NR511 / NR 511 Final Exam Q & A (Latest ):
Differential Diagnosis & Primary Care Practicum (Verified
Answers)
Discuss and identify the components of and HPI - ANSWER OLDCARTS
Onset of CC, Location of CC, Duration of CC, Characteristics of CC, Aggravating factors of CC,
Relieving factors of CC, Treatment of CC, Severity of CC
Medical coding - ANSWER the use of codes to communicate with payers about which
procedures were performed and why
Medical billing - ANSWER the process of submitting and following up on claims made to a
payer in order to receive payment for medical services rendered by a healthcare provider
2 Coding Classification systems that are currently used in the US healthcare system - ANSWER
CPT-recognized universally and provide logical means to be able to track healthcare data, trends,
and outcomes.
ICD-10-shorthand for the patient's diagnosis, which are used to provide the payer information on
the necessity of the visit or procedures performed.
Specificity - ANSWER referring to the ability of the test to correctly detect a specific condition
Sensitivity - ANSWER a test with a few false negatives
Predictive value - ANSWER likelihood the patient actually has a condition and is in part
dependent upon the prevalence of the condition in the population
Elements needed when developing a plan - ANSWER acknowledge the list, negotiate what to
cover, be honest, make a follow up
Components of medical decision making (E&M) coding - ANSWER history, physical, medical
decision making E&M coding requires a medical decision maker
a way of quantifying the complexity of the thinking that is required for the visit-complexity=risk,
data, diagnosis
MDM score gives credit for the excess work involved in management of a more complex patient
Correctly order the E&M office visits based on complexity from least to most complex -
ANSWER 99212-99214
Discuss a minimum of three purposes of the written H&P in relation to the importance of
documentation - ANSWER Important reference document that gives concise information about a
patient's history and exam finding
,Outlines a plan for addressing the issues that prompted the visit. This information should be
presented in a logical fashion that prominently features all data immediately relevant to the
patient's condition
Means of communicating information to all providers who are involved in the care of a particular
patient
Important medical-legal document
Essential in order to accurately code and bill for services
Accurately document why every procedure code must have a corresponding diagnosis code -
ANSWER every procedure code needs a diagnosis to explain the necessity whether the code
represents an actual procedure performed or a nonprocedural encounter like an office visit
Correctly identify a patient as a new patient given the historical information - ANSWER one
who has not received professional services from a provider from the same group practice within
the past 3 year.
Correctly identify a patient as an established patient given the historical information - ANSWER
one who has received professional service from a provider of the office within the past 3 years
Identify the 3 components required in determining an outpatient, office visit E&M code -
ANSWER place of service-inpatient, outpatient
type of service-consultation, office visit, hospital admission
patient status-new-has not received professional service from a provider in the same practice
within the past 3 year
established-has received professional care within 3 year
Explain what a well rounded clinical experience is - ANSWER Includes both children from
birth through young adult visits for well child and acute visits, as well as wellness, acute, and
routine visits of adults
What is the maximum number of hours that can be spent rounding in a facility - ANSWER
<25%
State 9 things that must be documented when inputting data into clinical encounters - ANSWER
Date of service, gender and ethnicity, tests performed or orderd, visit E&M code, chief concerns,
diagnosis, age, procedures, level of involvement
Identify and explain each part of the acronym SNAPPS - ANSWER S-summarize, N-narrow, A-
analyze, P-probe, P-plan-S-self-directing learning
Identify the most common type of pathogen responsible for acute gastroenteritis - ANSWER
viral: norovirus-adults
rotovirus-0-2yrs
,Define Diagnostic Reasoning - ANSWER To solve problems, to promote health, and to screen
for disease or illness. All require a sensitivity to complex stories, to contextual factors, and to
sense of probability and uncertainty.
Can be seen as a kind of critical thinking.
Discuss and identify subjective data - ANSWER reports, complaints of , replies to provider
questions, includes ROS, CC, HPI
Discuss and identify objective data - ANSWER what you can see, hear, or feel as part of a
clinical exam. Also includes laboratory data and test results.
Assessing for prior antibiotic use is a critical part of the history in patients with presenting with
_______________ due to_________________ - ANSWER Diarrhea/CDiff
Irritable bowel syndrome - ANSWER disorder of the bowel function not from anatomic
abnormality--constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small and large bowel
NOT associated with serious medical conditions, IBD, CA
Inflammatory bowel disorder - ANSWER chronic immunologic disease that manifests in
intestinal inflammation
Ulcerative colitis
crohn's disease
Two common inflammatory bowel diseases - ANSWER Ulcerative colitis-mucosal surface of
the colon is inflamed and ultimately results in frability, erosions, and bleeding--most common in
recto-sigmoid colon. Can involve entire colon, pain in RLQ
Crohns disease-inflammation extends deeper into the intestional wall and can involve all or any
layer of the bowel wall and any portion of the GI tract from the mouth to the anus--skipped
lesions, pain in LLQ
Diverticulitis - ANSWER Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free air=perforation; patient
may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
Identify the significance of Barrett's esophagus - ANSWER After repeated exposure to gastric
contents, inflammation of the esophageal mucosa becomes chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic columnar epithelium
containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
, Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
Diagnosis of GERD - ANSWER made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric tx
made by ambulatory esophageal pH monitoring
pH <4 above the lower esophageal sphincter correlates with symptoms = GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
Risks of GERD - ANSWER Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
Treatments of GERD - ANSWER Small frequent meals-main meal in midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of the bed
elevated.
Medications for GERD - ANSWER antacids or OTC H2 (Tagamet, zantac, axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI (pantoprazole 40mg daily,
omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
Differential diagnosis of acute abd pain - ANSWER Acute appendicitis
Acute pancreatitis
Acute cholecystitis
Acute appendicitis - ANSWER Inflammation of the vermiform appendix; due to obstruction or
infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
Acute pancreatitis - ANSWER Sudden inflammation and hemorrhaging of the pancreas due to
destruction by its own digestive enzymes
