Practice Management

Question 1

Need all of the following to bill for consultation

Answer 1

1. requested by another physician
2. request is documented
3. patient’s visit and consultant’s opinions are documented
4. opinion is communicated back to requesting physician

Question 2

If already billed for fx care (whether reduction was done in clinic or OR), then all services related to tx within…

Answer 2

90 days is considered global fee –> cannot bill.

Exception: application of splint or cast during global period is billed separately

Question 3

Modifier 25

Answer 3

significant, separately identifiable evaluation and management service by same physician on same day of procedure or other service

Question 4

Modifier 58

Answer 4

appended to 2nd procedure (staged or related procedure) during global period

Question 5

Physician Payments Sunshine Act

Answer 5

must report payments of > $10

Question 6

4 legal elements of medical negligence

Answer 6

1. duty
2. breach of duty
3. causation
4. damages

Question 7

Worker’s comp case can be settled once…

Answer 7

patient has reached maximum medical improvement.

Question 8

Stark Law

Answer 8

prohibits any provider from referring medicare or medicaid patients to a facility in which the provider has a financial relationship with

Question 9

A formal written complaint from a patient requires…

Answer 9

a formal written response from provider.

Question 10

What is a physician’s obligations regarding another physician’s error?

Answer 10

ethically but NOT lawfully obligated to inform patient

Question 11

The federal trade commission prohibits…

Answer 11

false advertising

Question 12

IMN. with stainless steel is associated with…

Answer 12

increased risk for adverse events (nonunion, revision, fx of implant) because stainless steel causes more autodynamization (screw breakage).

Question 13

What is the actual lifetime IPV among female patients and perceived IPV prevalence by surgeons?

Answer 13

40% and 10%

Question 14

Predictor of IPV

Answer 14

repeated ED visits

Question 15

Timed up and go test predicts…

Answer 15

functional outcome (need for walking aid) after hip hemi.

Question 16

For occult hip fx, if CT is neg and unable to obtain MRI, then obtain…

Answer 16

bone scan 72 hrs after initial injury.

Question 17

How to reverse bupivicaine-related cardiac arrest (asystole from injecting bupivicaine into femoral vein)

Answer 17

lipid (20%) fat emulsion

Question 18

Sheathed tendons receive blood supply from…

Answer 18

vincula.

Question 19

Tib ant rupture - treat with…

Answer 19

primary tendon repair and possible graft augmentation with EHL.

Also consider gastroc recession if there is contracture bc it can compromise repair.

Question 20

Scapular injury is most commonly associated with concomitant…

Answer 20

chest injury.

Question 21

Hip fracture mortality…

Answer 21

in hospital 6%
1 yr 30%

**better if operated on within 48 hours

Question 22

Outpatient UE surgery should only go home with…

Answer 22

10 narcotic pills.

Question 23

Compared to freeze-dried allograft, frozen allograft has…

Answer 23

greater torsional and bending strength.

Question 24

What allograft has the highest immunogenicity?

Answer 24

fresh

Question 25

What type of nerves are at bone-tendon junction?

Answer 25

free nerve endings --> nociception

Question 26

What metal has highest rate of bacterial adherence?

Answer 26

titanium

Question 27

adductor canal block blocks...

Answer 27

saphenous sensory but not femoral motor nerve.

Question 28

Best predictor of premature physeal closure in pediatric distal tibia fx

Answer 28

physeal gap > 3 mm

Question 29

Strongest risk factor for patellar tendonitis

Answer 29

hamstring/quad inflexibility

Question 30

osteoblasts regulate hematopoietic cells and immune response via...

Answer 30

PTH-Jagged1-Notch pathway.

Question 31

PTH induces Jagged1 on...

Answer 31

osteoblasts which stimulates notch receptors on hematopoietic stem cells leading to cell proliferation.

Question 32

ECD tendon laceration, after primary repair use...

Answer 32

a yoke splint (relative motion splint) that holds the MCP in slight extension but allows AROM of PIP and DIP.

Question 33

Tx of chronic SPN pain

Answer 33

neurotomy with transposition into bone

Question 34

During fx healing, MMP 13 acts to...

Answer 34

degrade cartilaginous ECM.

Question 35

Tooth avulsion

Answer 35

rinse in water or saline and place in milk, saliva, or sterile saline

Question 36

Pregnant patient, place in...

Answer 36

left lateral decubitus to minimize positional hypotension due to aortocaval compression.

Question 37

Malignant hyperthermia genetics

Answer 37

AD

Question 38

Hypersensitvity to implants is type...

Answer 38

IV (delayed, T-cell mediated)

Question 39

Osteopoikilosis

Answer 39

AD inheritance hundreds of bone islands usually around joints benign usually asymptomatic --> observe

Question 40

After flexi nailing of femur or tibia, often need...

Answer 40

supplemental immobilization.

Question 41

D-zone test

Answer 41

determine whether S aureus infxn that is resistant to erythromycin is also resistant to clindamycin (inducible resistance).

Question 42

AVN of the talus that requires TTC is best approached via....

Answer 42

lateral transfibular approach which allows removal of the talus, preparation of the tibiotalar and subtalar joints, and bone grafting.

Question 43

Motor evoked potential

Answer 43

stimulation of the motor cortex to the corticospinal tract --> spinal cord interneurons --> anterior horn cells --> peripheral nerve --> skeletal muscle in an efferent direction.

Question 44

Sensory evoked potential

Answer 44

afferent direction; signal initiation in UE and LE --> transcranial recording of somatosensory cortex

Question 45

Groin flap has risk to...

Answer 45

LFCN.

Question 46

Treatment of osteoporosis resistant to long term bisphosphonates

Answer 46

add teriparatide (anabolic)

Question 47

Most doctors interrupt patients within...

Answer 47

23 seconds.

Question 48

Does hypothermia improve otucomes after SCI?

Answer 48

no

Question 49

Pressure =

Answer 49

force/area

Question 50

Contact pressure is decreased by...

Answer 50

decreasing joint reactive forces and increasing contact area.

Question 51

PROMIS

Answer 51

computer adaptive test that minimizes floor and ceiling effects

Question 52

For tibial shaft fractures, suprapatellar nailing improves...

Answer 52

alignment compared to infrapatellar nailing.

Question 53

Process improvement

Answer 53

retrospective review of cases for quality improvement (not considered research)

Question 54

Tx of non-op 5th MC fx

Answer 54

one visit to evaluate and manage w/ taping or splint and optional follow-up

Question 55

Distal radial physeal injury (gymnast's wrist) involves the...

Answer 55

zone of provisional calcification.

Question 56

Bacteria to consider in fishing or water related injuries

Answer 56

Mycobacterium marinum **incubation of culture at 2 temperatures (35 C and 28-32 C)

Question 57

A front passenger seat airbag should be turned off for....

Answer 57

children < 80 pounds.