2 Coding Classification systems that are currently used in the
US healthcare system Correct 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.
31. Describe how to perform a
Tinnel test Correct Answer Purpose: Assess for compression
neuropathy
Procedure: Percuss the median nerve at the wrist. If the patient
complains of tingling in the digits (POSITIVE TINEL SIGN),
compression at the site of percussion is likely.
5ths disease Correct Answer o 3 Stages:
1. Classic "slapped cheek" rash bright red bilateral cheeks
which spare the forehead, nasal bridge, and perioral area
2. Pink lacy (or reticulated) erythematous macules on all
extremities and trunk spare the palms and sole surfaces.
• The rash may be itchy at this stage.
3. 2-3 weeks of the body rash.
This rash may come and can last for up to 3 weeks.
8. Discuss common characteristics (objective findings) of
patients with lumbar spinal stenosis Correct Answer - Muscle
weakness
,- Impaired proprioception
- Diminished reflexes
- Sensory changes (numbness/tingling)
- Bowel or bladder symptoms
o Sphincter tone decreased
o Don't confuse w/ prostate problems in older men
Accurately document why every procedure code must have a
corresponding diagnosis code Correct 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
Acute appendicitis Correct 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 appendicitis diagnostics Correct Answer Diagnosis is
made clinically and based on history and physical
Elevated WBC
Mild Fever, 99-100
RLQ pain/McBurneys point
,CT abd may help rule out other diagnostic possibilities
ABD ultrasound helps to visualize the inflamed appendix
Acute appendicitis treatment Correct Answer • Appendectomy
• Antibiotic
• Drain abscesses
• Can be removed prophylactically
Acute cholecystitis Correct Answer Inflammation of
gallbladder (GB)
Usually due to gallstone in cystic duct
1. Cystic duct - leaves gall bladder & connects to common bile
duct
Symptoms
Patient will have mid-epigastric pain
Because GB is still squeezing, increasing pressure w/ nowhere
for bile to go
Can lead to nausea/vomting
Stone can get more stuck w/ more squeezing
Bile starts to irritate mucosa
Mucosa starts to produce mucous and inflamm enzymes
Leads to inflammation, distention, pressure build up
Bacterial growth (E. coli, enterococci, bacteroides fragilis,
colstriduim)
As GB "balloons", pain shifts to RUQ, R scapula/shoulder
Bacteria invades in & through GB wall, into peritoneum,
causing peritonitis
Rebound tenderness
Murphy's Sign = Put pressure on right side under ribs. This will
hold GB in place. Have patient take a deep breath. The
, diaphragm will push on the GB & a painful response =
Cholecystitis
Immune response
Neutrophilic leukocytosis
Fever
Acute cholecystitis diagnostics Correct Answer US confirmed
Detects stones
Sonographic murphy sign
Tenderness when sonogram is over gallbladder
GB wall thickening
Sludge
Distention of GB or common bile duct
Cholescintigraphy (HIDA scan)
Radiolabeled marker used to visualize the biliary system
Acute cholecys - ducts are blocked, GB can't be seen
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscope down to pancreas
Dye injected & viewed via fluoro
Magnetic Resonance Cholangiopancreatography (MRCP)
1. Visualizes bili system with MRI
Acute cholecystitis treatment Correct Answer o Supportive
measures
IV
Pain management
ATB
o Surgical Removal
1. Cholecystectomy
1. Laparoscopic
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