Practicode III Exam Questions and Correct
Answers
Question 1
CaseID: OPD6926
Primary Diagnosis: M17.0
CPT: 27447-LT
Correct Answer
MEDICAL RECORD
OPERATION REPORTPREOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT
DISEASE, LEFT KNEE.PROCEDURES: LEFT TOTAL KNEE
ARTHROPLASTY.POSTOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT
DISEASE, LEFT KNEE.SURGEON:ANESTHESIA: GENERAL.ESTIMATED BLOOD LOSS:
MINIMAL.DRAINS: HEMOVAC, LEFT KNEE.IMPLANTS: ZIMMER NEXGEN KNEE
COMPONENTS AS FOLLOWS, NEXGEN LEGACY POSTERIOR STABILIZED LPS-FLEX
FEMORAL COMPONENT SIZE G, NEXGEN STEMMED TIBIAL COMPONENT SIZE 6,
ALL POLYETHYLENE PATELLA COMPONENT OF SIZE 38 9.5-MM THICKNESS, LPS-
FLEX TIBIAL ARTICULAR SURFACE 10-MM HEIGHT AND TAPER STEM PLUG FOR THE
TIBIAL COMPONENT.COMPLICATIONS: NONE.POSTOPERATIVE CONDITION:
STABLE.INDICATIONS: The patient is a male with past medical history of
hypertension, hepatitis-C and history of left ankle/foot triple arthrodesis ten years
ago, has had chronic history of bilateral knee primary DJD for approximately ten
years left greater than right. The patient has severe pain. The patient had no relief
with conservative therapy including anti-inflammatory pain medications, exercises,
rehab, knee braces and steroid injections. The patient was indicated for a total knee
arthroplasty. Surgical option was explained to patient at length. Risks, benefits and
alternatives of surgery were discussed with the patient at length. Risks explained
included but were not limited to infection, bleeding, nerve vessel damage, possible
need for transfusion, knee stiffness, risks of deep venous thrombosis, pulmonary
embolism, risks of pneumonia myocardial function, risk of anesthesia, need for
temporary blood thinners, possible need for prolong rehab after surgery and
possible need for revision of surgery in the future.The patient understood and
accepted all the risks. Surgical consent was signed. Correct surgical site was
marked.PROCEDURE: The patient was brought into th
Page 1 of 100
,Question 2
CaseID: OPD7345
Primary Diagnosis: M16.11
CPT: 27130-RT, 0054T-RT
Correct Answer
MEDICAL RECORD
OPERATIVE REPORT
Orthopedic Group General
SEX: M AGE: 85
Date of Service: 1/1/20XX
PREOPERATIVE DIAGNOSIS: Primary Osteoarthritis of the right hip
POSTOPERATIVE DIAGNOSIS: Primary Osteoarthritis of the right hip
NAME OF PROCEDURE: Right total hip arthroplasty
Computer assisted navigation Fluoroscopy
SURGEON: Brandon Andrews, MD
ANESTHESIA: General
ANESTHESIOLOGIST: Bob Thompson, MD
ESTIMATED BLOOD LOSS: 750 mL
COMPLICATIONS: None
DRAINS: ConstaVac reinfusion drain
IMPLANT: Stryker Accolade II, #6 stem, 58 mm Tritanium cup, 36 mm +5 mm Biolox
head.
INDICATIONS: The patient is an elderly male with a long-standing history of right
hip pain secondary to advanced primary osteoarthritis. He has failed conservative
management. He is a fall risk. He is presenting for right total hip arthroplasty. The
risks, benefits, alternatives, and potential complications were discussed in detail.
Informed consent was obtained.
DESCRIPTION OF PROCEDURE: After general anesthetic, the patient was carefully
positioned on the HANA table. The left iliac crest and right hip and thigh were
prepped and draped in the usual sterile fashion. Intravenous antibiotics were
administered and a time out was given.
The pins for the Stryker navigation were placed in the left iliac crest. The right lateral
distal femoral cortex was dimpled with the 2-mm drill bit through a small stab
incision for leg length assessment.
The right hip was approached through a direct anterior, minimally invasive incision,
creating full-thickness skin flaps. The fascia was incised in the interval between the
tensor fasciae latae and rectus femoris was developed. Retractors were then placed
superiorly and inferiorly along from the femoral neck and the anterior hip capsule
was excised.
The femoral neck was osteomitized at the appropriate height and the femoral head
wa
Page 2 of 100
,Question 3
CaseID: OPD6925
Primary Diagnosis: S52.571A
Secondary Diagnosis: V29.99XA
CPT: 25608-RT
Correct Answer
MEDICAL RECORD
PREOPERATIVE DIAGNOSIS: RIGHT DISTAL RADIUS COMMINUTED
INTRAARTICULAR FRACTURE.PROCEDURES: ORIF RIGHT WRIST.POSTOPERATIVE
DIAGNOSIS: RIGHT DISTAL RADIUS COMMINUTED INTRAARTICULAR
FRACTURE.SURGEON:ANESTHESIA: GENERAL VIA ENDOTRACHEAL TUBE.ESTIMATED
BLOOD LOSS: MINIMAL.TOURNIQUET TIME: 63 MINUTES.ANTIBIOTICS: 1 GM
ANCEF PREOP AND 1 GM ANCEF POSTOP.COMPLICATIONS: NONE.INDICATIONS:
The patient is a right-hand dominant male who sustained a 2-fragment closed right
distal radius comminuted intraarticular fracture due to motorcycle accident. It was
displaced and unable to adequately close reduced. Options, risks and benefits were
discussed with the patient. He agreed with open reduction internal
fixation.PROCEDURE: The patient was brought to the operating room and
anesthesia was induced via endotracheal tube. The right upper extremity was
prepped and draped in sterile fashion. It was exsanguinated, and the tourniquet was
inflated to 250.A longitudinal incision was made over the flexor carpi radialis tendon
and taken down through subcutaneous tissue to the tendon. The sheath was
opened, and the tendon was retracted radialward. The bottom of the sheath was
opened, and the severed tendinous space was exposed. The pronator quadratus
was reflected ulnarward. The fracture was subperiosteally dissected, irrigated out
and curetted. Anatomic reduction was performed, held by hand and an Acumed
plate was placed along the volar surface and adjusted and seemed to be in good
position. The oblong hole was drilled in place and final adjustments were made in
the plate. The distal holes were then drilled, measured and a combination of locking
and unlocking lag screws and plates were placed including the styloid screws.C-arm
imaging was used throughout to ensure good position of the fracture fragments
and hardware. The most proxim
Page 3 of 100
, Question 4
CaseID: OPD7012
Primary Diagnosis: E87.20
Secondary Diagnosis: Z98.890, Z90.49
CPT: 49002-78, 99152, 99153
Correct Answer
MEDICAL RECORD
Emergency Department ReportSex: FAGE: 90DOS: 01/01/20XXPatient arrived by
private vehicle accompanied by family. Historian is Patient.A female who complains
of difficulty breathing and weakness. She also complains of chest pain on and off
for the last 3 weeks. She has been seen here in the past, but did not follow up with
Dr. Kramer as recommended at that time.PHYSICAL ASSESSMENT: Alert. Oriented X
3. Appears in no acute distress. The patient has had new onset of generalized
weakness. Pupils equal, round and reactive to light. No facial asymmetry noted.
Respirations not labored. Chest nontender. Breath sounds within normal limits.
Normal sinus rhythm noted. Abdomen soft and nontender and normal bowel
sounds. Capillary refill less than 2 seconds. Pulses within normal limits. Skin intact.
Mucous membranes are pink. Skin is warm and dry. Normal skin
turgor.MEDICATIONS:ASA 81mg daily.CRESTOR 20MG AT NIGHT.METOPROLOL
12.5MG BID 1/2 TABLET.NTG 0.4 SUB L PRN.Pantoprazole 40mg daily.Plavix 75mg
daily.PAST MEDICAL HX: CAD, Acute MI (July 20XX) and knee problems.SURGERY
HX: Cholecystectomy. Hemorrhoidectomy. Tonsillectomy. (you should have them all
on record. I'm just too tired. I can't even think).SOCIAL HX: Functional assessment
performed: uses cane. The nutritional risk assessment revealed no
deficiencies.ALLERGIES:MSG.PenicillinsLABS AND XRAYS:The X-rays were by the
radiologistLaboratory Tests: Laboratory tests have been ordered, with results
reviewed and considered in the medical decision making process.
0401:YJ:CG00077R: (COLL: 01/01/20XX 09:50) ( MsgRcvd 01/01/20XX 10:34) Final
resultsCraig Kramer Electronically signed by CRAIG KRAMER 01/01/20XXLaboratory
Test ValueHOLD TUBE FOR COAG SEE NOTERAD CHEST AP ONLY PORTABLE
CHEST:1. ViewHISTORY: Difficulty breathing, chest painCompare December 1,
20XXThere are de
Page 4 of 100
Answers
Question 1
CaseID: OPD6926
Primary Diagnosis: M17.0
CPT: 27447-LT
Correct Answer
MEDICAL RECORD
OPERATION REPORTPREOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT
DISEASE, LEFT KNEE.PROCEDURES: LEFT TOTAL KNEE
ARTHROPLASTY.POSTOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT
DISEASE, LEFT KNEE.SURGEON:ANESTHESIA: GENERAL.ESTIMATED BLOOD LOSS:
MINIMAL.DRAINS: HEMOVAC, LEFT KNEE.IMPLANTS: ZIMMER NEXGEN KNEE
COMPONENTS AS FOLLOWS, NEXGEN LEGACY POSTERIOR STABILIZED LPS-FLEX
FEMORAL COMPONENT SIZE G, NEXGEN STEMMED TIBIAL COMPONENT SIZE 6,
ALL POLYETHYLENE PATELLA COMPONENT OF SIZE 38 9.5-MM THICKNESS, LPS-
FLEX TIBIAL ARTICULAR SURFACE 10-MM HEIGHT AND TAPER STEM PLUG FOR THE
TIBIAL COMPONENT.COMPLICATIONS: NONE.POSTOPERATIVE CONDITION:
STABLE.INDICATIONS: The patient is a male with past medical history of
hypertension, hepatitis-C and history of left ankle/foot triple arthrodesis ten years
ago, has had chronic history of bilateral knee primary DJD for approximately ten
years left greater than right. The patient has severe pain. The patient had no relief
with conservative therapy including anti-inflammatory pain medications, exercises,
rehab, knee braces and steroid injections. The patient was indicated for a total knee
arthroplasty. Surgical option was explained to patient at length. Risks, benefits and
alternatives of surgery were discussed with the patient at length. Risks explained
included but were not limited to infection, bleeding, nerve vessel damage, possible
need for transfusion, knee stiffness, risks of deep venous thrombosis, pulmonary
embolism, risks of pneumonia myocardial function, risk of anesthesia, need for
temporary blood thinners, possible need for prolong rehab after surgery and
possible need for revision of surgery in the future.The patient understood and
accepted all the risks. Surgical consent was signed. Correct surgical site was
marked.PROCEDURE: The patient was brought into th
Page 1 of 100
,Question 2
CaseID: OPD7345
Primary Diagnosis: M16.11
CPT: 27130-RT, 0054T-RT
Correct Answer
MEDICAL RECORD
OPERATIVE REPORT
Orthopedic Group General
SEX: M AGE: 85
Date of Service: 1/1/20XX
PREOPERATIVE DIAGNOSIS: Primary Osteoarthritis of the right hip
POSTOPERATIVE DIAGNOSIS: Primary Osteoarthritis of the right hip
NAME OF PROCEDURE: Right total hip arthroplasty
Computer assisted navigation Fluoroscopy
SURGEON: Brandon Andrews, MD
ANESTHESIA: General
ANESTHESIOLOGIST: Bob Thompson, MD
ESTIMATED BLOOD LOSS: 750 mL
COMPLICATIONS: None
DRAINS: ConstaVac reinfusion drain
IMPLANT: Stryker Accolade II, #6 stem, 58 mm Tritanium cup, 36 mm +5 mm Biolox
head.
INDICATIONS: The patient is an elderly male with a long-standing history of right
hip pain secondary to advanced primary osteoarthritis. He has failed conservative
management. He is a fall risk. He is presenting for right total hip arthroplasty. The
risks, benefits, alternatives, and potential complications were discussed in detail.
Informed consent was obtained.
DESCRIPTION OF PROCEDURE: After general anesthetic, the patient was carefully
positioned on the HANA table. The left iliac crest and right hip and thigh were
prepped and draped in the usual sterile fashion. Intravenous antibiotics were
administered and a time out was given.
The pins for the Stryker navigation were placed in the left iliac crest. The right lateral
distal femoral cortex was dimpled with the 2-mm drill bit through a small stab
incision for leg length assessment.
The right hip was approached through a direct anterior, minimally invasive incision,
creating full-thickness skin flaps. The fascia was incised in the interval between the
tensor fasciae latae and rectus femoris was developed. Retractors were then placed
superiorly and inferiorly along from the femoral neck and the anterior hip capsule
was excised.
The femoral neck was osteomitized at the appropriate height and the femoral head
wa
Page 2 of 100
,Question 3
CaseID: OPD6925
Primary Diagnosis: S52.571A
Secondary Diagnosis: V29.99XA
CPT: 25608-RT
Correct Answer
MEDICAL RECORD
PREOPERATIVE DIAGNOSIS: RIGHT DISTAL RADIUS COMMINUTED
INTRAARTICULAR FRACTURE.PROCEDURES: ORIF RIGHT WRIST.POSTOPERATIVE
DIAGNOSIS: RIGHT DISTAL RADIUS COMMINUTED INTRAARTICULAR
FRACTURE.SURGEON:ANESTHESIA: GENERAL VIA ENDOTRACHEAL TUBE.ESTIMATED
BLOOD LOSS: MINIMAL.TOURNIQUET TIME: 63 MINUTES.ANTIBIOTICS: 1 GM
ANCEF PREOP AND 1 GM ANCEF POSTOP.COMPLICATIONS: NONE.INDICATIONS:
The patient is a right-hand dominant male who sustained a 2-fragment closed right
distal radius comminuted intraarticular fracture due to motorcycle accident. It was
displaced and unable to adequately close reduced. Options, risks and benefits were
discussed with the patient. He agreed with open reduction internal
fixation.PROCEDURE: The patient was brought to the operating room and
anesthesia was induced via endotracheal tube. The right upper extremity was
prepped and draped in sterile fashion. It was exsanguinated, and the tourniquet was
inflated to 250.A longitudinal incision was made over the flexor carpi radialis tendon
and taken down through subcutaneous tissue to the tendon. The sheath was
opened, and the tendon was retracted radialward. The bottom of the sheath was
opened, and the severed tendinous space was exposed. The pronator quadratus
was reflected ulnarward. The fracture was subperiosteally dissected, irrigated out
and curetted. Anatomic reduction was performed, held by hand and an Acumed
plate was placed along the volar surface and adjusted and seemed to be in good
position. The oblong hole was drilled in place and final adjustments were made in
the plate. The distal holes were then drilled, measured and a combination of locking
and unlocking lag screws and plates were placed including the styloid screws.C-arm
imaging was used throughout to ensure good position of the fracture fragments
and hardware. The most proxim
Page 3 of 100
, Question 4
CaseID: OPD7012
Primary Diagnosis: E87.20
Secondary Diagnosis: Z98.890, Z90.49
CPT: 49002-78, 99152, 99153
Correct Answer
MEDICAL RECORD
Emergency Department ReportSex: FAGE: 90DOS: 01/01/20XXPatient arrived by
private vehicle accompanied by family. Historian is Patient.A female who complains
of difficulty breathing and weakness. She also complains of chest pain on and off
for the last 3 weeks. She has been seen here in the past, but did not follow up with
Dr. Kramer as recommended at that time.PHYSICAL ASSESSMENT: Alert. Oriented X
3. Appears in no acute distress. The patient has had new onset of generalized
weakness. Pupils equal, round and reactive to light. No facial asymmetry noted.
Respirations not labored. Chest nontender. Breath sounds within normal limits.
Normal sinus rhythm noted. Abdomen soft and nontender and normal bowel
sounds. Capillary refill less than 2 seconds. Pulses within normal limits. Skin intact.
Mucous membranes are pink. Skin is warm and dry. Normal skin
turgor.MEDICATIONS:ASA 81mg daily.CRESTOR 20MG AT NIGHT.METOPROLOL
12.5MG BID 1/2 TABLET.NTG 0.4 SUB L PRN.Pantoprazole 40mg daily.Plavix 75mg
daily.PAST MEDICAL HX: CAD, Acute MI (July 20XX) and knee problems.SURGERY
HX: Cholecystectomy. Hemorrhoidectomy. Tonsillectomy. (you should have them all
on record. I'm just too tired. I can't even think).SOCIAL HX: Functional assessment
performed: uses cane. The nutritional risk assessment revealed no
deficiencies.ALLERGIES:MSG.PenicillinsLABS AND XRAYS:The X-rays were by the
radiologistLaboratory Tests: Laboratory tests have been ordered, with results
reviewed and considered in the medical decision making process.
0401:YJ:CG00077R: (COLL: 01/01/20XX 09:50) ( MsgRcvd 01/01/20XX 10:34) Final
resultsCraig Kramer Electronically signed by CRAIG KRAMER 01/01/20XXLaboratory
Test ValueHOLD TUBE FOR COAG SEE NOTERAD CHEST AP ONLY PORTABLE
CHEST:1. ViewHISTORY: Difficulty breathing, chest painCompare December 1,
20XXThere are de
Page 4 of 100
