Internal Medicine Short Stay Quiz

This was a 59-year-old male admitted through the emergency room for witness seizure by wife. Patient was described as having jerking movements of upper extremities and unresponsive to verbal communications, wife is not sure if the patient hit his head. The patient has a history of chronic diastolic congestive heart failure and hypertension and was recently discharged five days ago from this hospital with an NSTEMI acute MI. The patient is maintained on 20 mg Lasix at home. 10 mg Coreg daily, Keppra.  The patient has a cat scan of the head which is negative for infarct and negative for intracranial injury. The patient is seen by the cardiologist with plans for continued management of CHF oral 20 mg Lasix chest x-ray negative. Patient will be seen by cardiology on discharge. The patient is seen by the neurologist CT of head is negative, EEG shows waveform abnormalities consistent with patient’s history. Unclear what triggered the seizure today. Will continue patient on home dose Keppra.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code:

This was a 59-year-old male admitted through the emergency room for witness seizure by wife. Patient was described as having jerking movements of upper extremities and unresponsive to verbal communications, wife is not sure if the patient hit his head. The patient has a history of chronic diastolic congestive heart failure and hypertension and was recently discharged five days ago from this hospital with an NSTEMI acute MI. The patient is maintained on 20 mg Lasix at home. 10 mg Coreg daily, Keppra.  The patient has a cat scan of the head which is negative for infarct and negative for intracranial injury. The patient is seen by the cardiologist with plans for continued management of CHF oral 20 mg Lasix chest x-ray negative. Patient will be seen by cardiology on discharge. The patient is seen by the neurologist CT of head is negative, EEG shows waveform abnormalities consistent with patient’s history. Unclear what triggered the seizure today. Will continue patient on home dose Keppra.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code:

This is a 28-year-old female that’s admitted with a two day history of crampy colicky abdominal pain radiating to the right lower side with foul-smelling urine and history of kidney stones in the past. Ultrasound of urinary system shows right sided dilated hydronephrosis with small calculus at the right kidney upper pole. Urine cultures are positive for > 100,000 E. coli infection. Patient is started on IV Urology sees the patient with instructions to follow up in the urology clinic in three days with planned cystoscopy and possibly stone fragmentation.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code:

This is a 28-year-old female that’s admitted with a two day history of crampy colicky abdominal pain radiating to the right lower side with foul-smelling urine and history of kidney stones in the past. Ultrasound of urinary system shows right sided dilated hydronephrosis with small calculus at the right kidney upper pole. Urine cultures are positive for > 100,000 E. coli infection. Patient is started on IV Urology sees the patient with instructions to follow up in the urology clinic in three days with planned cystoscopy and possibly stone fragmentation.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code:

This is a 76-year-old male that is admitted with the shortness of breath and chest pain describes fever with some nausea and no vomiting for the past two days. Provides a history of cold symptoms before the onset of the chest pain. Patient has known end-stage COPD is on home oxygen six liters. Patient has acute exacerbation of his COPD with pneumonia seen on the chest cat scan. Leukocytosis with chronic pulse oxygen around baseline 86%. Patient with mild respiratory distress relieved with oxygen. The patient has a history of hypertension and chronic kidney disease with the baseline creatinine of 2.5. Patient’s creatinine level on admission was 2.3. Will provide careful hydration for acute on chronic kidney failure stage III, and avoid nephrotoxic drugs. Sputum culture returns positive for Pseudomonas antibiotics changed to Zosyn IV.

From the list of available diagnosis codes below, Enter the correct Principal and Secondary diagnosis codes (Secondary diagnosis codes can be entered in any order):

• J44.0 = Chronic Obstructive Pulmonary Disease With Acute lower Respiratory Infection
• J44.1 = Chronic Obstructive Pulmonary Disease With (acute) Exacerbation
• R06.02 = Shortness of breath
• J15.1 = Pneumonia due to Pseudomonas
• N18.3 = Chronic Kindey Disease Stage III (moderate)
• I10 = Essential (primary) Hypertension
• I12.9 = Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• J18.9 = Pneumonia, unspecified organism
• N17.9 = Acute kidney failure, unspecified
• R07.9 = Chest pain, unspecified
• J44.9 = Chronic obstructive pulmonary disease, unspecified
• J16. 10 = Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
• Z99.81 = Dependence on supplemental oxygen

This is a 76-year-old male that is admitted with the shortness of breath and chest pain describes fever with some nausea and no vomiting for the past two days. Provides a history of cold symptoms before the onset of the chest pain. Patient has known end-stage COPD is on home oxygen six liters. Patient has acute exacerbation of his COPD with pneumonia seen on the chest cat scan. Leukocytosis with chronic pulse oxygen around baseline 86%. Patient with mild respiratory distress relieved with oxygen. The patient has a history of hypertension and chronic kidney disease with the baseline creatinine of 2.5. Patient’s creatinine level on admission was 2.3. Will provide careful hydration for acute on chronic kidney failure stage III, and avoid nephrotoxic drugs. Sputum culture returns positive for Pseudomonas antibiotics changed to Zosyn IV.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code:

This is a 43-year-old female brought in by ambulance following fall on the sidewalk witness by nearby bystanders. The patient was described as walking and talking with a friend and suddenly dropped to the ground. The patient was unresponsive at the scene  EMT  noted  GCS total of (3) with   E(1) V (1) M (1), patient was brought in as trauma. Trauma team assessment notes large laceration to forehead deep tissue with exposure of Periosteum. Large bleeding arterial vessel. Bleeding vessel ligated for control of hemorrhage.   Studies of head showed large traumatic subdural hemorrhage with left midline shift and brain herniation. Patient taken emergently to the OR for right sided temporal craniotomy for evacuation of large blood clots under extreme pressure.

From the list of available diagnosis codes below, Enter the correct Principal and Secondary diagnosis codes (Secondary diagnosis codes can be entered in any order; Do NOT code external cause codes):

• S06.5X9A = Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter
  I62.01 = Nontraumatic acute subdural hemorrhage
  R40.2112 Coma Scale, eyes open never at arrival to the Emergency department
  R40.2212 Coma Scale, best verbal response, none at arrival to the emergency department
  R40.2312 Coma Scale, best motor response, none at arrival to the emergency room
  R40.2432 Glasgow coma scale score 3-8, at arrival to emergency department
  S06.2X9A Diffuse traumatic brain injury with loss of consciousness of unspecified duration, initial encounter
  S01.81XA= Laceration without foreign body of other part of head, initial encounter
  S09.0XXA = Injury of blood vessels of head, not elsewhere classified, initial encounter
  G93.6 = Cerebral Edema

This is a 43-year-old female brought in by ambulance following fall on the sidewalk witness by nearby bystanders. The patient was described as walking and talking with a friend and suddenly dropped to the ground. The patient was unresponsive at the scene  EMT  noted  GCS total of (3) with   E(1) V (1) M (1), patient was brought in as trauma. Trauma team assessment notes large laceration to forehead deep tissue with exposure of Periosteum. Large bleeding arterial vessel. Bleeding vessel ligated for control of hemorrhage.   Studies of head showed large traumatic subdural hemorrhage with left midline shift and brain herniation. Patient taken emergently to the OR for right sided temporal craniotomy for evacuation of large blood clots under extreme pressure.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code:

This is a 43-year-old female brought in by ambulance following fall on the sidewalk witness by nearby bystanders. The patient was described as walking and talking with a friend and suddenly dropped to the ground. The patient was unresponsive at the scene  EMT  noted  GCS total of (3) with   E(1) V (1) M (1), patient was brought in as trauma. Trauma team assessment notes large laceration to forehead deep tissue with exposure of Periosteum. Large bleeding arterial vessel. Bleeding vessel ligated for control of hemorrhage.   Studies of head showed large traumatic subdural hemorrhage with left midline shift and brain herniation. Patient taken emergently to the OR for right sided temporal craniotomy for evacuation of large blood clots under extreme pressure.

From the list of available diagnosis codes below, Enter the correct Procedure codes in any order:

This was a 97 year old female transferred from the nursing home for positive blood cultures MRSA. The patient is status post stroke with right sided hemiplegia. Patient was recently admitted last month for pneumonia all antibiotics were completed. Blood cultures drawn times two show first bottle positive for MRSA, second bottle negative. Patient was seen by infectious disease for consult impression: blood culture positive bacteremia. The attending progress notes document MRSA positive sepsis now resolved. The discharge summary documents sepsis with bacteremia. The patient receives one dose of vancomycin which is discontinued on day one. The patient’s temp was normal and remained normal. No leukocytosis.  Attending Md documents “Will treat for sepsis”. The patient returns to the nursing home within 48 hours.

Select the query template description that best describes the query  and would be most appropriate for this situation:

This was a 49-year-old male admitted with acute pyelonephritis patient with a history of HIV positive/AIDS. Known AIDS infection compliant with antiviral meds and is seen in the infectious disease clinic regularly. Patient states his CD4 counts are better and has follow-up appointment next week.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code:

This was a 49-year-old male admitted with acute pyelonephritis patient with a history of HIV positive/AIDS. Known AIDS infection compliant with antiviral meds and is seen in the infectious disease clinic regularly. Patient states his CD4 counts are better and has follow-up appointment next week.

From the list of available diagnosis codes below, select the correct Principal Diagnosis code: