Practicode II (101-200) Exam Questions and
Correct Answers
Question 1
CaseID: OPD7180
Primary Diagnosis: S36.438A
CPT: 44602
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSEX: Male AGE: 23DATE OF OPERATION: 01/01/20XXSURGEON:
Dr. Cohen AndrewsPREOPERATIVE DIAGNOSIS: Blunt abdominal trauma with small-
bowel perforation.
POSTOPERATIVE DIAGNOSIS: Blunt abdominal trauma with small-bowel perforation.
PROCEDURE PERFORMED: Exploratory laparotomy and repair of small-bowel
perforation.
ANESTHESIA: General.
SKIN PREP: ChloraPrep.
DRAINS: None.
INDICATIONS: Blunt abdominal trauma with seatbelt injury and abdominal
tenderness with guarding and CT scan suggesting extraluminal gas.
FINDINGS: Mid jejunal perforation. No other significant injuries were identified.
DESCRIPTION OF PROCEDURE: The patient was anesthetized, prepped and draped,
and a vertical midline incision was made. Succus entericus was present and was
suctioned out. The small bowel was followed from the ligament of Treitz to the
ileocecal valve and a single perforation was identified and was closed with a TA60
stapler. The colon was inspected from the peritoneal reflection around to the
cecum. The appendix was normal as well. The stomach and duodenum appeared to
be normal as was the liver and gallbladder. There was no evidence of any
retroperitoneal hemorrhage or hematoma. The abdomen was thoroughly irrigated.
The midline fascia was closed with running 0 PDS suture. Subcutaneous tissues were
irrigated and approximated with 3-0 Vicryl interrupted subcutaneous suture
followed by a running subcuticular 4-0 Vicryl skin closure. Sterile OpSite dressing
was applied. The patient was taken to the recovery room in satisfactory condition
having tolerated the procedure well. Sponge, instrument and needle counts were
reported as correct. Blood loss was minimal.Cohen Andrews, MDElectronically
signed by COHEN ANDREWS, MD 1/1/20XX
Page 1 of 99
,Question 2
CaseID: OPD7332
Primary Diagnosis: M19.012
CPT: 23472-LT
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSEX: MALEAGE: 64DATE: 01/01/20XXPREOPERATIVE DIAGNOSIS:
Primary Osteoarthritis, left shoulder.POSTOPERATIVE DIAGNOSIS: Primary
Osteoarthritis, left shoulder.OPERATION: Left total shoulder arthroplasty.Surgeon:
Francisco Jones, M.D.Anesthesia: General with an LMA following interscalene block
catheter.POSITION: Beach chair.COMPLICATIONS: None.BLOOD LOSS: 100
mL.HISTORY: The patient is a pleasant gentleman with severe primary osteoarthritis
in his left shoulder. It was painful and limited his function. He understood the risks
and benefits of arthroplasty and wanted to proceed.PROCEDURE: He was taken to
the operating room where he was given a general anesthetic after an interscalene
catheter block was placed. He was then put in the beach chair position, and his left
arm and shoulder were prepped and draped in the usual sterile fashion.We made an
incision from the clavicle over the coracoid and then down on the anterolateral
aspect of the arm. We carried it down through the skin and subcutaneous tissues
and we identified the deltopectoral interval and opened it up, retracting the
cephalic vein medially with the pectoralis and the deltoid laterally. The lateral border
of the conjoined tendon was then released, and the conjoined tendon was retracted
medially. The subscapularis was released from the rotator interval down the anterior
neck of the humerus. We released the subscapularis from the coracoid underneath
the labrum and then around inferiorly and along the anterior glenoid neck. We then
put the anterior glenoid neck retractor in place. We released the capsule inferiorly
on the humeral head. There was a huge osteophyte that we removed with a rongeur
and the osteotome. We released the leading edge of the supraspinatus from the
anterior part of the coracoid and released the superior labrum of
Page 2 of 99
,Question 3
CaseID: OPD6995
Primary Diagnosis: K40.90
CPT: 49505
Correct Answer
MEDICAL RECORD
OPERATIVE NOTEAGE: 30SEX: MaleDOS: 1/1/20XXPHYSICIAN: MDPREOPERATIVE
DIAGNOSIS: Symptomatic right inguinal hernia.POSTOPERATIVE DIAGNOSIS: Right
inguinal hernia.OPERATIVE PROCEDURE: Open right inguinal hernia repair with
mesh (PHSL).SURGEON: MDANESTHESIA: General and local.COMPLICATIONS:
None.FINDINGS: He had a medium-sized indirect inguinal hernia sac.INDICATIONS:
The patient is a male, who has had a right inguinal bulge. This is tender and getting
larger. He now presents for repair of this right inguinal hernia.DESCRIPTION: After
informed consent was obtained, the patient was brought back to the operating
room and placed on operating table in supine fashion. After adequate monitors
were placed, the patient underwent general anesthesia. The right groin was prepped
with Hibiclens soap and sterilely draped. A time out was performed, confirming the
patient and the procedure. Local anesthetic was infiltrated into the skin and the
deep tissue. A skin incision was made and the incision was taken down to the
external oblique fascia. The external ring was divided, and the external oblique
fascia was divided in the direction of the fibers. Retractors were placed. I then swept
my finger around the spermatic cord and placed a Penrose drain around this. I then
entered into the spermatic cord through the cremasteric fibers and then grasped an
indirect inguinal hernia sac. This seemed to be scarred in place. This took a little
while, but eventually I was able to dissect it. This was then skeletonized all the way
down to its neck, freeing up the spermatic vessels and the vas deferens. This was
then pushed back into the preperitoneal space and then I created a preperitoneal
space using blunt dissection. An Ethicon PHSL mesh was used. The onlay mesh was
then placed in the preperitoneal space and opened up. The overlay m
Page 3 of 99
, Question 4
CaseID: OPD7485
Primary Diagnosis: I10, E87.6
E/M Level: 99213
Correct Answer
MEDICAL RECORD
OFFICE-ESTABLISHEDSEX: FEMALEAGE: 81DOS: 1/1/20XXCHIEF COMPLAINT:
Medication follow up.HPI: Hypertension. Reported by patient. Quality: taking her
Bystolic and lisinopril and she is having coughing with the lisinopril. She would like
to change. She started having persistent coughing about the time of the lisinopril.
Duration: she was having some persistent abd pain and had multiple testing and
found mass in her stomach and was found to be benign. She is feeling some better;
but does have some occasional still persistent abd pain. About 80% better.
Associated Symptoms: no shortness of breath; no fatigue; no palpitations; no
decline in exercise capacity. Notes: She has kept bp log and running good at
117/70s to 140/80s. Elevated today but she states it goes up every time she is here.
She has Hx of hypokalemia and she is to take her k+ daily. Denies any problems
with it. CMP normal 6 mo. ago. She needs refill. She reports her bp and hair
loss/cough is resolved after stopping the lisinopril. Taking Bystolic and doing
well.PROBLEMS: • Hypopotassemia.• Hypertension controlled.• Alopecia,
unspecified.• Cough. ALLERGIES: Reviewed Allergies: DEMEROL: vomiting. LORTAB:
vomiting.SULFA ANTIBIOTICS: Hives.MEDICATIONS: Reviewed Medications.BYSTOLIC
10 MG TABHYDROCODONE 5 MG TABLANSOPRAZOLE 40 MG CAPMECLIZINE 25
MG TABPOTASSIUM CHLORIDE ER 10 MEQSOCIAL HISTORY: Reviewed Social
History: Smoking Status: never smoker.PAST MEDICAL HISTORY: Reviewed Past
Medical History.FAMILY HISTORY: Reviewed Family History: non-contributory.GYN
HISTORY: Reviewed GYN History.OBSTETRIC HISTORY: Reviewed Obstetric
History.SURGICAL HISTORY: Reviewed Surgical History.• Abdominal Surgery - 20XX -
tumor removed from stomach. VITALS: Height: 4'11.75". Weight: 104 lbs. BMI: 20.5.
BP: 180/90 sitting R arm. Pulse: 60 bpm regular. RR: 12. O2Sat: 98%
Page 4 of 99
Correct Answers
Question 1
CaseID: OPD7180
Primary Diagnosis: S36.438A
CPT: 44602
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSEX: Male AGE: 23DATE OF OPERATION: 01/01/20XXSURGEON:
Dr. Cohen AndrewsPREOPERATIVE DIAGNOSIS: Blunt abdominal trauma with small-
bowel perforation.
POSTOPERATIVE DIAGNOSIS: Blunt abdominal trauma with small-bowel perforation.
PROCEDURE PERFORMED: Exploratory laparotomy and repair of small-bowel
perforation.
ANESTHESIA: General.
SKIN PREP: ChloraPrep.
DRAINS: None.
INDICATIONS: Blunt abdominal trauma with seatbelt injury and abdominal
tenderness with guarding and CT scan suggesting extraluminal gas.
FINDINGS: Mid jejunal perforation. No other significant injuries were identified.
DESCRIPTION OF PROCEDURE: The patient was anesthetized, prepped and draped,
and a vertical midline incision was made. Succus entericus was present and was
suctioned out. The small bowel was followed from the ligament of Treitz to the
ileocecal valve and a single perforation was identified and was closed with a TA60
stapler. The colon was inspected from the peritoneal reflection around to the
cecum. The appendix was normal as well. The stomach and duodenum appeared to
be normal as was the liver and gallbladder. There was no evidence of any
retroperitoneal hemorrhage or hematoma. The abdomen was thoroughly irrigated.
The midline fascia was closed with running 0 PDS suture. Subcutaneous tissues were
irrigated and approximated with 3-0 Vicryl interrupted subcutaneous suture
followed by a running subcuticular 4-0 Vicryl skin closure. Sterile OpSite dressing
was applied. The patient was taken to the recovery room in satisfactory condition
having tolerated the procedure well. Sponge, instrument and needle counts were
reported as correct. Blood loss was minimal.Cohen Andrews, MDElectronically
signed by COHEN ANDREWS, MD 1/1/20XX
Page 1 of 99
,Question 2
CaseID: OPD7332
Primary Diagnosis: M19.012
CPT: 23472-LT
Correct Answer
MEDICAL RECORD
OPERATIVE REPORTSEX: MALEAGE: 64DATE: 01/01/20XXPREOPERATIVE DIAGNOSIS:
Primary Osteoarthritis, left shoulder.POSTOPERATIVE DIAGNOSIS: Primary
Osteoarthritis, left shoulder.OPERATION: Left total shoulder arthroplasty.Surgeon:
Francisco Jones, M.D.Anesthesia: General with an LMA following interscalene block
catheter.POSITION: Beach chair.COMPLICATIONS: None.BLOOD LOSS: 100
mL.HISTORY: The patient is a pleasant gentleman with severe primary osteoarthritis
in his left shoulder. It was painful and limited his function. He understood the risks
and benefits of arthroplasty and wanted to proceed.PROCEDURE: He was taken to
the operating room where he was given a general anesthetic after an interscalene
catheter block was placed. He was then put in the beach chair position, and his left
arm and shoulder were prepped and draped in the usual sterile fashion.We made an
incision from the clavicle over the coracoid and then down on the anterolateral
aspect of the arm. We carried it down through the skin and subcutaneous tissues
and we identified the deltopectoral interval and opened it up, retracting the
cephalic vein medially with the pectoralis and the deltoid laterally. The lateral border
of the conjoined tendon was then released, and the conjoined tendon was retracted
medially. The subscapularis was released from the rotator interval down the anterior
neck of the humerus. We released the subscapularis from the coracoid underneath
the labrum and then around inferiorly and along the anterior glenoid neck. We then
put the anterior glenoid neck retractor in place. We released the capsule inferiorly
on the humeral head. There was a huge osteophyte that we removed with a rongeur
and the osteotome. We released the leading edge of the supraspinatus from the
anterior part of the coracoid and released the superior labrum of
Page 2 of 99
,Question 3
CaseID: OPD6995
Primary Diagnosis: K40.90
CPT: 49505
Correct Answer
MEDICAL RECORD
OPERATIVE NOTEAGE: 30SEX: MaleDOS: 1/1/20XXPHYSICIAN: MDPREOPERATIVE
DIAGNOSIS: Symptomatic right inguinal hernia.POSTOPERATIVE DIAGNOSIS: Right
inguinal hernia.OPERATIVE PROCEDURE: Open right inguinal hernia repair with
mesh (PHSL).SURGEON: MDANESTHESIA: General and local.COMPLICATIONS:
None.FINDINGS: He had a medium-sized indirect inguinal hernia sac.INDICATIONS:
The patient is a male, who has had a right inguinal bulge. This is tender and getting
larger. He now presents for repair of this right inguinal hernia.DESCRIPTION: After
informed consent was obtained, the patient was brought back to the operating
room and placed on operating table in supine fashion. After adequate monitors
were placed, the patient underwent general anesthesia. The right groin was prepped
with Hibiclens soap and sterilely draped. A time out was performed, confirming the
patient and the procedure. Local anesthetic was infiltrated into the skin and the
deep tissue. A skin incision was made and the incision was taken down to the
external oblique fascia. The external ring was divided, and the external oblique
fascia was divided in the direction of the fibers. Retractors were placed. I then swept
my finger around the spermatic cord and placed a Penrose drain around this. I then
entered into the spermatic cord through the cremasteric fibers and then grasped an
indirect inguinal hernia sac. This seemed to be scarred in place. This took a little
while, but eventually I was able to dissect it. This was then skeletonized all the way
down to its neck, freeing up the spermatic vessels and the vas deferens. This was
then pushed back into the preperitoneal space and then I created a preperitoneal
space using blunt dissection. An Ethicon PHSL mesh was used. The onlay mesh was
then placed in the preperitoneal space and opened up. The overlay m
Page 3 of 99
, Question 4
CaseID: OPD7485
Primary Diagnosis: I10, E87.6
E/M Level: 99213
Correct Answer
MEDICAL RECORD
OFFICE-ESTABLISHEDSEX: FEMALEAGE: 81DOS: 1/1/20XXCHIEF COMPLAINT:
Medication follow up.HPI: Hypertension. Reported by patient. Quality: taking her
Bystolic and lisinopril and she is having coughing with the lisinopril. She would like
to change. She started having persistent coughing about the time of the lisinopril.
Duration: she was having some persistent abd pain and had multiple testing and
found mass in her stomach and was found to be benign. She is feeling some better;
but does have some occasional still persistent abd pain. About 80% better.
Associated Symptoms: no shortness of breath; no fatigue; no palpitations; no
decline in exercise capacity. Notes: She has kept bp log and running good at
117/70s to 140/80s. Elevated today but she states it goes up every time she is here.
She has Hx of hypokalemia and she is to take her k+ daily. Denies any problems
with it. CMP normal 6 mo. ago. She needs refill. She reports her bp and hair
loss/cough is resolved after stopping the lisinopril. Taking Bystolic and doing
well.PROBLEMS: • Hypopotassemia.• Hypertension controlled.• Alopecia,
unspecified.• Cough. ALLERGIES: Reviewed Allergies: DEMEROL: vomiting. LORTAB:
vomiting.SULFA ANTIBIOTICS: Hives.MEDICATIONS: Reviewed Medications.BYSTOLIC
10 MG TABHYDROCODONE 5 MG TABLANSOPRAZOLE 40 MG CAPMECLIZINE 25
MG TABPOTASSIUM CHLORIDE ER 10 MEQSOCIAL HISTORY: Reviewed Social
History: Smoking Status: never smoker.PAST MEDICAL HISTORY: Reviewed Past
Medical History.FAMILY HISTORY: Reviewed Family History: non-contributory.GYN
HISTORY: Reviewed GYN History.OBSTETRIC HISTORY: Reviewed Obstetric
History.SURGICAL HISTORY: Reviewed Surgical History.• Abdominal Surgery - 20XX -
tumor removed from stomach. VITALS: Height: 4'11.75". Weight: 104 lbs. BMI: 20.5.
BP: 180/90 sitting R arm. Pulse: 60 bpm regular. RR: 12. O2Sat: 98%
Page 4 of 99
