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Practicode II (Cases 101–
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and Answers
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Practicode II (Cases 101–200) Practice Questions and Answers
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Practicode II (101-200)
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1. CaseID: MEDICAL RECORD
OPD6933 SEX: MALE Age: 38DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
Primary Diagno- COMMINUTED AND DISPLACED FRACTURE OF THE RIGHT TIBIA-MID SHAFT.PRO-
sis: S82.251A CEDURES: LOCKING, INTRAMEDULLARY ROD FIXATION-FRACTURED RIGHT TIBIA;
CPT: 27759-RT STRYKER.1. ROD-375 X 9-MM.2. PROXIMAL SCREW-40 AND 45 X 5-MM.3. DIS-
TAL SCREW-35 X 5-MM.POSTOPERATIVE DIAGNOSIS: COMMINUTED AND DIS-
PLACED FRACTURE OF THE RIGHT TIBIA-MID SHAFT.SURGEON:ANESTHESIA: GEN-
ERAL.ANESTHESIOLOGIST:PROCEDURE: After adequate induction with general
anesthesia and the patient in supine position, a pneumatic tourniquet was ap-
plied to the high right thigh region and not inflated. The right lower extremity
was scrubbed, prepped with Betadine and draped in the usual manner for lower
extremity surgery. An Esmarch tourniquet was applied to the right lower extremity,
which was elevated for a period of two minutes. The pneumatic tourniquet was
inflated to the appropriate level and the Esmarch tourniquet removed.A 2-inch
linear incision was made over the patellar tendon which was split in the midline.
Appropriate retraction was applied and a limited portion of the infrapatellar fat
pad was excised. Under the guidance of the image intensifier, a guidewire was
introduced into the proximal right tibia, followed by application of the proximal
drill. The drill and guide wire were both removed, and a ball-tip guide was
introduced into the proximal tibial fracture fragment and advanced to the fracture
site. Utilizing the manual technique, fracture alignment was achieved, and the
ball-tip guide was advanced into the distal fragment. The guidewire was advanced
to the appropriate level and measured proximally. The appropriate length nail was
selected. An un-reamed device was utilized.The 375-mm x 5-mm unreamed rod
was attached to the guide. The IM rod was advanced through the proximal and
distal fracture
2. CaseID: MEDICAL RECORD
OPD6934 AGE: 82SEX: MALEDate of Service: 1/1/20XXService Department: Orthopedic
Primary Diagno- Group GeneralOPERATIVE NOTE:PREOPERATIVE DIAGNOSIS: Primary Osteoarthri-
sis: M16.11 tis right hip.POSTOPERATIVE DIAGNOSIS: Primary Osteoarthritis right hip.NAME
CPT: 27130-RT OF PROCEDURE: Right AML Pressfit metal-on-metal total hip arthroplasty.SUR-
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Practicode II (101-200)
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GEON:ASSISTANT:DESCRIPTION OF PROCEDURE: The patient was given 1 gm of
vancomycin slowly IV, then a general anesthetic. He was placed in the right lateral
position where his right hip and lower extremity prepped and draped in the usual
sterile fashion. Spacesuits were used.A straight lateral approach was made and
carefully carried down to the fascia lata which was split. Bleeders were cauterized.
A Charnley retractor was placed in the anterior one-half of the gluteus medius and
minimus freeing the greater trochanter. The capsule was opened anterolaterally
in a T-shaped fashion.The hip was dislocated. The neck was sectioned at the
appropriate level for the AML component. The acetabular ligament was excised.
We irrigated with PB solution, removed the anterior lip and then we deepened
and reamed to a 58-outside diameter. The wound was thoroughly irrigated with
PB solution and then the spiked pore coated 58 outside diameter AML cup was
impacted in 15 degrees of anteversion and a hole eliminator was applied. The
wound was irrigated with PB solution and a 40 inside diameter metal-on-metal
component was impacted.Attention was turned to the proximal femur which was
prepared with the reamers and broaches to accept a standard 12. The wound
was again irrigated with PB solution. Then the standard fully coated standard
12 AML component was impacted in the neutral position. There was a proximal
crack medially and we passed on 2-mm cerclage wire to keep this crack from
propagating. Trial reduction with a +5 gave excellent stabilit
3. CaseID: MEDICAL RECORD
OPD6935 AGE: 64 SEX: MALEDate of Service: 1/1/20XXService Department: Orthopedic
Primary Diagno- Group GeneralOPERATIVE NOTE:PREOPERATIVE DIAGNOSIS: Primary Degener-
sis: M17.0 ative arthritis of both knees.POSTOPERATIVE DIAGNOSIS: Primary Degenerative
CPT: 27447-50 arthritis of both knees.NAME OF PROCEDURE: Bilateral total knee arthroplas-
ty.SURGEON:DESCRIPTION OF PROCEDURE: The patient was taken to the oper-
ating room after satisfactory general anesthesia, both knees were thoroughly
scrubbed, prepped and draped in the usual sterile manner. The right knee was
operated on first. The leg was elevated and exsanguinated and the tourniquet
about the upper thigh was inflated to 300 mmHg.The knee was incised longitu-
dinally on the anterior aspect of the knee. The incision was deepened through
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode II (101-200)
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Practicode II (101-200)
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the subcutaneous tissue to the rectus femoris. The interval between the rectus
and the vastus medialis was incised. This incision was carried down the medial
border of the patella and patellar tendon. The patella was everted and dislocated
laterally. The knee was then prepared with the Johnson & Johnson instruments
to hold a size 4 femoral component, a size 4 tibial component with a 10-mm
thick polyethylene insert and a 38-mm patellar prosthesis. After finishing all the
bone cuts, a trial reduction demonstrated excellent range of motion and good
stability. The trial prosthesis was therefore removed, and the tourniquet was
released. Hemostasis was obtained with electro cauterization. The leg was then
re-elevated and exsanguinated and the tourniquet reinflated. The bone surfaces
were thoroughly cleansed with the pulsating lavage system. The cement was
mixed. It was pressurized over the bony surfaces and the respective prostheses
cemented in position. Any excess cement was removed in the hardening time.The
wound was then with irrigated with antibiotic solution. The polyethylene
4. CaseID: MEDICAL RECORD
OPD6945 Age: 82 Sex: MALEDate of Service:1/1/20XXService Department: Orthopedic
Primary Diagno- Group GeneralPREOPERATIVE DIAGNOSIS: Chronic methicillin-resistant Staphy-
sis: T84.53XA lococcus aureus infected right total knee replacement arthroplasty.POSTOPER-
Secondary Diag- ATIVE DIAGNOSIS: Chronic methicillin-resistant Staphylococcus aureus infected
nosis: B95.62 right total knee replacement arthroplasty.NAME OF PROCEDURE: Irrigation, de-
CPT: 29871-RT bridement, washing out with Betadine and drainage of wound.SURGEON: Dr.
MDDESCRIPTION OF PROCEDURE: The patient was taken to the operating room
and after satisfactory general anesthesia his right knee was thoroughly scrubbed,
prepped and draped in the usual manner. The arthroscope was inserted through
the medial superior portal, advanced to the pouch. The arthroscopic shaver was
inserted laterally and Ringer's lactate run through the knee. The shaver was
used to debride the abundant scar tissue. The knee was copiously irrigated with
Ringer's lactate. I then ran Betadine solution through the knee. This was held in
place for approximately 3 minutes and then was washed out copiously using large
volumes of Ringer's lactate and shaving. The wound was irrigated with antibiotic
solution once more. He subsequently had the wounds closed with four staples
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Practicode II (Cases 101–
200) Practice Questions
and Answers
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Practicode II (Cases 101–200) Practice Questions and Answers
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Practicode II (101-200)
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1. CaseID: MEDICAL RECORD
OPD6933 SEX: MALE Age: 38DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
Primary Diagno- COMMINUTED AND DISPLACED FRACTURE OF THE RIGHT TIBIA-MID SHAFT.PRO-
sis: S82.251A CEDURES: LOCKING, INTRAMEDULLARY ROD FIXATION-FRACTURED RIGHT TIBIA;
CPT: 27759-RT STRYKER.1. ROD-375 X 9-MM.2. PROXIMAL SCREW-40 AND 45 X 5-MM.3. DIS-
TAL SCREW-35 X 5-MM.POSTOPERATIVE DIAGNOSIS: COMMINUTED AND DIS-
PLACED FRACTURE OF THE RIGHT TIBIA-MID SHAFT.SURGEON:ANESTHESIA: GEN-
ERAL.ANESTHESIOLOGIST:PROCEDURE: After adequate induction with general
anesthesia and the patient in supine position, a pneumatic tourniquet was ap-
plied to the high right thigh region and not inflated. The right lower extremity
was scrubbed, prepped with Betadine and draped in the usual manner for lower
extremity surgery. An Esmarch tourniquet was applied to the right lower extremity,
which was elevated for a period of two minutes. The pneumatic tourniquet was
inflated to the appropriate level and the Esmarch tourniquet removed.A 2-inch
linear incision was made over the patellar tendon which was split in the midline.
Appropriate retraction was applied and a limited portion of the infrapatellar fat
pad was excised. Under the guidance of the image intensifier, a guidewire was
introduced into the proximal right tibia, followed by application of the proximal
drill. The drill and guide wire were both removed, and a ball-tip guide was
introduced into the proximal tibial fracture fragment and advanced to the fracture
site. Utilizing the manual technique, fracture alignment was achieved, and the
ball-tip guide was advanced into the distal fragment. The guidewire was advanced
to the appropriate level and measured proximally. The appropriate length nail was
selected. An un-reamed device was utilized.The 375-mm x 5-mm unreamed rod
was attached to the guide. The IM rod was advanced through the proximal and
distal fracture
2. CaseID: MEDICAL RECORD
OPD6934 AGE: 82SEX: MALEDate of Service: 1/1/20XXService Department: Orthopedic
Primary Diagno- Group GeneralOPERATIVE NOTE:PREOPERATIVE DIAGNOSIS: Primary Osteoarthri-
sis: M16.11 tis right hip.POSTOPERATIVE DIAGNOSIS: Primary Osteoarthritis right hip.NAME
CPT: 27130-RT OF PROCEDURE: Right AML Pressfit metal-on-metal total hip arthroplasty.SUR-
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode II (101-200)
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Practicode II (101-200)
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GEON:ASSISTANT:DESCRIPTION OF PROCEDURE: The patient was given 1 gm of
vancomycin slowly IV, then a general anesthetic. He was placed in the right lateral
position where his right hip and lower extremity prepped and draped in the usual
sterile fashion. Spacesuits were used.A straight lateral approach was made and
carefully carried down to the fascia lata which was split. Bleeders were cauterized.
A Charnley retractor was placed in the anterior one-half of the gluteus medius and
minimus freeing the greater trochanter. The capsule was opened anterolaterally
in a T-shaped fashion.The hip was dislocated. The neck was sectioned at the
appropriate level for the AML component. The acetabular ligament was excised.
We irrigated with PB solution, removed the anterior lip and then we deepened
and reamed to a 58-outside diameter. The wound was thoroughly irrigated with
PB solution and then the spiked pore coated 58 outside diameter AML cup was
impacted in 15 degrees of anteversion and a hole eliminator was applied. The
wound was irrigated with PB solution and a 40 inside diameter metal-on-metal
component was impacted.Attention was turned to the proximal femur which was
prepared with the reamers and broaches to accept a standard 12. The wound
was again irrigated with PB solution. Then the standard fully coated standard
12 AML component was impacted in the neutral position. There was a proximal
crack medially and we passed on 2-mm cerclage wire to keep this crack from
propagating. Trial reduction with a +5 gave excellent stabilit
3. CaseID: MEDICAL RECORD
OPD6935 AGE: 64 SEX: MALEDate of Service: 1/1/20XXService Department: Orthopedic
Primary Diagno- Group GeneralOPERATIVE NOTE:PREOPERATIVE DIAGNOSIS: Primary Degener-
sis: M17.0 ative arthritis of both knees.POSTOPERATIVE DIAGNOSIS: Primary Degenerative
CPT: 27447-50 arthritis of both knees.NAME OF PROCEDURE: Bilateral total knee arthroplas-
ty.SURGEON:DESCRIPTION OF PROCEDURE: The patient was taken to the oper-
ating room after satisfactory general anesthesia, both knees were thoroughly
scrubbed, prepped and draped in the usual sterile manner. The right knee was
operated on first. The leg was elevated and exsanguinated and the tourniquet
about the upper thigh was inflated to 300 mmHg.The knee was incised longitu-
dinally on the anterior aspect of the knee. The incision was deepened through
https://www.stuvia.com/user/edupac https://www.stuvia.com/user/edupac Practicode II (101-200)
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Practicode II (101-200)
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the subcutaneous tissue to the rectus femoris. The interval between the rectus
and the vastus medialis was incised. This incision was carried down the medial
border of the patella and patellar tendon. The patella was everted and dislocated
laterally. The knee was then prepared with the Johnson & Johnson instruments
to hold a size 4 femoral component, a size 4 tibial component with a 10-mm
thick polyethylene insert and a 38-mm patellar prosthesis. After finishing all the
bone cuts, a trial reduction demonstrated excellent range of motion and good
stability. The trial prosthesis was therefore removed, and the tourniquet was
released. Hemostasis was obtained with electro cauterization. The leg was then
re-elevated and exsanguinated and the tourniquet reinflated. The bone surfaces
were thoroughly cleansed with the pulsating lavage system. The cement was
mixed. It was pressurized over the bony surfaces and the respective prostheses
cemented in position. Any excess cement was removed in the hardening time.The
wound was then with irrigated with antibiotic solution. The polyethylene
4. CaseID: MEDICAL RECORD
OPD6945 Age: 82 Sex: MALEDate of Service:1/1/20XXService Department: Orthopedic
Primary Diagno- Group GeneralPREOPERATIVE DIAGNOSIS: Chronic methicillin-resistant Staphy-
sis: T84.53XA lococcus aureus infected right total knee replacement arthroplasty.POSTOPER-
Secondary Diag- ATIVE DIAGNOSIS: Chronic methicillin-resistant Staphylococcus aureus infected
nosis: B95.62 right total knee replacement arthroplasty.NAME OF PROCEDURE: Irrigation, de-
CPT: 29871-RT bridement, washing out with Betadine and drainage of wound.SURGEON: Dr.
MDDESCRIPTION OF PROCEDURE: The patient was taken to the operating room
and after satisfactory general anesthesia his right knee was thoroughly scrubbed,
prepped and draped in the usual manner. The arthroscope was inserted through
the medial superior portal, advanced to the pouch. The arthroscopic shaver was
inserted laterally and Ringer's lactate run through the knee. The shaver was
used to debride the abundant scar tissue. The knee was copiously irrigated with
Ringer's lactate. I then ran Betadine solution through the knee. This was held in
place for approximately 3 minutes and then was washed out copiously using large
volumes of Ringer's lactate and shaving. The wound was irrigated with antibiotic
solution once more. He subsequently had the wounds closed with four staples
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