ESTIMATED BLOOD LOSS: MINIMAL.COMPLICATIONS:
NONE.INDICATIONS: The patient is a male with chronic venous insufficiency
and bilateral lower extremity venous stasis ulcers limited to breakdown 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
CaseID: OPD6924
Primary Diagnosis: T84.84XA
CPT: 20680 - ANSWER MEDICAL RECORD
PREOPERATIVE DIAGNOSIS: REMOVAL OF HARDWARE DUE TO PAIN STATUS
POST-OP-KNOWLES PIN (X 3) FIXATION OF RIGHT HIPPROCEDURES:
REMOVAL OF KNOWLES PIN X 3; RIGHT HIP.POSTOPERATIVE DIAGNOSIS:
REMOVAL OF 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 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
CaseID: OPD6929
Primary Diagnosis: S82.301D, S82.302D
E/M Level: 20680-RT, 20694-RT - ANSWER MEDICAL RECORD
SEX: MALE Age: 62DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
RIGHT LOWER END TIBIA STATUS POST ORIF WITH RETAINED SYNDESMOTIC
SCREW, LEFT LOWER END TIBIA STATUS POST EXTERNAL FIXATION WITH
RETAINED HARDWARE.PROCEDURES: RIGHT LOWER END TIBIA REMOVAL OF
SYNDESMOTIC SCREWS, LEFT LOWER END TIBIA REMOVAL OF EXTERNAL
FIXATOR.POSTOPERATIVE DIAGNOSIS: RIGHT LOWER END TIBIA STATUS
POST ORIF WITH RETAINED SYNDESMOTIC SCREW AND LEFT LOWER END
TIBIA STATUS POST EXTERNAL FIXATION WITH RETAINED
HARDWARE.SURGEON: Stephanie Andrews MDANESTHESIA: LOCAL WITH IV
SEDATION. (MAC)ESTIMATE BLOOD LOSS: 20 CC.TOURNIQUET TIME:
NONE.ANTIBIOTICS: 1 GM OF ANCEF.COMPLICATIONS: NONE.INDICATIONS:
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 were removed and sterilely dressed in this area.The
patient was then taken to the recovery room in stable condition.Electronically
signed by 1/1/20XX
CaseID: OPD6937
Primary Diagnosis: M75.121
Secondary Diagnosis: S46.211A
CPT: 23410-RT and 29824-RT - ANSWER Age: 71SEX: FEMALEDate of Service:
1/1/20XXService Department: Orthopedic Group GeneralProvider:OPERATIVE
NOTE:OPERATIVE DIAGNOSIS: Right shoulder partial biceps tendon tearing
with full-thickness supraspinatus tear 1 cmNAME OF PROCEDURE: Right
shoulder examination under anesthesia, arthroscopy, biceps tendon
debridement, Open rotator cuff repairSURGEON:ANESTHESIA: General with
scalene block.ESTIMATED BLOOD LOSS: Minimal.COMPLICATIONS:
None.DESCRIPTION OF PROCEDURE: With the patient in a beach-chair position
under endotracheal intubation and general anesthesia, the right shoulder was
examined. It had a full range of motion. Ligaments were stable. The right
, shoulder was then prepped and draped free in the usual manner. A posterior
portal was established after insufflating the joint with 50 mL of sterile
saline.Within the shoulder joint we found normal cartilage on both articular
surfaces. The interior recess was clear. We established a portal anteriorly in the
interval above the subscapularis tendon. The subscapularis was intact. There
was obvious partial degeneration and tearing the biceps tendon. We used a
shaver and debrided this back to good stable tissue. Superior labrum was
attached normally. There was a full-thickness tear in the supraspinatus
tendon.We removed the instruments and placed the arthroscope into the
subacromial space. Here we identified the superior surface of the tear and
found its length to be about 1 to 1.5 cm. We established a lateral portal. We
performed bursectomy and debrided the undersurface of the acromion of soft
tissue. We performed an acromioplasty. We then took out the anterior hook of
the acromion and the anterior-inferior half of the acromion as far back as the
posterior edge of the distal clavicle. We then entered the AC joint through the
anterior portal and performed a distal clavicu
CaseID: OPD6942
Primary Diagnosis: S52.572A
CPT: 25609-LT - ANSWER Age 72 Sex: MALEDate of Service: 1/1/20XXService
Department: Orthopedic Group GeneralPREOPERATIVE DIAGNOSIS: Left distal
radius intraarticular fracture.POSTOPERATIVE DIAGNOSIS: Left distal radius
intraarticular fracture.NAME OF PROCEDURE:1. Open reduction internal
fixation of left distal radius intraarticular fracture.2. Intraoperative use of
fluoroscopy.SURGEON: Dr.XINDICATIONS: The patient is a male with a
comminuted fracture of his distal intraarticular radius. He presents at this time
for open reduction internal fixation.DESCRIPTION OF PROCEDURE: The patient
was taken to the operating room where he was first given an axillary block
anesthetic. Next, his forearm, arm and hand were prepped and draped in normal
sterile circumferential fashion. Next, his arm was elevated, exsanguinated with
an Esmarch bandage, tourniquet inflated to 250 mmHg. Next, an incision was
made over his volar radial forearm with a 15 blade. Next, pickups and tenotomy
scissors were used to dissect through the subcutaneous tissue down to the
antebrachial fascia. Next, the antebrachial fascia was opened between the
flexor carpi radialis tendon and the radial artery and its vena comitantes. I then
developed the plane between these 2 structures using the pickups and tenotomy
scissors right down to the volar surface of the radius and the pronator
quadratus. Next, I incised the pronator quadratus and reflected the pronator
quadratus off the volar surface of the radius from proximal to distal and thereby
exposed the fracture. The fracture was comminuted. There were several
fragments: there was a large ulnar piece, there was an interarticular extension
particularly into the DRUJ, there was a dorsal fragment that was out of the place
as well, there were at least 4 or more fragments. In order to reduce this, I had to
flex the wrist and distract it. Once I
CaseID: OPD6954
With Complete Answers
CaseID: OPD6921
Primary Diagnosis: Z41.1
Secondary Diagnosis: N64.81, N63.22, Q83.1, E65, L98.7
CPT: 15830, 19316-50, 19120-LT, 15877 - ANSWER MEDICAL RECORD
OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. Localized
abdominal adiposity2. Left axillary glandular tissue.3. Bilateral breast
ptosis.POSTOPERATIVE DIAGNOSES:1. Localized abdominal adiposity.2. Left
axillary glandular tissue.3. Bilateral breast ptosis.4. Left breast lump upper inner
quadrantOPERATIVE PROCEDURE:1. Bilateral mastopexy.2. Bilateral axillary
and chest wall suction-assisted lipectomy.3. Excision of left breast lump upper
inner quadrant.4. Abdominoplasty with upper abdomen and flank
liposuction.SURGEON:ANESTHESIA: General.COMPLICATIONS:
None.INDICATIONS: Ms. Smith is a female, who presented to clinic with
significant abdominal dermatolipodystrophy, breast ptosis, and redundant 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.
CaseID: OPD6922
Primary Diagnosis: I87.2
Secondary Diagnosis: L97.411, L97.421
CPT: 15120 - ANSWER DATE OF OPERATION: 1/01/20XXPREOPERATIVE
DIAGNOSIS: NONHEALING VENOUS STASIS ULCERS, BILATERAL LOWER
EXTREMITY.PROCEDURES: BILATERAL LOWER EXTREMITY SPLIT-THICKNESS
SKIN GRAFTINGPOSTOPERATIVE DIAGNOSIS: CHRONIC, VENOUS STASIS
ULCERS BILATERAL LOWER EXTREMITY.SURGEON:ANESTHESIA:
,SPINAL.ESTIMATED BLOOD LOSS: MINIMAL.COMPLICATIONS:
NONE.INDICATIONS: The patient is a male with chronic venous insufficiency
and bilateral lower extremity venous stasis ulcers limited to breakdown 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
CaseID: OPD6924
Primary Diagnosis: T84.84XA
CPT: 20680 - ANSWER MEDICAL RECORD
PREOPERATIVE DIAGNOSIS: REMOVAL OF HARDWARE DUE TO PAIN STATUS
POST-OP-KNOWLES PIN (X 3) FIXATION OF RIGHT HIPPROCEDURES:
REMOVAL OF KNOWLES PIN X 3; RIGHT HIP.POSTOPERATIVE DIAGNOSIS:
REMOVAL OF 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 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
CaseID: OPD6929
Primary Diagnosis: S82.301D, S82.302D
E/M Level: 20680-RT, 20694-RT - ANSWER MEDICAL RECORD
SEX: MALE Age: 62DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
RIGHT LOWER END TIBIA STATUS POST ORIF WITH RETAINED SYNDESMOTIC
SCREW, LEFT LOWER END TIBIA STATUS POST EXTERNAL FIXATION WITH
RETAINED HARDWARE.PROCEDURES: RIGHT LOWER END TIBIA REMOVAL OF
SYNDESMOTIC SCREWS, LEFT LOWER END TIBIA REMOVAL OF EXTERNAL
FIXATOR.POSTOPERATIVE DIAGNOSIS: RIGHT LOWER END TIBIA STATUS
POST ORIF WITH RETAINED SYNDESMOTIC SCREW AND LEFT LOWER END
TIBIA STATUS POST EXTERNAL FIXATION WITH RETAINED
HARDWARE.SURGEON: Stephanie Andrews MDANESTHESIA: LOCAL WITH IV
SEDATION. (MAC)ESTIMATE BLOOD LOSS: 20 CC.TOURNIQUET TIME:
NONE.ANTIBIOTICS: 1 GM OF ANCEF.COMPLICATIONS: NONE.INDICATIONS:
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 were removed and sterilely dressed in this area.The
patient was then taken to the recovery room in stable condition.Electronically
signed by 1/1/20XX
CaseID: OPD6937
Primary Diagnosis: M75.121
Secondary Diagnosis: S46.211A
CPT: 23410-RT and 29824-RT - ANSWER Age: 71SEX: FEMALEDate of Service:
1/1/20XXService Department: Orthopedic Group GeneralProvider:OPERATIVE
NOTE:OPERATIVE DIAGNOSIS: Right shoulder partial biceps tendon tearing
with full-thickness supraspinatus tear 1 cmNAME OF PROCEDURE: Right
shoulder examination under anesthesia, arthroscopy, biceps tendon
debridement, Open rotator cuff repairSURGEON:ANESTHESIA: General with
scalene block.ESTIMATED BLOOD LOSS: Minimal.COMPLICATIONS:
None.DESCRIPTION OF PROCEDURE: With the patient in a beach-chair position
under endotracheal intubation and general anesthesia, the right shoulder was
examined. It had a full range of motion. Ligaments were stable. The right
, shoulder was then prepped and draped free in the usual manner. A posterior
portal was established after insufflating the joint with 50 mL of sterile
saline.Within the shoulder joint we found normal cartilage on both articular
surfaces. The interior recess was clear. We established a portal anteriorly in the
interval above the subscapularis tendon. The subscapularis was intact. There
was obvious partial degeneration and tearing the biceps tendon. We used a
shaver and debrided this back to good stable tissue. Superior labrum was
attached normally. There was a full-thickness tear in the supraspinatus
tendon.We removed the instruments and placed the arthroscope into the
subacromial space. Here we identified the superior surface of the tear and
found its length to be about 1 to 1.5 cm. We established a lateral portal. We
performed bursectomy and debrided the undersurface of the acromion of soft
tissue. We performed an acromioplasty. We then took out the anterior hook of
the acromion and the anterior-inferior half of the acromion as far back as the
posterior edge of the distal clavicle. We then entered the AC joint through the
anterior portal and performed a distal clavicu
CaseID: OPD6942
Primary Diagnosis: S52.572A
CPT: 25609-LT - ANSWER Age 72 Sex: MALEDate of Service: 1/1/20XXService
Department: Orthopedic Group GeneralPREOPERATIVE DIAGNOSIS: Left distal
radius intraarticular fracture.POSTOPERATIVE DIAGNOSIS: Left distal radius
intraarticular fracture.NAME OF PROCEDURE:1. Open reduction internal
fixation of left distal radius intraarticular fracture.2. Intraoperative use of
fluoroscopy.SURGEON: Dr.XINDICATIONS: The patient is a male with a
comminuted fracture of his distal intraarticular radius. He presents at this time
for open reduction internal fixation.DESCRIPTION OF PROCEDURE: The patient
was taken to the operating room where he was first given an axillary block
anesthetic. Next, his forearm, arm and hand were prepped and draped in normal
sterile circumferential fashion. Next, his arm was elevated, exsanguinated with
an Esmarch bandage, tourniquet inflated to 250 mmHg. Next, an incision was
made over his volar radial forearm with a 15 blade. Next, pickups and tenotomy
scissors were used to dissect through the subcutaneous tissue down to the
antebrachial fascia. Next, the antebrachial fascia was opened between the
flexor carpi radialis tendon and the radial artery and its vena comitantes. I then
developed the plane between these 2 structures using the pickups and tenotomy
scissors right down to the volar surface of the radius and the pronator
quadratus. Next, I incised the pronator quadratus and reflected the pronator
quadratus off the volar surface of the radius from proximal to distal and thereby
exposed the fracture. The fracture was comminuted. There were several
fragments: there was a large ulnar piece, there was an interarticular extension
particularly into the DRUJ, there was a dorsal fragment that was out of the place
as well, there were at least 4 or more fragments. In order to reduce this, I had to
flex the wrist and distract it. Once I
CaseID: OPD6954
