Final Exam Flashcards
1
Q
What medical specialty treats diseases of the bones, joints, and muscles?
A
Orthopedics
2
Q
What term refers to the excision of part of the colon?
A
Colectomy
3
Q
What specialist focuses on the diseases and conditions of the foot and ankle?
A
Podiatrist
4
Q
What is the outer layer of the meninges?
A
Dura mater
5
Q
Which system controls the body’s response to internal and external changes?
A
Nervous System
6
Q
Medical treatment can be divided into how many categories?
A
Three
7
Q
Which service is not specific to a medical specialty or one body system or anatomical area?
A
Evaluation and management
8
Q
What statement is true regarding a chief complaint?
A
It is a description of why the patient is presenting for healthcare services.
9
Q
What is the term to determine the source of an illness?
A
Etiology
10
Q
What is a stethoscope used for?
A
To listen to heart and lungs sounds
11
Q
What is palpation?
A
Examination of the body by touch
12
Q
What is the term for creating sounds from tapping on body areas to examine body organs and body cavities?
A
Percussion
13
Q
Which component of a medical record provides a brief history outlining the reasons for the procedure?
A
Indication
14
Q
Which membrane is composed of epithelium?
A
Mucous membranes
15
Q
Which organ system houses white blood cells?
A
Lymphatic system
16
Q
What section is missing from the below documentation?
SUBJECTIVE: The patient is a male being seen for lumbar back pain. The symptoms have been gradual in onset with a severity of 6/10 in pain score. This lumbar back pain is also associated with headaches. Both sides are affected equally. He has had no history of surgery.
OBJECTIVE: On exam, he has diffuse lower lumbar back pain and headache.
PLAN: The patient will need a lumbar AP and lateral plain film for further evaluation. Patient to return to office after obtaining further studies or if symptoms get worse.
A
Assessment
17
Q
What is this type of medical record?
PROCEDURE: CT HEAD WITHOUT CONTRAST
COMPARISON: None.
INDICATIONS: Status-post fall with loss of consciousness.
TECHNIQUE: Noncontrast head CT was performed with axial 5 mm reformations.
FINDINGS: There is a small extra-axial fluid collection on the right side. It overlies the right parietal hemisphere. It is moderately dense. The pattern suggests a small subdural hematoma. It is perhaps 7-8 mm in greatest thickness. There is effacement of the sulcal markings in the right parietal lobe. The ventricles are still in the midline. No signs of any intraaxial hemorrhage. At the base of the brain, the cisterns are still open. On the bone window settings, no definite skull fracture is seen on that side.
CONCLUSION: SMALL RIGHT SIDED SUBDURAL HEMATOMA WITH MILD MASS EFFECT.
A
Radiology report
18
Q
What does this documentation represent? CC: Jaundice.
A
Chief complaint
19
Q
What does the abbreviation ROM stand for in the following documentation and what type of document is this?
Extremities: No clubbing, cyanosis, or edema. Right shoulder is tender. No obvious deformation. Decreased ROM in abduction and extension.
A
A physical exam including the range of motion
20
Q
What does the abbreviation HEENT refer to in the following documentation and what type of document is it?
HEIGHT: 5’4
WEIGHT: 165 pounds
GENERAL: Very pleasant African American female in no acute distress.
HEENT: Negative
LUNGS: Clear to auscultation bilaterally.
CVS: Regular rate and rhythm.
ABDOMEN: Soft, obese, and nontender.
EXTREMITIES: The left foot is wrapped. There is a 1+ common femoral artery pulse with a nonpalpable left common femoral artery pulse.
NEUROLOGIC: Cranial nerves II-XII are grossly intact. Alert and oriented times three.
A
Head, eyes, ears, nose, throat; physical examination
21
Q
What type of documentation is the following and what instrument was required?
Respiration rate is normal. No wheezing. Auscultate good airflow. Lungs are clear bilaterally. CV: Rate is regular. Rhythm is regular. No heart murmur appreciated.
A
A physician exam requiring a stethoscope
22
Q
What information is missing from the below document?
OPERATIVE NOTE
PATIENT:
AGE:47
This is a commercial payer (follow Medicare rules if 65 and older).
DOS: 1/1/20XX
PREOPERATIVE DIAGNOSIS: Family history of colon cancer and multiple colon polyps.
POSTOPERATIVE DIAGNOSIS: Normal colon.
OPERATIVE PROCEDURE: Screening colonoscopy with conscious sedation. Time 19 min.
SURGEON:
FINDINGS: The patient is a male with regular bowel movements and no history of bleeding, and whose family, multiple people, have had multiple colon polyps and colon cancer. His examination shows essentially normal rectum. His prostate does not feel enlarged but is difficult to palpate because of his body habitus. The remainder of his colon is well prepared, and the mucosa appears normal, without evidence of pathology. I would recommend maintaining adequate fiber intake in his diet and repeat colonoscopy at age 50, or sooner if he develops bowel habit change or bleeding.
TECHNIQUE: After explaining the operative procedure, the risks, and potential complications of bleeding and perforation, the patient was given 320 mg of propofol intravenously for conscious sedation by me. His pulse was 70, saturations 97, blood pressure 134/83. A rectal examination was done and then the colonoscope was inserted through the anorectum, rectosigmoid, descending, transverse, and ascending colon to the ileocecal valve. The areas were examined carefully. Then, the air and instrument were gradually withdrawn. The patient tolerated the procedure well.
Analgesia/sedation given. Patient status during sedation was attended constantly and was cooperative. Vitals were stable monitored.
A
Name of the surgeon
23
Q
What type of information is provided in the following documentation?
INDICATION: This patient was seen in the surgery clinic after an admission for his second bout of sigmoid diverticulitis. A CAT scan showed a segment of colon approximately 15 to 20 cm from the anal verge with inflammation and diverticulum. The patient was cooled off on antibiotics, and sent to the clinic where barium enema was done with diverticulum and spasm of sigmoid colon and scattered diverticuli in the area of the previous episode. The patient was seen in the clinic and booked for laparoscopic sigmoid colectomy.
A
Brief history outlining the reasons for the procedure
24
Q
What type of documentation is the following?
Const: Appears obese. No signs of apparent distress present.
Musculo: Walks with a normal gait.
A
A general and musculoskeletal exam
25
What type of documentation is the following?
CV: Denies chest pain and palpitations.
Cardiovascular system review
26
What is the term for the space inside the skull?
Cranial cavity
27
What is the linear strand made of DNA called?
Chromosome
28
What space contains the spinal cord?
Vertebral canal
29
What is the membrane that covers the interior walls of the organs and tubes opening to the outside of the body?
Mucous membranes
30
Which one is NOT a serous membrane?
Synovial
31
What cavities are included in the ventral cavity?
Thoracic, abdominal, and pelvic cavities
32
The term hemic specifically refers to what bodily fluid?
Blood
33
Which type of treatment requires an antibiotic?
Curative
34
What option is true regarding pathophysiology?
It enables us to understand what occurs in a healthy body in normal life and what goes wrong when someone becomes ill.
35
What is another term for skin tags?
Acrochordons
36
What is another term for hives?
Urticaria
37
Which statement is true regarding sarcomas?
Sarcomas grow in connective tissues.
38
Which of the following best describes psoriasis?
A chronic condition characterized by red, dry, elevated lesions covered by silvery scales.
39
Which type of cancer forms in the cells at the base of the epidermis?
Basal cell carcinoma
40
What type of cancer is known as human herpes virus 8?
Kaposi's sarcoma
41
Second-degree burns involve which of the following?
Epidermis and dermis
42
What are the characteristics of eczema?
It makes skin inflamed, scaly, and dark.
43
Which cells make melanin?
Melanocytes
44
What option is true regarding primary skin lesions?
Present at birth or acquired over a person's lifetime.
45
Which is NOT a function of the skin?
Acts as a gland by synthesizing vitamin A
46
What type of dermatitis is a reaction to irritants in the form of itchy rashes?
Allergic contact dermatitis
47
What is commonly known as a boil of the skin?
Furuncle
48
The classification of burns is determined by how many criteria?
Two
49
What is another term for connective tissue in the breast?
Fibrous stroma
50
Which option describes the following documentation?
Postoperative diagnosis: Fibroadenoma
Noncancerous growth found in the breast tissue
51
Which option describes the following documentation?
Procedure: Radical mastectomy
All of the breast tissue, the underarm lymph nodes, and the chest muscle that lies underneath the affected breast are removed.
52
Which option describes the following documentation?
Procedure: After prepping the area, the physician injects the sites with lidocaine 1 percent and .05 percent epinephrine. A 3 mm punch biopsy of the lesion of the left arm and a 4 mm punch biopsy of the lesion of the right arm is taken.
A circular instrument is used to remove a sample of the lesion.
53
Which option describes the following documentation?
Operation performed: Advancement flap
Undermining or freeing up tissue surrounding a defect.
54
Which option describes the following documentation?
Diagnosis: Ecchymosis
Condition in which blood seeps into the skin, causing discoloration
55
Based on the bolded terms in the following documentation, what procedure is performed?
Procedure: Using a #15 blade, a sharp dissection was carried along both medial and lateral ankle ulcers with removal of all necrotic skin and subcutaneous tissues and muscle. The surrounding callus was then sharply removed with a #15 blade. The base of the wounds was scraped with curette with removal of necrotic subcutaneous tissue. There was good amount of bleeding noted bilaterally. The wounds were then copiously irrigated with saline solution after sharp debridement with #15 blade. Hemostasis was achieved with Bovie cautery. After cleansing the wounds with saline solution, the wounds were covered with Xeroform along with 4x4 and Kerlix wrap. The patient tolerated the procedure without any complications. I was present for the entire case. Total debridement 19.5 cm.
Debridement
56
Based on the bolded terms in the following documentation, what procedure is performed?
Procedure: The site of the skin cancer was identified concurrently by both the patient and doctor and marked with a surgical pen; the margins of the excision were delineated with the marking pen. The patient was placed supine on the operating table. The area identified for excision was cleaned, draped and infiltrated with 1% lidocaine with epinephrine 1:100,000. The area of the tumor and margins were marked for excision. Additional soft tissue markings were created to keep the specimen oriented with the excision site. Hemostasis was obtained by electrocautery. A pressure dressing was placed. The tissue was divided into two tissue blocks which were mapped and sent to the technician for frozen sectioning. The surgeon examined the tissue and no microscopic tumor was found persisting in the tumor margins on the tissue blocks. Following surgery, the defect measured 10 x 13 mm to the subcutaneous tissue. Closure will be done by the Dr. Hill from Plastics with a Burow’s graft.
Mohs micrographic surgery
57
Based on the bolded terms in the following documentation, what procedure is performed?
Procedure: The patient was taken to the operating room, placed in the supine position, given a spinal IV sedation anesthetic due to a family history of malignant hyperthermia. After proper anesthesia, he was prepped and draped in the usual sterile fashion. A transverse hockey stick incision was made over the palpable pocket of induration and fluctuance. Incision was carried down to the skin and subcutaneous tissue. A large abscess cavity was encountered. Cultures were taken. Pockets were all broken up for digital manipulation and dissection. Once proper dissection had been carried out, all pockets were uncovered. The wound was irrigated with saline and then packed with Kerlix. The patient tolerated the procedure well. There were no apparent complications. Lap, sponge, and instrument counts were correct.
Incision and drainage
58
Which option describes the following documentation?
Diagnosis: Venous stasis ulcers
Develop in the skin of the lower leg as a result of poor venous circulation
59
Which option describes the following documentation?
Diagnosis: Third-degree burns
Effect on epidermis, dermis, and fat
60
What layer of tissue contains subcutaneous fat?
Hypodermis
61
What statement is TRUE regarding the stratum germinativum?
It lies on top of the dermis and has access to a rich supply of blood.
62
The suffix =rrhea means which of the following?
Excessive discharge
63
What does the root word mamm/o mean?
Breast
64
What percentage is assigned for genitals in the burn rule of nines?
1%
65
Which is NOT an exocrine gland?
Thyroid glands
66
What term describes clogging of hair follicles and oil glands with dirt and oil?
Acne vulgaris
67
What term best describes a mass of hypertrophic scar tissue?
Keloid
68
Which structure is responsible for raising the level of the skin slightly and causing hair to stand up in the cold?
Arrector pili
69
What is the meaning of osteochondritis?
Inflammation of bone and cartilage
70
Which bones are named for their elongated shape?
Long bones
71
What is a transverse fracture?
Breaks in the shaft of a bone across the longitudinal axis
72
What is the thick triangular muscle covering the soulder joint called?
Deltoid
73
What is removed in a hallux valgus correction surgery?
Bunion
74
Which procedure is done to treat a spinal compression fracture?
Vertebroplasty
75
Which procedure is required to first reach the heart in open heart surgery?
Sternotomy
76
Which of the following is commonly caused by arthritis or wearing ill-fitting shoes?
Hammer toe
77
What is the term for cartilage break down or deterioration?
Chondrosis
78
Which joints connect the vertebrae to each other, above and below?
Facet joint
79
Which of the following is NOT another term used for osteoarthritis?
Rheumatoid arthritis
80
A positive FABER test is diagnostic of which disorder?
Sacroiliac dysfunction
81
When a fracture occurs through both the metaphysis and the growth plate, which Salter-Harris classification is it?
Type II
82
Which structure reduces friction between bones?
Bursa
83
Which test is done to check for Achilles tendon rupture?
Thompson test
84
Diagnosis: Comminuted intra-articular distal radial Colles' fracture, left wrist.
Which bone is involved in the fracture?
Radius
85
The patient is a 66-year-old female who sustained a traumatic severe comminuted proximal humerus fracture.
What type of fracture is this?
Bone is broken into more than two fragments
86
Documentation: Utilizing a 61 blade, a stab incision was made, taking care to identify and retract all vital structures. The incision was deepened to the medial band insertion of the fascia. The fascia was then incised and avulsed from the calcaneus.
Which procedure is being performed?
Fasciotomy
87
We connected these two pins with clamps, and then under C-arm control, we reduced the fracture. All pins are now attached to the external fixation. This fracture at both the dorsal and volar comminution and intraarticular fractures was significantly shortened and telescoped.
Based on the documentation in bold, what type of fracture is this?
Comminuted
88
Based on the bolded terms in the following documentation, what procedure is performed?
Using biplane image intensifiers, the skin incision sites were marked. 0.5% Marcaine with epinephrine was injected. Initially on the left side, a Kyphon trocar was passed down to the superior lateral edge of the pedicle, through the pedicle, and into the vertebral body in the usual fashion. The drill was placed into the vertebral body followed by the Kyphon bone tamp. In a similar fashion, the same thing was done on the other side. Balloons were inflated uneventfully. The balloons were then deflated and removed, and the cement (when it was in the doughy state) was injected into the two sides in the usual fashion. This was done carefully and sequentially to make sure there were no cement extrusions, which, after inspection, there were none. There was a good fill to the vertebral body edges, up toward the superior end plate, and across the midline. The bone filling devices were removed, and the trocars were removed. Pressure was applied after which the skin was sutured with 4-0 nylon. Band-Aids were applied and she was taken to recovery in stable condition.
Kyphoplasty
89
Which option is TRUE regarding the below procedure report?
Once the patient was under adequate anesthesia, the reduction maneuver was performed. The elbow was reduced and was stable. Through full range of motion, there was noted to be a slight crepitus on the medial elbow and some mobility was felt in the medial epicondyle. Examination under C-arm imagery revealed a concentric reduction of the elbow, but with mildly unstable medial epicondyle fracture.
Closed reduction of the elbow is being performed
90
Based on the bolded terms in the following documentation, what procedure is performed?
OPERATIVE REPORT: The patient was brought into the operating room and while on the stretcher, general anesthesia was induced and she was endotracheally intubated. She was then transferred to the Jackson table in a prone position where the surgical site was sterilely prepped and draped in usual fashion. Using both lateral and AP fluoroscopy, Jamshidi needles were placed percutaneously through the pedicles of L2 bilaterally into the fractured body of the L2 vertebra. Once position of both needles was confirmed, using fluoroscopy as a guide, liquid methylmethacrylate cement was gradually introduced into the vertebral body. We injected enough methylmethacrylate to bridge the fracture and to include the majority of the trabecular bone and retract the vertebral body as well. We monitored the procedure of injecting in order to ascertain that at no time there was any extravasation of the methylmethacrylate either into prevertebral tissues or into the spinal canal.
Satisfied with the adequate injection of the cement, the Jamshidi needles were removed and the skin incisions were closed by simply reapproximating with a small staple on either side. A sterile dressing was applied in the usual fashion.
The patient was then transferred to the stretcher in a supine position where anesthesia was reversed and she was extubated. Under sedation, she was sleepy but easily arousable. She was following simple commands and she was moving all her extremities without any evidence of weakness as she was preop.
The patient tolerated the procedure well. The patient was transferred to the recovery room in stable condition for further monitoring.
Vertebroplasty
91
I made an incision over the A1 pulley in the distal transverse palmar crease, about an inch in length. This was taken through skin and subcutaneous tissue. The Al pulley was identified and released in its entirety. Care was taken to avoid injury to the neurovascular bundle.
What procedure is being performed?
Trigger finger release
92
Procedure: Examination under C-arm imagery revealed a concentric reduction of the elbow, but with mildly unstable medial epicondyle fracture.
What is C-arm used for?
Fluoroscopy system
93
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 after evacuating all excess fluid. The patient was taken to the recovery room in satisfactory condition.
What surgical approach is taken in this procedure?
Percutaneous endoscopic
94
What does the suffix -ooraphy mean?
Surgical repair with suture
95
What does the root word myel(o) mean?
Bone marrow and spinal cord
96
Hallux rigidus affects what part of the body?
Toe
97
What is the primary function of the bicep muscle?
Flex the elbow and rotate the forearm
98
How are Le Fort II fractures described?
Pyramidal
99
Which procedure is for tendon release of the A1 pulley?
Trigger finger release
100
What is the term for stiffening of a joint?
Ankylosis
101
Arthritis is inflammation of which of the following?
Joint
102
Which of the following types of stroke is most prevalent?
Ischemic strokes
103
Which one of the following is not true for amyotrophic lateral sclerosis?
It impairs a person's intellectual reasoning
104
Which is the most common disability following stroke?
Hemiplegia
105
How many bones make up the skull?
22
106
Where are burr hole surgeries performed?
In the skull
107
Which part of the cerebrum processes visual information?
Occipital lobe
108
Schizophrenia usually occurs in which age?
Average age of onset is late teens to the early 20s for men.
109
What is amyotrophic lateral sclerosis (ALS) also known as?
Lou Gehrig's disease
110
Which age group is most vulnerable and likely to use addictive substances?
Adults between the ages of 18 and 25
111
What procedure is an excision of the vertebral posterior arch or spinal process?
Laminectomy
112
Cerebrospinal fluid (CSF) shunt is a standard treatment for which of the following?
Hydrocephalus
113
How many fontanels are there in an infant's skull?
6
114
In which of the following is abnormal electrical activity in the brain seen?
Epilepsy
115
Which one of the following is not a function of the frontal lobe of the cerebrum?
Visual memory
116
Which one of the following is not a function of the temporal lobes of the cerebrum?
Balance
117
Which of the following is responsible for involuntary movements?
Autonomic nervous system
118
Which one of the following innervates the thumb?
Median nerve
119
One of the diabilities that may follow stroke is hemiparesis. What does hemiparesis mean?
Weakness on one side of the body
120
What controls the neurological functions necessary for survival (breathing, digestion, heart rate, blood pressure)?
Brain stem
121
Which one of the following is a center for coordinating reflexes?
Spinal cord
122
Which of the following is responsible for voluntary movements?
Somatic nervous system
123
Most of the cranial nerves come from which part of the brain?
Brainstem
124
Which one of the following is TRUE for coccygeal nerves?
Three to five coccygeal vertebral segments fuse to form the coccyx with one pair of coccygeal nerves.
125
Based on the bolded terms in the following documentation, what procedure is performed?
A curvilinear incision was made beginning just anterior to the left ear, curving posteriorly, then upward and anteriorly, to and at the hair line just off the midline. The resulting musculocutaneous flap was then reflected anteriorly. Multiple burr holes were then placed and connected using the high-speed drill to create a large free bone flap. This was removed from the immediate operative field. Directly beneath the bone flap was a large well-formed clot which delivered itself from the epidural space. A bleeding point was found in the region of the middle meningeal artery. This was carefully and thoroughly coagulated using bipolar cauterization. A small opening was then made in the dura to ensure that there was not an underlying blood clot. There was not. This opening was primarily closed using 4-0 Nurolon. Additional meticulous hemostasis was then obtained. The bone flap was then replaced and held in place using multiple KLS fixation devices. Skin was then reapproximated using 2-0 Vicryl for the subcutaneous tissues and 5-0 Monocryl for the skin. The patient was then awakened from anesthesia at which time his vital signs were stable, and he was neurologically improved from preoperatively.
Craniotomy
126
Which option describes the following documentation?
Postoperative Diagnosis: Post-hemorrhagic hydrocephalus.
Prior bleeding on the brain resulting in excessive fluid accumulation in the brain
127
In which of the following do the symptoms of psychosis, such as hallucinations or delusions, occur?
Schizophrenia
128
What does the root word encephal/o mean?
Brain
129
Which cells make the myelin sheath?
Schwann cells
130
Which of the following is not a risk factor for stroke?
Anxiety
131
What does subdural hematoma refer to?
Leakage of blood between the dura and arachnoid membranes
132
The common peroneal nerve is a branch of?
Sciatic nerve
133
What is the direction of flow of signals at a synapse?
Axon terminals (synaptic bulbs) of a transmitting neuron and dendrites of a receiving neuron.
134
What is the function of the ventricles of the brain?
Contain CSF that baths and cushions the spinal cord
135
What does the root word gloss/o mean?
Tongue
136
What is the term for the inflammation of the labyrinth?
Labyrinthitis
137
Which of the following is another term for earwax?
Cerumen
138
What is the term for excision of a portion of the temporal bone?
Apicectomy
139
What is the term for ear lobe?
Auricle
140
What is the term for ingesting toxins that damage the inner ear?
Ototoxic hearing loss
141
What option is true regarding sensorineural hearing loss?
It can be caused by a lesion on the cochlea
142
Which structure(s) connect the middle ear to the pharynx?
Eustachian tubes
143
What is the term for inflammation of the cornea?
Keratitis
144
What is the term for perception of pain?
Nociception
145
What causes vertigo?
Increased hydraulic pressure
146
What option is true regarding ageusia?
Lack of taste
147
Where are the vallate papillae located?
On the anterior dorsum of the tongue
148
What is the term for distorted sense of taste?
Dysgeusia
149
What option is true regarding cholesteatoma?
Fatty tumor that forms in the middle ear
150
A 19-year-old male patient presents to the physician’s office with the chief complaint of fever, sore throat, and complete loss of smell and taste. The patient has had a fever throughout the day, and it usually spikes up at night. Physician orders a COVID test for the patient and prescribes antipyretic medicines to lower the fever. Physician also advise the patient to stay in isolation and follow all COVID-related protocols until the test results come back.
Which of the following are the medical terms used to describe two out of the four chief complaints patient presented with?
Ageusia and anosmia
151
Which diagnosis best describes the following documentation?
Tim presents to the ophthalmologist for his routine eye check-up. He denies eye pain, brow pain, or change in vision OU. During examination of his eyes, Tim’s doctor noted the fluid in his eyes was not properly flowing through the trabecular meshwork. The patient was unable to perform the visual field test. The intraocular pressure is increased in both eyes. Patient is prescribed eyedrops for the same and advised to also close eyes after instilling drops for a few minutes.
Open angle glaucoma
152
An 80-year-old female patient presented to the clinic complaining of vertigo. This is often extensive, leading to nausea and jerky eye movements called nystagmus. All other systems are unremarkable. Otologic examination indicates a diagnosis called benign paroxysmal positional vertigo (BPPV). Treatment involves medication to temporarily suppress the vertigo, followed by progressive changes in head orientation that relieve the vertigo more permanently. The treatment may be permanent or may need to be repeated periodically when BPPV reappears.
What is the functional division of the vestibular system affected in this condition?
Semicircular ducts
153
Preoperative Diagnosis: Bilateral profound sensorineural hearing loss.
Postoperative Diagnosis: Bilateral profound sensorineural hearing loss.
Indications: This is a 69-year-old woman who has had progressive hearing loss over the last 10-15 years. Hearing aids are not useful for her. She is a candidate for cochlear implant by FDA standards.
Procedure: The patient was prepped and draped in a sterile fashion after placing facial nerve monitoring probes, which were tested and found to work well. At this time, the previously outlined incision line was incised, and flaps were elevated. A sub temporal pocket was designed in the usual fashion for placement of the device. A standard cortical mastoidectomy was then performed and the fascial recess was opened exposing the area of the round window niche and the device was then placed into the pocket. A 1 mm cochleostomy was made, and the device was inserted into the cochleostomy with an advance off stylet technique. A small piece of temporalis muscle was packed around the cochleostomy, and the wound was closed in layers.
What option describes the procedure performed in the documentation?
Placement of nucleus cochlear implant
154
Parents of a 3-year-old male who has chronic serous otitis media in the right ear have consented to surgery. The patient is placed under general anesthesia and the provider makes an incision in the tympanic membrane. Fluid is suctioned out and a ventilating tube is placed in the ear to provide a drainage route to help reduce infections.
What part of the ear is affected in this scenario?
Middle ear
155
What option describes the procedure performed in the following documentation?
The patient had another examination of the retina and was noted to have a moderate amount of subretinal fluid, so a drainage sclerotomy site was created at approximately the 9:30 o’clock position incising the sclera until the choroid was visible. The choroid was then punctured with a #30-gauge needle. A moderate amount of subretinal fluid was drained from the subretinal space. The eye became relatively soft and 0.35 ml of C3FS gas was injected into the vitreous cavity 3.5 mm posterior to the limbus. The superior temporal and inferior temporal and superior nasal sutures were tied down over the scleral buckle. The 240 band was tightened up and excessive scleral buckling material was removed from the eye.
This is a procedure on a large tear of the retina since scleral buckle is used on large tears
156
A 60-year-old female presents to the clinic complaining of haziness and glare especially at nighttime. She has no other complaints and denies any previous intraocular surgery or eye diseases. Past medical and surgical histories are non-contributory. Visual activity is 20/100 OU best corrected to 20/50 OD and 20/60 OS. Intraocular pressure is 12mmHg OD by applanation. The slit lamp examination is remarkable for nuclear sclerosis. The indirect fundus examination is unremarkable. Potential acuity meter yields a best corrected vision of 20/20 OU.
What is the most likely diagnosis here?
Nuclear cataract
157
Mandy was seen today by her pediatrician as her mom noted that since they got back from the pool two days ago, Mandy has been tugging at her left ear and her mom states the outer ear appears swollen and red.
Dr. Smith diagnosed her with an infection of the external auditory canal and prescribed an antibiotic. What is Mandy’s diagnosis?
Swimmer's ear
158
PREOPERATIVE DIAGNOSIS: Cataract of the left eye
POSTOPERATIVE DIAGNOSIS: Cataract of the left eye
Cataract extraction, foldable posterior chamber intraocular lens of the left eye
PROCEDURE: The patient was brought to the operating room and placed supine on the operating table. An intravenous line was started in the patient's left arm. After appropriate sedation, a left O'Brien and left retrobulbar block were administered, which consisted of a 50/60 mixture of 0.75% Bupivacaine and 2% lidocaine. The Honan balloon was then placed over the operative eye. While the surgeon scrubbed for 5 minutes the patient was prepped and draped in the usual sterile fashion including instillation of 5% Betadine solution to the left cornea, which was irrigated with balanced salt solution and the use an eyelid drape. A limbal incision was performed with the super sharp blade. Provisc was injected into the anterior chamber. A capsulotomy was performed. Hydrodissection was performed with balanced salt solution. The nucleus was removed using the Alcon 20,000 Legacy Series System by divide and conquer technique under Viscoat control. The cortex was removed using the irrigation aspiration mode. The anterior chamber was then filled with Proviso and the AcrySof foldable posterior chamber intraocular lens was then inserted into the capsular bag and rotated into position such that the optic was well centered. The standard postoperative patch and shield were placed and the patient was transferred to the recovery room in stable condition.
What option describes the procedure performed in the above documentation?
Phacoemulsification
159
A mother brings her 2-year-old child to the office. She states that her daughter has been crying for the past two days and she keeps tugging at her right ear. The child was termed, and delivery was without complications. She is up to date on her vaccinations and her growth, height, and weight are as per age. The otologic exam is significant for a bulging, hyperemic tympanic membrane – AS. The tympanic membrane is dull but there was no evidence of rupture.
What diagnosis describes the child’s condition?
Myringitis
160
What are bony overgrowth(s) in the ear canal called?
Exostosis
161
What are the three small bones in the middle ear called?
Ossicles
162
Which cells detect the taste of the food?
Gustatory cells
163
What does the root word myring/o- mean?
Tympanic membrane
164
What does the suffix -esthesia mean?
Feeling or sensation
165
What is the term for lack of sense of smell?
Anosmia
166
What anatomical structure detects the movement and position of the body?
Proprioceptors
167
Which structure is called the hammer bone?
Malleus
168
For what condition can antihistamines can be used?
Vertigo
169
What is the term for noninfectious inflammation of the middle ear?
Serous otitis media
170
What is the term for a distorted sense of smell?
Dysosmia
171
Hypophysis is a part of which endocrine gland?
Pituitary gland
172
What is the location of the thymus gland?
In front of the heart
173
What is the diagnosis when adrenal glands do not produce enough cortisol and aldosterone?
Addison's disease
174
Which of the following is NOT a lymphoid organ?
Kidney
175
Which of the following is NOT a type of tonsil?
Maxillary
176
An excess of cortisol, caused either by an overactive adrenal gland or glucocorticoid medications causes which of the following?
Cushing's Syndrome
177
Which of the following options describes a condition involving overgrowth of bone and soft tissue, especially in the hands, feet, and face, caused by excess growth hormone in adult?
Acromegaly
178
Which of the following hormone over production causes Cushing's syndrome?
Cortisol
179
Which of the following hormones is NOT secreted by adrenal medulla?
Cortisol
180
Which of the following statements is FALSE regarding the pituitary gland?
Posterior pituitary produces growth hormone and luteinizing hormone
181
Which of the following zones is not part of the adrenal cortex?
Zona muscularis
182
Which organ is responsible for T-lymphocyte maturation, enabling them to function against specific pathogens in the immune response?
Thymus
183
The procedure orchiopexy is related to which part of the endocrine system?
Testes
184
What is the test used for diagnosing Addison's disease?
ACTH stimulation test
185
What is the meaning of the term Euthyroid?
Normal thyroid gland activity
186
Which of the following organ atrophies gradually after puberty?
Thymus
187
Preoperative Diagnosis: Papillary thyroid cancer.
Postoperative Diagnosis: Papillary thyroid cancer.
Description of Operative Procedure: The patient was placed in the supine position on the operating table. Once adequate sedation was given, the patient was intubated. A towel was placed behind the patient’s shoulder blades and the neck slightly extended. The neck was prepped and draped in the standard surgical fashion. The superior and inferior flaps were created and using electrocautery, a midline incision was made. The right thyroid appeared nodular. Using blunt dissection and electrocautery, the right thyroid lobe was freed from surrounding tissues and removed. Using the scalpel, two-thirds of the left thyroid lobe and the isthmus were removed, sparing the parathyroids and staying clear of the recurrent laryngeal nerve. Once this was completed, hemostasis was achieved using electrocautery. The patient was then transferred to the recovery room in stable condition.
What option describes the procedure performed in the following documentation?
Thyroidectomy
188
The patient is 21-year-old female presents to the clinic complaining of irregular menstrual cycle, abnormal weight gain and excess body hair. Her physical examination showed body weight of 200lbs. Provider has ordered blood tests to measure the hormone levels and pelvic ultrasound to get a closer look at ovaries. By looking at blood report provider has noted high levels of testosterone. On her ultrasound provider has noted 25 or more cysts on ovaries. In this scenario, what is the possible diagnosis of patient?
Polycystic ovarian syndrome
189
Preoperative diagnosis: Bilateral undescended testes.
Postoperative diagnosis: Undescended testes.
Description of procedure: After informed consent had been obtained previously and reviewed again in the preoperative area, the patient was brought back to the OR, placed supine and general anesthesia was induced without problems. It was somewhat difficult to find an IV site, because of the patient’s body habitus. However, there were no complications with anesthesia. The patient was then appropriately padded and prepped and draped in sterile fashion. 0.25% Marcaine plain was used for bilateral inguinal blocks as well as injected in the sub-q in the inguinal crease. A scalpel was used to make a skin incision following the creases and this was extended down through very generous subcutaneous fat and Scarpa’s fascia to expose the external oblique aponeurosis. The external ring was identified as was the ilioinguinal ligament. The ring was opened for a short distance. The testis was high in the scrotum and was brought through. The testis was pink and viable. A dartos pouch was created and the testis brought through it. The neck of the pouch was tightened with a few interrupted sutures of 3-0 Vicryl. Care was taken to make sure it did not twist the testicle that the testis lay in a normal anatomical position. The scrotal incision was then closed with 5-0 plain gut. The external ring was recreated by approximating the aponeurosis of the external oblique. The underlying ilioinguinal nerve was identified and spared. Scarpa’s was approximated with 3-0 Vicryl and the skin closed with 5-0 Monocryl in a running subcuticular stitch. Steri-strips and dressing were placed over this. Similar procedure was repeated on the left side as well.
What is the operative procedure performed in the note above?
Bilateral Orchiopexy
190
Preoperative Diagnosis: Grade 3 squamous cell carcinoma of penis with inguinal lymphatic metastasis
Postoperative Diagnosis: Grade 3 squamous cell carcinoma of penis with inguinal lymphatic metastasis
Procedure Performed: Laparoscopic bilateral pelvic lymph node excision
Description of Procedure: The patient is placed in supine position with thigh abduction. A 1.5 cm incision was made 2 cm distally of the lower vertex of the femoral triangle. The second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions. The last trocar was placed 2 cm proximally and 6 cm laterally from the first port.
Radical endoscopic bilateral pelvic lymph node excision was performed. The main landmarks-adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly, were well visualized. The retrograde dissection using a harmonic scalpel was started distally near the vertex of the femoral triangle towards the fossa ovalis, where the saphenous vein was identified, clipped, and divided, towards the femoral artery laterally. After the procedure, one can identify the skeletonized femoral vessels and the empty femoral channel, showing that the lymphatic tissue in this region was completely resected.
The surgical specimen was removed through the first port incision. A suction drain was placed to prevent lymphocele and were kept until the drainage reached 50 ml or less in 24 hours. Patient tolerated the procedure well and was transferred to recovery in stable condition.
Which procedure is being performed in the above documentation?
Pelvic lymphadenectomy
191
Evaluation and Management Visit
Chief Complaint: Follow-up on diabetes
Reason for Visit: The patient is a 66-year-old male here today for follow up of his diabetes.
Meds:
GlipiZIDE 10 MG PO tablet
Diagnosis:
Type 2 DM fairly well controlled
Plan:
Reviewed recent labs done, A1c remains below 8, goal to get under 7.5. Discussed improved focus on dietary and exercise. He would prefer to avoid med changes if he can hold A1c steady and/or lower.
Recheck labs in about 3 months.
Depending on the above E/M visit, which statement is true?
Patient has type 2 DM controlled with oral medications.
192
PREOPERATIVE DIAGNOSIS: Left adnexal mass.
POSTOPERATIVE DIAGNOSIS: Left ovarian lesion, malignant
PROCEDURE IN DETAIL: After informed consent was obtained, the patient was taken back to the operative suite, prepped and draped, and placed in the dorsal lithotomy position. A 1 cm skin incision was made in the infraumbilical vault. While tenting up the abdominal wall, the Veress needle was inserted without difficulty and the abdomen was insufflated. This was done using appropriate flow and volume of CO2. The #11 step trocar was then placed without difficulty. The above findings were confirmed. A #12 mm port was then placed approximately 2 cm above the pubic symphysis under direct visualization. Two additional ports were placed, one on the left lateral aspect of the abdominal wall and one on the right lateral aspect of the abdominal wall. Both #12 step ports were done under direct visualization. Using a grasper, the mass was tented up at the inferior pelvic ligament and the LigaSure was placed across this and several bites were taken with good visualization while ligating. The left ovary and fallopian tube was then placed in an Endocatch bag and removed through the suprapubic incision. The skin was extended around this incision and the fascia was extended using the Mayo scissors. The specimen was removed intact in the Endocatch bag through this site. Prior to desufflation of the abdomen, the site where the left adnexa was removed was appeared to be hemostatic. All the port sites were hemostatic as well. The fascia of the suprapubic incision was then repaired using a running #0 Vicryl stitch on a UR6 needle. The skin was then closed with #4-0 undyed Vicryl in a subcuticular fashion. The remaining incisions were also closed with #4-0 undyed Vicryl in a running fashion after all instruments were removed and the abdomen was completely desufflated. Steri-Strips were placed on each of the incisions. The patient tolerated the procedure well. Sponge, lap, and needle count were x2.
What is the procedure performed on ovaries along with left salpingectomy?
Laparoscopic left oophorectomy
193
PREOPERATIVE DIAGNOSIS: Right inferior parathyroid adenoma and primary hyperparathyroidism
POSTOPERATIVE DIAGNOSIS: Right inferior parathyroid adenoma intrathyroidal and primary hyperparathyroidism
DESCRIPTION OF OPERATION: Following adequate general endotracheal anesthesia, the patient’s neck was prepped and draped in sterile fashion. Minimally invasive incision in a natural crease one fingerbreadth above the clavicle eccentric to the right of midline was outlined. Incision then carried out through skin and subcutaneous tissue deep to the platysma. Fascia overlying the anterior border of the sternocleidomastoid muscles incised and dissection carried medial to the SCM, lateral to the strap muscles, medial to the contents of carotid sheath, which were identified and preserved lateral to the visceral fascia carried down to the viscera vertebral angle. The patient had a deep neck a lot of adipose tissue encountered during the dissection. Posterolateral aspect of the right thyroid gland was then identified and soft tissue dissected. No obvious parathyroid adenoma or parathyroid glands were initially identified. Dissection carried deep, during dissection, the right recurrent laryngeal nerve was identified and with care taken to preserve the nerve throughout its course in the neck the dissection continued up along the posterolateral aspect of the thyroid gland to assess the superior parathyroid gland, which was normal. At this point, the skin incision was extended to allow better visualization, Strap muscles were then split in the midline. Thyroid isthmus was identified and there was no obvious parathyroid tissue. A small suspicious ring in the right paratracheal space was sent for frozen section, Histologic evaluation appeared to be lymph node came back as thyroid tissue approximately 1 cm totally independent from the gland. We decided to further resect the nodule and the inferior pole of the thyroid gland this was then carried out, the inferior aspect was freed, the superior aspect of the mass was imbedded in the thyroid and suspicion of an intrathyroidal parathyroid adenoma was entertained, this was dissected free and sent to pathology. Subsequent to this intraoperative parathyroid hormone levels had been sent and came back as baseline of 148, manipulation of 11.33 and 10 minutes postresection of the mass at the inferior aspect of the thyroid at 360 picograms per mL. This suggested that the culprit had been removed. The wound was irrigated. Hemostasis obtained and confirmed. Recurrent laryngeal nerve was intact. Interior aspect of the thyroid gland removed, paratracheal dissection had been completed. After confirming hemostasis, Hemovac drain was placed. The wound was closed in layers with interrupted 3-0 Vicryl.
What procedure is performed by the surgeon in the operative note?
Parathyroidectomy and partial thyroid lobectomy
194
Preoperative Diagnosis:
Chronic hyperplastic rhinosinusitis
Status post-prior polypectomy and sinus surgery
Postoperative Diagnosis:
Intranasal and sinus polyps
Chronic hyperplastic rhinosinusitis
Procedure: The patient was taken to the operating room, placed in the supine position, and general endotracheal anesthesia was obtained adequately. The 30-degree, wide-angle sinus telescope with Endo-scrub and the Stryker Hummer device were used to remove the polyps starting anteriorly and working posteriorly.
Using blunt dissection, the agger nasi cells, ethmoid and sphenoid sinuses were entered, and the contents removed with forceps and suction. sinus endoscopy was performed, and inspissated mucus and debris cleaned out of the sinuses.
The patient was then suctioned free of secretions, with adequate hemostasis noted. He tolerated it well and left the operating room in satisfactory condition.
What option describes the procedure performed in the following documentation?
Endoscopic removal of sinus contents with polypectomy
195
The patient is a 51-year-old female who was admitted to the hospital for treatment of an unknown insect bite which caused her left arm to swell considerably. The physician administered dexamethasone to alleviate the swelling. Her physical examination showed her bodyweight of 250 lbs. She complained of muscle cramps, general fatigue, weakness and hair loss. The physician ordered blood to be taken to run a hormone panel. The lab report noted abnormally low thyroid levels. What is the possible diagnosis of a patient in this visit?
Hypothyroidism
196
Which of the following is an organ of the lymphatic system that lies in the left upper abdomen and helps in destroying RBCs that are no longer effective?
Spleen
197
Thyrotoxicosis is _______
Overactivity of thyroid gland
198
What does the root word insul/o mean?
Pancreatic islets
199
What is the main function of parathyroid glands?
Regulate the body's phosphorous metabolism
200
Which of the following terms indicate excess glucose in the blood?
Hyperglycemia
201
What are the hormones released from islets of Langerhans?
Insulin, Glucagon
202
Glucagon:
accelerates liver glycogenolysis
203
What procedure is a graphical record of the heart's electrical activity?
Electrocardiogram
204
What does LAD stand for?
Left anterior descending
205
What does the root word angi/o mean?
Vessel
206
When does tachycardia occur?
The heart rate, at rest, goes above 100 beats per minute
207
What is the term for the procedure in which transcutaneous sound waves (ultrasonography) are used to produce images of the heart?
Echocardiogram
208
What is a flutter?
Organized and regular irregularity of heartbeat
209
Which is the function of a ventricular assist device (VAD)?
To help pump blood from the left ventricle to the rest of the body
210
Radiographic visualization of blood vessels following introduction of contrast material is called which of the following?
Angiography
211
Which vessel brings oxygen-deficient blood into the right atrium?
Vena cava
212
Which statement is true regarding cardioplegia?
Cardioplegia is stopping the heart to do a surgical procedure
213
Which chamber of the heart is responsible for distributing oxygen rich blood throughout the body?
Left ventricle
214
Which statement is TRUE regarding enhanced external counterpulsation (EECP)?
Stimulate the formation of small branches of blood vessels to create a natural bypass around narrowed or blockded arteries
215
What is fibrillation?
A disorganized, irregular heartbeat which can occur in the atria or the ventricles
216
What is the purpose of using a coronary stent?
To keep an artery open and prevent it from narrowing again
217
Which of the following are the inlet valves of the heart?
Tricuspid and mitral valves
218
Which option describes the following documentation?
Preoperative Diagnosis: Pericardial effusion
Fluid accumulation within the membrane surrounding the heart
219
Procedure: We rewarmed the patient. The territory of the left anterior descending artery was exposed. The RIMA was prepared. The RIMA to left anterior descending coronary artery (LAD) anastomosIs was fashioned using the 7-0 Prolene. Once this was completed, the wings of the mammary were tacked.
Based on the bolded terms in the documentation, what procedure is performed?
Creating a connection of right internal mammary artery to LAD
220
Based on the terms in bold on the following documentation, which procedures were performed?
At this point, we made additional incision in the right proximal upper arm in the projection of the axillary artery. The incision was 4 cm in length and carried down through the skin and subcutaneous tissue fascia until we encountered artery, which was dissected out of surrounding tissue. The proximal portion of axillary artery appeared to be palpable. There were no pulses distal to the skin incision and in the lower portion of the skin incision. Again, it was a very difficult dissection due to significant inflammatory changes and tightly adherent vein to the wall of the artery. Finally, artery was dissected out and taken on two Vessel loops. Similar transverse arteriotomy was made. Small amount of fresh clot was noted in this area. Fogarty catheter was sent in the distal direction; however, we could advance it only for 2 cm and it could not go any further. After that we sent the catheter in proximal direction and after repeated attempts, we removed some whitish type of material, although we were ultimately unsuccessful in removing the entire portion of the well-organized clot. Only a small amount of material was removed from the proximal end. However, after multiple attempts with an inflated balloon passing through the axillary artery, we noted return of the pulsatile flow to this area of the arteriotomy. The wound was irrigated with heparinized solution. Both arteriotomies were repaired with 6-0 Prolene interrupted stitches.
At this point, a decision was made to terminate the procedure. A decision was made to not proceed with a bypass graft due to no evidence of limb-threatening ischemia. Decision was made to treat the patient with anticoagulation and steroids for possible inflammatory arteritis.
Thrombectomy
221
Which option describes the following documentation?
Preoperative Diagnosis: Coronary artery disease
Blockage of the coronary arteries
222
Reason for visit: Patient presents for replacement of a permanent dual chamber pacemaker with another transvenous dual permanent chamber pacemaker.
Which is the function of a permanent pacemaker?
It stimulates cardiac contractions at a certain rate by electrical impulses.
223
PROBLEM LIST: Patient with severe ischemic cardiomyopathy, now 30-35%. Angiographically documented diffuse circumflex vein graft high grade stenosis. Complete occlusion of right coronary artery and vein graft to this vessel.
Which option describes the ischemic cardiomyopathy?
Loss of blood flow and oxygen to the heart and weakened heart muscle
224
Diagnosis: Heart Failure
What option is true regarding the diagnosis mentioned above?
Heart cannot pump enough blood to supply the body's other organs
225
Procedure: The patient was brought to the operating room and, after having the appropriate monitoring devices placed, was intubated and general endotracheal anesthesia was achieved. The patient was prepared and draped in the usual sterile fashion. The chest was entered via a small left posterior thoracotomy. The left anterior chest generator pocket was opened, and the generator explanted. The left lung was collapsed. The pericardium was opened, and two unipolar epicardial leads were placed in the posterolateral left ventricle. Thresholds were checked and found to be adequate. The leads were tunneled subcutaneously to the generator pocket.
Based on the bolded terms in the documentation, what procedure is performed?
Placement of leads for the pacemaker
226
Procedure: We cannulated the ascending aorta. Antegrade and retrograde cardioplegia catheters were placed. The patient was placed on cardiopulmonary bypass with an ACT greater than 400. We examined the targets, and they were deemed to be graftable. At this point, the pulmonary artery was dissected off the aorta. We placed a vent through the right superior pulmonary vein, and then we cross-clamped the ascending aorta and gave cardioplegia in antegrade and retrograde fashion, as well as topical ice. We cooled the patient to 32° C. With an excellent arrest, we exposed the territory of the obtuse marginal. It was opened, and found to be a graftable vessel. A reverse saphenous vein graft to the obtuse marginal was fashioned using 7-0 Prolene. The flow was measured at 90 ml/min. At this point, the territory of the LAD was exposed. It was opened, and a reverse saphenous vein graft to left anterior descending artery anastomosis was fashioned using 7-0 Prolene. Flow was measured at 110 ml/min. Cardioplegia was given down these grafts as well as in a retrograde fashion throughout the case, every 20 minutes.
We performed a hockey-stick incision of the aorta approximately 1.5 cm above the right coronary artery. We used silk sutures to expose the aortic valve. It was a severely calcified, trileaflet aortic valve. The leaflets were cut out. The annulus was debrided. We irrigated the ventricle, then we proceeded to size the valve to a 19 mm valve. Sutures of 2-0 Ethibond were placed in ventriculoaortic fashion circumferentially. They were then passed through the valve. The valve was seated and tied down without difficulty. The right and left coronary ostia appeared to be intact and free of obstruction. There appeared to be no evidence of weakness around the annulus.
Based on the bolded terms in the documentation, what procedure is performed?
Aortic valve replacement
227
What device is being replaced per the bolded documentation?
Procedure: Patient to the cath lab fasting. Left infraclavicular site prepped, draped, and infiltrated with 2% lidocaine. With a #15 scalpel blade a 4 cm horizontal incision was made and S/C dissection to the fibrous pocket surrounding the device. The latter incised and the pacer explanted. The new device was then connected to the appropriate leads. The pocket flushed with an antibiotic solution. The device placed into the pocket and the wound closed with S/C 29 Vicryl and subcuticular 30 Vicryl. Noninvasive testing showed stable lead impedances. Pace was programmed to the original settings. The patient tolerated the procedure uneventfully.
Complete pacemaker replacement
228
What procedure is used to check blood flow through arteries at pulse points in the arms, legs, hands, and feet?
Doppler ultrasound
229
What is the term for the divider between the heart chamber walls?
Septum
230
What is the layer of the wall of the heart below the epicardium called?
Myocardium
231
