Practicode- Practicode V (401-500)
Final Study Guide Exam With 100%
Correct Answers.
CaseID: OPD6928
Primary Diagnosis: S82.62XA
Secondary Diagnosis: S93.492A, Y93.51
CPT: 27829-LT, 27792-LT - Answer MEDICAL RECORD
SEX: MALEAGE: 26DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS: DISPLACED LEFT
ANKLE BIMALLEOLAR EQUIVALENT FRACTURE.PROCEDURES: LEFT ANKLE ORIF, LATERAL
MALLEOLUS.POSTOPERATIVE DIAGNOSIS: LEFT ANKLE DISPLACED FRACTURE OF LATERAL
MALLEOLUS OF LEFT FIBULA WITH DISRUPTION OF SYNDEMOSISSURGEON:ANESTHESIA:
GENERAL, ENDOTRACHEAL TUBE.ESTIMATE BLOOD LOSS: 25 CC.TOURNIQUET TIME:
NONE.ANTIBIOTICS: 1 GM ANCEF PREOP AND 1 GM ANCEF POSTOP.COMPLICATIONS:
NONE.INDICATIONS: The patient is a male who was rollerblading and sustained an injury to the
left ankle, which was bimalleolar equivalent with fracture dislocation. This was closed reduced
in the emergency room but was unstable. Options, risks and benefits were discussed with the
patient and he agreed with the open reduction internal fixation.PROCEDURE: The patient was
brought to the operating room and anesthesia was induced via the endotracheal tube. The left
lower extremity was prepped and draped in sterile fashion.A longitudinal incision was made
over the lateral malleolus and taken down through the subcutaneous tissue to the fracture site
which was subperiosteally dissected, irrigated out and curetted. Anatomic reduction was
performed and held with a clamp. A 3.5 drill was then used to create a gliding hole in the
proximal fragment and then a 2.5 drill to the drill distal. This measured and interfragmentary
screw was placed.A 6-hole one-third tubular plate from Smith & Nephew was then placed along
the lateral cortex and the proximal three holes were filled with cortical screws. The syndesmosis
was viewed, and disruption and we elected to put in two syndesmotic screws which was done
by holding the syndesmosis reduced in a neutral.This was done with 3 cortex technique using
3.5 cortical screws and then another cortical screw was placed distally. The interfragme
CaseID: OPD6943
Primary Diagnosis: S62.317A
CPT: 26608 - Answer MEDICAL RECORD
Age: 16 Sex: FemaleDate of Service: 1/1/20XXService Department: Orthopedic Group
GeneralPREOPERATIVE DIAGNOSIS: Left fifth metacarpal base fracture.POSTOPERATIVE
DIAGNOSIS: Left fifth metacarpal base fracture.NAME OF PROCEDURE:1. Closed reduction pin
fixation of the left fifth metacarpal base fracture.2. Intraoperative use of fluoroscopy.SURGEON:
Dr. MDINDICATIONS: The patient is a female who presents with a displaced left fifth base
metacarpal fracture.DESCRIPTION OF PROCEDURE: The patient was taken to the operating room
where she was first given axillary block anesthesia. Next her forearm and hand were prepped
and draped in the normal sterile circumferential fashion. Next her arm was exsanguinated,
tourniquet inflated 250 mmHg. Next, I manipulated the fracture and was able to get satisfactory
,reduction. I then placed one 0.62 K-wire across the fracture site through the joint. I used the
image intensifier to assess the reduction, and placement of this wire which were both deemed
to be quite good. At that point I bent and cut the wire, irrigated the pin site, released tourniquet
for a total tourniquet time of 6 minutes. The patient was then placed in dressing and ulnar
gutter splint. She tolerated the procedure well, and was sent to the discharge area in stable
condition.Electronically signed by 1/1/20XX
CaseID: OPD6944
Primary Diagnosis: M19.011
CPT: 23470-RT - Answer MEDICAL RECORD
Age: 60Sex: FEMALEDate of Service: 1/1/20XXService Department: Orthopedic Group
GeneralPREOPERATIVE DIAGNOSIS: (Degenerative) primary osteoarthritis of right
shoulder.POSTOPERATIVE DIAGNOSIS: Same.NAME OF PROCEDURE: Arthroplasty, glenohumeral
joint; hemiarthroplastySURGEON:DESCRIPTION OF PROCEDURE: The patient was taken to the
Operating Room and after satisfactory general anesthesia, her right shoulder was thoroughly
scrubbed, prepped and draped in the usual sterile manner. The shoulder was incised
longitudinally at the deltopectoral interval, starting just distal and anterior to the distal clavicle
and lateral to the coracoid process. The incision was carefully carried down through
subcutaneous tissue. The deltopectoral interval was identified and the deltoid was retracted
laterally and the pectoralis medially. The Hawkins-Bell retractor was then inserted and the
deltoid reflected laterally and the short head of the biceps medially. The pectoral fascia was
incised. The scapularis was incised at it's insertion on the proximal humerus and reflected
medially. The shoulder was then dislocated anteriorly. The Biomet guide was then inserted and
the humeral head resected at 45 degrees of retroversion angle. Then using the Biomet reamers,
the patient's shoulder was reamed at a size 9. The broach was then inserted. The glenoid was
inspected and was quite smooth. There was no glenoid wear. Therefore, this was left alone. The
punch was used to create the keel and the final prosthesis selected with appropriate matching
humeral head. This was impacted into the humerus. The head was then impacted on the Morse
taper of the stem and shoulder reduced. The patient had excellent range of motion and stability.
The insertion site for the subscapularis had been prepared prior to the insertion of the
prosthesis, by placing dr
CaseID: OPD6946
Primary Diagnosis: M17.11
Secondary Diagnosis: M21.061
CPT: 27447-RT - Answer MEDICAL RECORD
SEX: Female AGE: 70DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:1. ADVANCED
DEGENERATIVE JOINT - RIGHT KNEE2. VALGUS DEFORMITYPROCEDURES: RIGHT TOTAL KNEE
ARTHROPLASTYPOSTOPERATIVE DIAGNOSIS: ADVANCED PRIMARY DEGENERATIVE JOINT-RIGHT
KNEE; VALGUS DEFORMITYSURGEON: Dr. MDANESTHESIA:
GENERAL.ANESTHESIOLOGIST:PROCEDURE: After adequate induction with general anesthesia
and the patient in the supine position, a pneumatic tourniquet was applied 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 knee 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 was removed. The Alvarado
,apparatus was applied to the right leg with Coban.A linear incision was made along the anterior
aspect of the right knee extending from the distal quadriceps, over the mid patella and
terminating at the tibial tubercle. The incision was brought down through subcutaneous tissue
and undermined medially. A medial capsular peripatellar incision was made extending from the
proximal quadriceps raphe and ending at the tibial tubercle. The patella was mobilized laterally
and the infrapatellar fat pad was excised. The anteromedial and anterolateral capsules of the
proximal tibia were elevated. The knee was flexed and the patella was everted. Advanced
degenerative changes of the interior of the right knee were observed. The extramedullary rod
was applied to the mechanical axis of the tibia and pin fixed proximally. A proximal tibial cut was
made, having determined the height by 10-mm of the medial tibial plateau. The alignment rod
was removed. A drill hole was made through the distal femur and the intramed
CaseID: OPD6962
Primary Diagnosis: S83.511A, S83.241A
CPT: 29888-RT, 29881-RT - Answer MEDICAL RECORD
OPERATIVE REPORT
SEX: Male AGE: 34
DATE OF OPERATION: 01/01/20XX
PREOPERATIVE DIAGNOSIS: RIGHT KNEE TORN ANTERIOR CRUCIATE LIGAMENT, TORN MEDIAL
MENISCUS.
PROCEDURES: RIGHT KNEE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH ACHILLES
TENDON ALLOGRAFT ALL SOFT TISSUE AND PARTIAL MEDIAL MENISCECTOMY.
POSTOPERATIVE DIAGNOSIS: RIGHT KNEE TORN ANTERIOR CRUCIATE LIGAMENT, TORN MEDIAL
MENISCUS.
SURGEON: M.D.
ANESTHESIA: GENERAL VIA ENDOTRACHEAL TUBE.
ESTIMATE BLOOD LOSS: 10 CC.
TOURNIQUET TIME: 83 MINUTES.
ANTIBIOTICS: ANCEF 1 GM PREOP, ANCEF 1 GM POSTOP.
COMPLICATIONS: NONE.
INDICATIONS: The patient is a male who sustained an injury to the right knee six months ago,
who was complaining of instability and pain. He was found on physical exam to have instability
with the positive Lachman, positive Pivot shift. On MRI, he was found to have torn ACL and a
probable torn medial meniscus. Options, risks and benefits were discussed with the patient. He
agreed with anterior cruciate ligament reconstruction with hamstring if suitable and if not
allograft.
PROCEDURE: The patient was brought to the operating room and anesthesia was induced via
endotracheal tube. Examination under anesthesia confirmed 2+ Lachman in the right knee and
1+ Pivot shift which were negative Lachman and negative Pivot shift on the left knee. The right
lower extremity was prepped and draped in sterile fashion. His bony landmarks were marked
and incisions were infiltrated with the 50:50 mixture of 1% lidocaine with epinephrine and 25%
Marcaine. The incision to harvest the hamstrings, tendons was created first which was centered
, between the tibial tubercle in the posterior aspect of the tibia approximately 4 cm below the
joint line. It was taken down through subcutaneous tissues and sartorius fascia which was
opened between the two tendons. The graci
CaseID: OPD6967
Primary Diagnosis: I82.422
Secondary Diagnosis: B20, R29.818
CPT: 37191 - Answer MEDICAL RECORD
General Surgery ReportAGE: 52 SEX: MALEDATE OF OPERATION: 01/01/20XXPREOPERATIVE
DIAGNOSIS: LEFT ILIAC VEIN THROMBOSIS END-STAGE AIDS DISEASE WITH NEUROLOGIC
DEFICIT.
POSTOPERATIVE DIAGNOSIS: ACUTE LEFT ILIAC VEIN THROMBOSIS END-STAGE AIDS DISEASE
WITH NEUROLOGIC DEFICIT.PROCEDURES: CAVOGRAM AND INSERTION OF FILTER.SURGEON:
M.D.
ANESTHESIA: LOCAL.INDICATIONS: The patient is a 52-year-old gentleman with AIDS significant
instability in his walking, who has left iliac vein thrombosis and the concern was that while on
anticoagulation he may fall down. He lives alone and could develop intracerebral bleeding. So at
this point insertion of a filter was considered appropriate to stop the coagulation
present.PROCEDURE: As soon as consent obtained, both groins were prepped and draped in the
usual fashion. By history the left iliac was thrombosed vein so we accessed the right iliac vein. A
wire was placed all the way up to the vena cava. A 5-French sheath was placed over the wire
contrast through the sheath revealed patent right femoral and right iliac vein. Patent vena cava
less than a 30-mm and both renal veins were identified coming off at about L2 vertebral body.
The left iliac vein was thrombosed.Again the 5-French sheath was removed and dilator from the
kit was used to dilate the puncture and then an IVC filter was inserted and was deployed at the
L2-L3 level below the renal. The filter was deployed without complication. It was a Cook Tulip
filter. The sheath was withdrawn and then through the sheath venogram was obtained and
showed that the filter was in good place opposed against the vena cava. The sheath was
removed. All counts were correct x 2.The patient tolerated the procedure well. I was physically
present for the entire procedure.Electronically signed by: MD 01/01/20XX
CaseID: OPD6978
Primary Diagnosis: I25.10, I10, R07.9, R94.39
Secondary Diagnosis: Z95.820
CPT: 36252, 93458-26, 99152, 99153 x2 - Answer MEDICAL RECORD
PATIENT INFORMATIONEmployer Name: Retired
Financial Class: Managed care.
Cardiac Catheterization / Angiography Report
Diagnostic Report
Study Date: 01/01/20XX
Height: 162.6 cm
BSA: 1.75 m2
Final Study Guide Exam With 100%
Correct Answers.
CaseID: OPD6928
Primary Diagnosis: S82.62XA
Secondary Diagnosis: S93.492A, Y93.51
CPT: 27829-LT, 27792-LT - Answer MEDICAL RECORD
SEX: MALEAGE: 26DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS: DISPLACED LEFT
ANKLE BIMALLEOLAR EQUIVALENT FRACTURE.PROCEDURES: LEFT ANKLE ORIF, LATERAL
MALLEOLUS.POSTOPERATIVE DIAGNOSIS: LEFT ANKLE DISPLACED FRACTURE OF LATERAL
MALLEOLUS OF LEFT FIBULA WITH DISRUPTION OF SYNDEMOSISSURGEON:ANESTHESIA:
GENERAL, ENDOTRACHEAL TUBE.ESTIMATE BLOOD LOSS: 25 CC.TOURNIQUET TIME:
NONE.ANTIBIOTICS: 1 GM ANCEF PREOP AND 1 GM ANCEF POSTOP.COMPLICATIONS:
NONE.INDICATIONS: The patient is a male who was rollerblading and sustained an injury to the
left ankle, which was bimalleolar equivalent with fracture dislocation. This was closed reduced
in the emergency room but was unstable. Options, risks and benefits were discussed with the
patient and he agreed with the open reduction internal fixation.PROCEDURE: The patient was
brought to the operating room and anesthesia was induced via the endotracheal tube. The left
lower extremity was prepped and draped in sterile fashion.A longitudinal incision was made
over the lateral malleolus and taken down through the subcutaneous tissue to the fracture site
which was subperiosteally dissected, irrigated out and curetted. Anatomic reduction was
performed and held with a clamp. A 3.5 drill was then used to create a gliding hole in the
proximal fragment and then a 2.5 drill to the drill distal. This measured and interfragmentary
screw was placed.A 6-hole one-third tubular plate from Smith & Nephew was then placed along
the lateral cortex and the proximal three holes were filled with cortical screws. The syndesmosis
was viewed, and disruption and we elected to put in two syndesmotic screws which was done
by holding the syndesmosis reduced in a neutral.This was done with 3 cortex technique using
3.5 cortical screws and then another cortical screw was placed distally. The interfragme
CaseID: OPD6943
Primary Diagnosis: S62.317A
CPT: 26608 - Answer MEDICAL RECORD
Age: 16 Sex: FemaleDate of Service: 1/1/20XXService Department: Orthopedic Group
GeneralPREOPERATIVE DIAGNOSIS: Left fifth metacarpal base fracture.POSTOPERATIVE
DIAGNOSIS: Left fifth metacarpal base fracture.NAME OF PROCEDURE:1. Closed reduction pin
fixation of the left fifth metacarpal base fracture.2. Intraoperative use of fluoroscopy.SURGEON:
Dr. MDINDICATIONS: The patient is a female who presents with a displaced left fifth base
metacarpal fracture.DESCRIPTION OF PROCEDURE: The patient was taken to the operating room
where she was first given axillary block anesthesia. Next her forearm and hand were prepped
and draped in the normal sterile circumferential fashion. Next her arm was exsanguinated,
tourniquet inflated 250 mmHg. Next, I manipulated the fracture and was able to get satisfactory
,reduction. I then placed one 0.62 K-wire across the fracture site through the joint. I used the
image intensifier to assess the reduction, and placement of this wire which were both deemed
to be quite good. At that point I bent and cut the wire, irrigated the pin site, released tourniquet
for a total tourniquet time of 6 minutes. The patient was then placed in dressing and ulnar
gutter splint. She tolerated the procedure well, and was sent to the discharge area in stable
condition.Electronically signed by 1/1/20XX
CaseID: OPD6944
Primary Diagnosis: M19.011
CPT: 23470-RT - Answer MEDICAL RECORD
Age: 60Sex: FEMALEDate of Service: 1/1/20XXService Department: Orthopedic Group
GeneralPREOPERATIVE DIAGNOSIS: (Degenerative) primary osteoarthritis of right
shoulder.POSTOPERATIVE DIAGNOSIS: Same.NAME OF PROCEDURE: Arthroplasty, glenohumeral
joint; hemiarthroplastySURGEON:DESCRIPTION OF PROCEDURE: The patient was taken to the
Operating Room and after satisfactory general anesthesia, her right shoulder was thoroughly
scrubbed, prepped and draped in the usual sterile manner. The shoulder was incised
longitudinally at the deltopectoral interval, starting just distal and anterior to the distal clavicle
and lateral to the coracoid process. The incision was carefully carried down through
subcutaneous tissue. The deltopectoral interval was identified and the deltoid was retracted
laterally and the pectoralis medially. The Hawkins-Bell retractor was then inserted and the
deltoid reflected laterally and the short head of the biceps medially. The pectoral fascia was
incised. The scapularis was incised at it's insertion on the proximal humerus and reflected
medially. The shoulder was then dislocated anteriorly. The Biomet guide was then inserted and
the humeral head resected at 45 degrees of retroversion angle. Then using the Biomet reamers,
the patient's shoulder was reamed at a size 9. The broach was then inserted. The glenoid was
inspected and was quite smooth. There was no glenoid wear. Therefore, this was left alone. The
punch was used to create the keel and the final prosthesis selected with appropriate matching
humeral head. This was impacted into the humerus. The head was then impacted on the Morse
taper of the stem and shoulder reduced. The patient had excellent range of motion and stability.
The insertion site for the subscapularis had been prepared prior to the insertion of the
prosthesis, by placing dr
CaseID: OPD6946
Primary Diagnosis: M17.11
Secondary Diagnosis: M21.061
CPT: 27447-RT - Answer MEDICAL RECORD
SEX: Female AGE: 70DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:1. ADVANCED
DEGENERATIVE JOINT - RIGHT KNEE2. VALGUS DEFORMITYPROCEDURES: RIGHT TOTAL KNEE
ARTHROPLASTYPOSTOPERATIVE DIAGNOSIS: ADVANCED PRIMARY DEGENERATIVE JOINT-RIGHT
KNEE; VALGUS DEFORMITYSURGEON: Dr. MDANESTHESIA:
GENERAL.ANESTHESIOLOGIST:PROCEDURE: After adequate induction with general anesthesia
and the patient in the supine position, a pneumatic tourniquet was applied 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 knee 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 was removed. The Alvarado
,apparatus was applied to the right leg with Coban.A linear incision was made along the anterior
aspect of the right knee extending from the distal quadriceps, over the mid patella and
terminating at the tibial tubercle. The incision was brought down through subcutaneous tissue
and undermined medially. A medial capsular peripatellar incision was made extending from the
proximal quadriceps raphe and ending at the tibial tubercle. The patella was mobilized laterally
and the infrapatellar fat pad was excised. The anteromedial and anterolateral capsules of the
proximal tibia were elevated. The knee was flexed and the patella was everted. Advanced
degenerative changes of the interior of the right knee were observed. The extramedullary rod
was applied to the mechanical axis of the tibia and pin fixed proximally. A proximal tibial cut was
made, having determined the height by 10-mm of the medial tibial plateau. The alignment rod
was removed. A drill hole was made through the distal femur and the intramed
CaseID: OPD6962
Primary Diagnosis: S83.511A, S83.241A
CPT: 29888-RT, 29881-RT - Answer MEDICAL RECORD
OPERATIVE REPORT
SEX: Male AGE: 34
DATE OF OPERATION: 01/01/20XX
PREOPERATIVE DIAGNOSIS: RIGHT KNEE TORN ANTERIOR CRUCIATE LIGAMENT, TORN MEDIAL
MENISCUS.
PROCEDURES: RIGHT KNEE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH ACHILLES
TENDON ALLOGRAFT ALL SOFT TISSUE AND PARTIAL MEDIAL MENISCECTOMY.
POSTOPERATIVE DIAGNOSIS: RIGHT KNEE TORN ANTERIOR CRUCIATE LIGAMENT, TORN MEDIAL
MENISCUS.
SURGEON: M.D.
ANESTHESIA: GENERAL VIA ENDOTRACHEAL TUBE.
ESTIMATE BLOOD LOSS: 10 CC.
TOURNIQUET TIME: 83 MINUTES.
ANTIBIOTICS: ANCEF 1 GM PREOP, ANCEF 1 GM POSTOP.
COMPLICATIONS: NONE.
INDICATIONS: The patient is a male who sustained an injury to the right knee six months ago,
who was complaining of instability and pain. He was found on physical exam to have instability
with the positive Lachman, positive Pivot shift. On MRI, he was found to have torn ACL and a
probable torn medial meniscus. Options, risks and benefits were discussed with the patient. He
agreed with anterior cruciate ligament reconstruction with hamstring if suitable and if not
allograft.
PROCEDURE: The patient was brought to the operating room and anesthesia was induced via
endotracheal tube. Examination under anesthesia confirmed 2+ Lachman in the right knee and
1+ Pivot shift which were negative Lachman and negative Pivot shift on the left knee. The right
lower extremity was prepped and draped in sterile fashion. His bony landmarks were marked
and incisions were infiltrated with the 50:50 mixture of 1% lidocaine with epinephrine and 25%
Marcaine. The incision to harvest the hamstrings, tendons was created first which was centered
, between the tibial tubercle in the posterior aspect of the tibia approximately 4 cm below the
joint line. It was taken down through subcutaneous tissues and sartorius fascia which was
opened between the two tendons. The graci
CaseID: OPD6967
Primary Diagnosis: I82.422
Secondary Diagnosis: B20, R29.818
CPT: 37191 - Answer MEDICAL RECORD
General Surgery ReportAGE: 52 SEX: MALEDATE OF OPERATION: 01/01/20XXPREOPERATIVE
DIAGNOSIS: LEFT ILIAC VEIN THROMBOSIS END-STAGE AIDS DISEASE WITH NEUROLOGIC
DEFICIT.
POSTOPERATIVE DIAGNOSIS: ACUTE LEFT ILIAC VEIN THROMBOSIS END-STAGE AIDS DISEASE
WITH NEUROLOGIC DEFICIT.PROCEDURES: CAVOGRAM AND INSERTION OF FILTER.SURGEON:
M.D.
ANESTHESIA: LOCAL.INDICATIONS: The patient is a 52-year-old gentleman with AIDS significant
instability in his walking, who has left iliac vein thrombosis and the concern was that while on
anticoagulation he may fall down. He lives alone and could develop intracerebral bleeding. So at
this point insertion of a filter was considered appropriate to stop the coagulation
present.PROCEDURE: As soon as consent obtained, both groins were prepped and draped in the
usual fashion. By history the left iliac was thrombosed vein so we accessed the right iliac vein. A
wire was placed all the way up to the vena cava. A 5-French sheath was placed over the wire
contrast through the sheath revealed patent right femoral and right iliac vein. Patent vena cava
less than a 30-mm and both renal veins were identified coming off at about L2 vertebral body.
The left iliac vein was thrombosed.Again the 5-French sheath was removed and dilator from the
kit was used to dilate the puncture and then an IVC filter was inserted and was deployed at the
L2-L3 level below the renal. The filter was deployed without complication. It was a Cook Tulip
filter. The sheath was withdrawn and then through the sheath venogram was obtained and
showed that the filter was in good place opposed against the vena cava. The sheath was
removed. All counts were correct x 2.The patient tolerated the procedure well. I was physically
present for the entire procedure.Electronically signed by: MD 01/01/20XX
CaseID: OPD6978
Primary Diagnosis: I25.10, I10, R07.9, R94.39
Secondary Diagnosis: Z95.820
CPT: 36252, 93458-26, 99152, 99153 x2 - Answer MEDICAL RECORD
PATIENT INFORMATIONEmployer Name: Retired
Financial Class: Managed care.
Cardiac Catheterization / Angiography Report
Diagnostic Report
Study Date: 01/01/20XX
Height: 162.6 cm
BSA: 1.75 m2
