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CAISS EXAM CERTIFICATION EXAM 2 LATEST VERSIONS ACTUAL EXAM 900+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES
Origins of AIS (3) - correct answer 1) Standardized system
- Classify type/severity of injury from MVC
- Consensus Injury descriptors are organized _________________________? - correct answer Anatomically Injury severity is ranked relative to its importance to _______________? - correct answer The whole body AIS reflects severity of single injuries and are unaffected by what three things? - correct answer 1) time
- sequela
- outcome What type of scale does AIS use? - correct answer 6 point ordinal scale Which type of measurement is more variable? Anatomic or Physiologic? - correct answer Physiologic Is clinical training necessary for collecting injury data? - correct answer NO AIS is based on what three (3) factors? - correct answer 1) anatomically- based
- consensus driven
- global Severity is NOT contingent upon what two (2) factors? - correct answer 1) Outcome
- time Numerical ranking of severity: 1 - correct answer minor Numerical ranking of severity: 2 - correct answer moderate Numerical ranking of severity: 3 - correct answer serious Numerical ranking of severity: 4 - correct answer severe Numerical ranking of severity: 5 - correct answer critical Numerical ranking of severity: 6 - correct answer maximum (currently untreatable) Is mortality a sole determinant of AIS severity? - correct answer NO
Are all AIS data comparable from year to year? - correct answer NO (updates) Is "DEATH" part of the severity scale? - correct answer NO Is a patient who dies automatically assigned the highest AIS severity of 6? - correct answer NO (patients w/ minor injuries can die) Does a linear relationship exist between AIS severity codes? - correct answer NO (AIS 4 is more, NOT twice as severe as AIS 2) Are all injuries within the same AIS code strictly compatible? - correct answer NO (tibia fx & alveolar ridge are both AIS - 2, although one may be worse than the other, both are considered 'moderate') What AIS code is assigned to a patient with inadequate information regarding an injury? - correct answer 9 AIS single digit severity codes are based on what type of patient? - correct answer Average What four (4) things define the "average" patient? - correct answer 1) 25-40 yrs old
- no pre-existing conditions
- no tx complications
- received timely/appropriate care Approximately how many injury descriptors are included in AIS? - correct answer 2000 What part of the AIS code is considered the "Pre-Dot Code?" - correct answer 6 digits BEFORE the decimal point (left) What part of the AIS code is considered the "AIS Severity Number?" - correct answer single digit after the decimal (right) (T/F) The 6 digit pre-dot codes are unique and allow for more specificity and accurate coding? - correct answer TRUE The first digit in the pre-dot code corresponds to what? - correct answer Body Region The second digit in the pre-dot code corresponds to what? - correct answer Type of anatomic structure (skeletal, solid organ) The third/fourth digits in the pre-dot code correspond to what? - correct answer Specific anatomic structure (femur) The fifth/sixth digits in the pre-dot code correspond to what? - correct answer Level of injury within the specific body region and anatomic structure (NFS, minor, major)
- AIS of 6 in a single body region Do patients with an AIS 9 achieve an accurate ISS score? - correct answer NO Can less than three regions be used to calculate an ISS? - correct answer YES Can more than three regions be used to calculate an ISS? - correct answer NO Do all ISS scores have the same mortality rates? - correct answer NO (depends on body regions affected) Assigning injuries to too few body regions results in what? - correct answer underestimation of ISS Assigning injuries to too many body regions results in what? - correct answer overestimation of ISS Are complications or sequela included in the definition of an injury? - correct answer NO Define injury? - correct answer Anatomic lesion resulting from transfer of injury. List seven (7) examples of sequela that are coded in AIS as injuries? - correct answer 1) HTX/PTX
- retroperitoneal hemorrhage
- cerebral edema/swelling
- ischemic brain damage r/t head trauma
- blood loss
- asphyxia
- compartment syndrome Are preliminary (suspected, possible, rule out) dx codeable? - correct answer NO Are all clinical dx alone codeable? - correct answer NO (some require radiologic/autopsy findings) Cranial nerve contusion is coded when there is what documented? - correct answer weakness/paresthesia subtotal loss of function Cranial nerve laceration is coded when what is documented? - correct answer paralysis/total loss of function What five (5) physical signs/manifestations are codeable as basilar skull fx? - correct answer 1) raccoon's eyes (periorbital ecchymosis)
- Battle's sign (mastoid ecchymosis)
- CSF rhinorrhea
- CSF otorrhea
- hemotympanum What must also exists to code a basilar skull fx when only physical manifestations are present? - correct answer evidence of head trauma (not r/t facial fx/injury) Are complications coded as injuries? - correct answer NO Are sequela or outcomes coded as injuries? - correct answer NO Are injury etiologies (causes) related to AIS injury scores? - correct answer NO Can injuries be assumed based on a particular outcome occurrence? - correct answer NO If an AIS code of 6 is assigned, is it acceptable to stop coding subsequent injuries? - correct answer NO Is death automatically coded as an AIS 6? - correct answer NO Can an AIS of 1 result in death? - correct answer YES (rare) Are cord lesions and vertebral fxs coded separately? - correct answer NO What is important to look for when coding blunt trauma? - correct answer associated/underlying injuries Penetrating injuries that do not injure underlying structures should be coded in what ISS body region? - correct answer External Injuries that result from energy dissipated from a penetrating wound are called direct or indirect? - correct answer indirect With penetrating injuries to internal structures, is the overlying skin injury coded separately? - correct answer NO Bullet wounds/penetrating injuries resulting in fx are coded as open or closed fractures? - correct answer OPEN When detailed information regarding an injury is lacking, what descriptor is often used? - correct answer NFS NFS can refer to what two components of a code? - correct answer 1) injury unspecified
- severity unspecified Should patients with AIS code 9 injuries be included in research studies? - correct answer NO An articular fracture involves what structure? - correct answer JOINT
(T/F) When a vessel injury and related organ injury occur together, if the descriptor includes the vessel injury in the organ injury descriptor it should still be coded separately. - correct answer FALSE Are branches of vessels coded as separate injuries? - correct answer NO (unless named/listed in descriptor) When more than one injury claims the qualifier "blood loss > 20%," the blood loss is assigned to which associated injury? - correct answer most severe Blood loss of 20% in a 100 kg patient is approximately how many cc? - correct answer 1500 cc List the four (4) types of injures defined as penetrating? - correct answer 1) GSW
- Stabbing
- impalement
- spearing-type Penetrating injuries that do not involve internal organs or structures should be coded under what ISS body region? - correct answer External A penetrating injury to the skull is coded under what ISS body region? - correct answer Head/Neck A penetrating injury to the face w/ massive destruction is coded under what ISS body region? - correct answer Face Are entry/exit wounds reflected in the severity of internal organ/structure injuries? - correct answer YES "GSW to abdomen" with no further description would be coded to External or Abdominal ISS body region? - correct answer Abdominal If a single penetrating injury to the brain involves more than one structure (entry to cerebrum, exit cerebellum) do you code each region separately? - correct answer NO (use whole area section) (T/F) When a penetrating injury exists, and using the penetrating code results in a higher AIS than using subsequent qualifiers, the higher AIS penetrating code should be used. - correct answer True Vague descriptions such as "blunt trauma" or "closed head injury" should be assigned which AIS code? - correct answer 9 When assigning severity codes, the coder should use the physicians description of the injury or the AIS definition? - correct answer AIS definition
If the physicians OIS grading differs from the AIS definition of the injury, which should be used for coding? - correct answer AIS definition If no description is available for a solid organ injury other than the OIS grade, is it acceptable to use this information for assigning an AIS code? - correct answer YES (T/F) In order to assign an AIS code with "blood loss > 20%" you must know to what area of the body the blood loss is linked. - correct answer TRUE Are dimensions of lesions used to determine injury severity? - correct answer YES In an adult, 100% blood volume is considered approximately how many cc? - correct answer 5000 cc (T/F) The severity of codes in AIS are NOT age adjusted in some categories. - correct answer FALSE Fractures may be best described in what type of report? - correct answer radiology Organ injuries may best be described in what type of report? - correct answer operative Can patient or bystander reports of LOC be used for coding purposes? - correct answer NO Which type of report is highest on the ranking of most reliable sources of injury information? - correct answer M.E./Autopsy reports List the eight (8) types of hospital/medical record reports from highest to lowest rank in reliability of injury information. - correct answer 1) Autopsy
- Operative
- Radiology
- Nursing/ICU
- MD progress notes
- ED record
- D/C Summary
- Face Sheet What is considered the least reliable source of injury information? - correct answer patient List the seven (7) injury descriptions included in the ISS external body region? - correct answer
- abrasion
- contusion
- laceration
2nd degree burn is described as __________? - correct answer partial thickness 3rd degree burn is described as _________? - correct answer full thickness Is age adjustment required for burns? - correct answer YES When burns are only described as combined degrees, the coder should choose the least or most severe code? - correct answer most severe When burns occur in varying degrees, which type of burns are coded separately from the others? - correct answer 1st degree When either 2nd and/or 3rd degree burns are < 10% TBSA, should the 2nd and 3rd degree burns be coded separately or combined? - correct answer separately If 2nd and 3rd degree burns combined are > 10% TBSA, they should be coded separately or combined? - correct answer combined Burn amputations should be coded to which ISS body region? - correct answer specific to body part Are burns coded separately from burn amputations they cause? - correct answer NO If an electrical injury causes a "flash" burn, should the burn injury be coded separately? - correct answer NO Frostbite is assigned to which ISS body region? - correct answer external Asphyxia/suffocation is assigned to which ISS body region? - correct answer Head Caustic agent inhalation injuries are assigned to which ISS body region? - correct answer Chest Caustic agent ingestion injuries are coded to which ISS body region? - correct answer specific organ injured Drowning is assigned to which ISS body region? - correct answer Chest Hypothermia is coded to which ISS body region? - correct answer External Whole body blast injuries are assigned an AIS code of _______ and are coded to which ISS body region? - correct answer 6;External List the five (5) body parts coded in the AIS face body region. - correct answer 1) eyes
- ears
- nose
- mouth
- facial bones
What is the only vessel included in the Face AIS body region? - correct answer external carotid (and its branches, facial/internal maxillary) What is the only nerve included in the Face AIS body region? - correct answer optic (intraorbital) A compound fracture is considered open or closed? - correct answer open A simple fracture is considered open or closed? - correct answer closed The face is divided into how many sections for coding purposes? - correct answer three A transverse horizontal maxillary alveolar fracture, or palate facial disjunction (Guerin) is known as what type of LeFort Fx? - correct answer LeFort I A pyramidal facial disjunction is known as what type of LeFort Fx? - correct answer LeFort II A craniofacial disjunction is known as what type of LeFort Fx? - correct answer LeFort III (T/F) The size and associated severity of soft tissue injuries is the same across all body regions. - correct answer FALSE (face > 10cm, other > 20cm) Are bilateral injures to the eyes and ears usually coded combined or separately? - correct answer separate Traumatic enucleation of the eye is coded as what type of external injury? - correct answer avulsion Bilateral maxilla or mandible fractures are coded separately or combined? - correct answer combined Nose fractures by definition are included in which LeFort Fxs and should not be coded separately? - correct answer LeFort II LeFort III Should minimally displaced facial fractures be coded as displaced? - correct answer NO Multiple and complex fxs involving the middle and lower, upper and middle, or all three locations of the face that are NOT LeFort fractures are called what? - correct answer Panfacial What facial bone must be fractured to have a LeFort fracture? - correct answer pterygoid plate Can you have more than one type LeFort fracture? - correct answer YES (one on each side) The cheek bone is also known as what? - correct answer malar complex What bone is associated with the malar complex (cheek)? - correct answer zygoma
What should be used when a specific artery or vein is not named in the AIS description but is injured? - correct answer other named "Incomplete transection" vessel injuries are coded as what in AIS? - correct answer incomplete circumferential involvement What two ISS body regions may the aorta and vena cava be coded under depending on the location of their injury? - correct answer chest abdomen The lumbar spinal cord and lumbar vertebrae are assigned to which ISS body region? - correct answer abdomen Avulsion, complex, rupture, tissue loss, and deep are all synonyms for what severity of organ injury? - correct answer massive What type of organ injury involves the ripping away of an organ from its vascular attachment? - correct answer avulsion No perforation or serosal tear is considered a full thickness or partial thickness tear? - correct answer partial thickness Is a perforation always considered a complete transection? - correct answer NO When two parts of a structure are completely separated from each other it is known as what type of injury? - correct answer transection If retroperitoneal hemorrhage/hematoma occurs in combination with an associated injury, it should be coded as combined or separate? - correct answer combined If a vessel injury occurs in combination with an associated organ and it is included in the organ injury AIS description, it should be coded as combined or separate? - correct answer combined When an injury occurs at the junction of the duodenum and the jejunum, the injury should be coded to which part of the intestine? - correct answer jejunum Injuries to bilateral abdominal organs such as the kidneys are coded as combined or separate? - correct answer separate (T/F) If OIS grading descriptions are NOT available and no other descriptors are mentioned, it is acceptable to use the terms "minor, major, or massive" as severity descriptors of solid organ injuries. - correct answer TRUE Is a positive DPL (diagnostic peritoneal lavage) a codeable injury in and of itself? - correct answer NO
When an organ has a laceration AND associated contusion, they should be coded combined as what type of injury? - correct answer laceration (T/F) Fetal demise as a result of abdominal injury is a codeable AIS injury. - correct answer FALSE (T/F) Abdominal compartment syndrome is a sequela of abdominal trauma and is therefore NOT coded. - correct answer TRUE When only one ductal injury occurs, it should be assigned to EITHER, or BOTH of the associated organs? - correct answer either Injuries to the shoulders, hip, buttocks, and pelvic girdle are assigned to which ISS body region?
- correct answer extremities and pelvic girdle Shoulder joint injuries such as acromioclavicular and sternoclavicular are assigned to which ISS body region? - correct answer extremities and pelvic girdle (T/F) Pelvic bones are coded to the abdominal ISS body region. - correct answer FALSE Nerve palsy is synonymous with what type of injury? - correct answer contusion Sprains refer to the tearing of what type of tissue? - correct answer ligament Strains refer to the tearing of what type of tissue? - correct answer tendon (T/F) Closed and NFS fractures share the same 7 digit AIS numerical identifier. - correct answer TRUE Partial separation of a joint, or partial dislocation is known as what type of injury? - correct answer subluxation Complete separation of a joint is known as what type of injury? - correct answer dislocation The overall severity of pelvic fractures is related to __________ or ____________. - correct answer stability instability Penetrating injuries to bones and tissues are coded as what type of fractures to the specific bone? - correct answer open (T/F) Thumb and non-thumb fingers are separate injury categories. - correct answer TRUE Are degloving injuries to extremities coded to the extremity or external ISS body region? - correct answer external Does fracture displacement affect the severity of an injury for AIS coding purposes? - correct answer NO
Quadriplegia or paraplegia with no sensation or motor function is classified as what type of cord syndrome? - correct answer complete (T/F) In the spine, dislocation and subluxation are synonymous. - correct answer TRUE "Whiplash" is what type of cervical injury? - correct answer strain (T/F) Cord injuries and vertebral fractures are coded as separate injuries. - correct answer FALSE Injuries to more than one location of the spinal cord should be coded as combined or separate?
- correct answer separate When it is not clear whether the spinal cord was lacerated or contused, which injury should be coded? - correct answer contusion (T/F) Sequela of spinal cord injuries such as transient neurological signs, incomplete cord syndromes, and complete cord syndromes are not codable injuries. - correct answer FALSE How many hours POST injury in paralysis should the neurological status of a patient be used to code spinal injuries? - correct answer 24 SCIWORA (Spinal Cord Injury without Radiological Abnormality) should be coded as what type of injury? - correct answer spinal cord contusion NFS Vertebral dislocations should be coded to which vertebra? - correct answer superior Is vertebral dislocation coded when a fracture or spinal cord injury is present? - correct answer NO (T/F) Separate vertebral fractures should be combined when no associated spinal cord injury is present. - correct answer FALSE A single vertebra that sustains more than one fracture should be coded separately or combined? - correct answer combined Which two types of vertebral fractures are coded in addition to multiple fractures of same vertebra? - correct answer 1) odontoid
- major compression A vertebral fracture described as "lateral mass" should be coded to which portion of the vertebra? - correct answer pedicle "Burst" fractures are coded to which portion of the vertebra? - correct answer body (T/F) The amount of compression of a vertebral body fracture will affect its AIS code and severity. - correct answer TRUE
The forehead is assigned to which ISS body region? - correct answer face (T/F) A subgaleal hematoma lies over the skull but under the scalp. - correct answer TRUE Concussion and DAI are considered focal or diffuse brain injuries? - correct answer diffuse DAI (diffuse axonal injuries) are also know as what type of injury? - correct answer white matter shearing Immediate and prolonged coma due to widespread damage to axons and other neuronal processes in the brain is known as what? - correct answer Diffuse axonal injury Vessel thrombosis results in ___________ of the vessel. - correct answer Occlusion The term "compound" when used to describe skull fractures indicates what type of fracture? - correct answer open What two injuries must occur for a skull fracture to be termed "open?" - correct answer 1) torn dura
- compound fracture How many hours after injury/arrival should brain injury diagnoses be used for coding? - correct answer 24 What two things must be present to code LOC? - correct answer 1) evidence of head trauma
- dx by a physician Can the GCS be used as an indication of LOC for coding purposes? - correct answer NO (T/F) Brain edema accompanying a contusion or hematoma is considered part of the lesion when assessing its size. - correct answer TRUE When head injuries and vessel injuries occur simultaneously, they shoud be coded combined or separate? - correct answer separate "Closed cisterns" implies what type of brain injury? - correct answer swelling If a single fracture involves both the skull vault and base, what fracture should be coded? - correct answer most severe If a single fracture involves both the skull vault and base, and both are equal in severity, which fracture is coded? - correct answer point of origin Unless specified as base, all skull fractures should be coded as what? - correct answer vault List five (5) skull bones that comprise the base? - correct answer 1) ethmoid
- sphenoid
20% blood loss in adults - correct answer > 1000 cc Nerve paresis (palsy) - correct answer Subtotal loss of function Nerve paralysis - correct answer Total loss of function Transection, Laceration, Contusion & Segmental Spasm, Aneurysm/Pseudoaneurysm, A-V Fistula, Intimal Flap - correct answer Types of Arterial Injuries (T/F) You should code conservatively. - correct answer T (T/F) Foreign bodies are not injuries and therefore not coded. - correct answer T (T/F) You should base the injure severity based on procedure or treatment interventions. - correct answer F (T/F) Multiple fractures to the same bone but in different regions of the bone are coded separately. - correct answer T (T/F) "Crush" should only be used when vascular, skeletal and soft tissue injury occur with an injury. - correct answer T (T/F) If "crush" code is used, you should also code the injuries separately. - correct answer F (T/F) Transection should be coded as a complete transection. - correct answer T (T/F) An incomplete transection should be coded one AIS code less severe than a complete transection. - correct answer T (T/F) If a vessel injury occurs in combination with an organ injury, the vessel injury is not coded separately if it is already included in the organ injury descriptor. - correct answer T (T/F) Branches of vessels are not coded unless they are named vessels and/or are listed within a specific vessel descriptor. - correct answer T (T/F) When more than one injury claims the qualifier "blood loss > 20%", the blood loss is assigned to the most severe associated injury. - correct answer T (T/F) For AIS coding, penetrating injuries are defined as injuries resulting from gunshot or stab wounds, or from impalement or spearing-type trauma, with or without damage to underlying organs or structures. - correct answer T (T/F) Penetrating injuries that do not involve underlying structures or internal organs are coded to the Whole Body region except injuries to the skull and face. - correct answer T (T/F) You should code all internal injuries for a penetrating injury that involves internal organs and structures. - correct answer T
(T/F) If a penetrating injury in the brain crosses more than one region it should be coded to "penetrating major" under the Whole Area section rather than specific site of the brain. - correct answer T (T/F) Penetrating injury to the brain stem is an AIS .6 injury and should be coded there even if two regions of the brain are involved. - correct answer T (T/F) If a physician describes an injury as severe, you should automatically assign the injury AIS .4. - correct answer F (T/F) It is correct to assign a higher AIS code when you know there is a hemorrhage but do not know the specific source of the bleeding. - correct answer F (T/F) Recording the dimensions of lesions may be helpful in determining the severity of the injury. - correct answer T (T/F) AIS severity is age-adjusted for all injuries. - correct answer F (T/F) When faced with contradictory information, rely on the source that is the most reliable. - correct answer T (T/F) Patient-reported brief loss of consciousness or reports by bystanders of LOC without corroboration by EMS or medical personnel can be used for coding purposes. - correct answer F Abrasion - correct answer A rubbed or scarped area on skin or mucous membrane caused by contact with a rough surface or object with sufficient force to remove surface layers. Contusion - correct answer A black and blue mark resulting from a blunt force which causes tiny underlying blood vessels to burst and leak blood into the skin without causing a break in the skin. Scratch, Scrap, Graze, Road Rash, Friction Burn - correct answer Abrasions Bruise, Contused Wound, Ecchymosis, Subcutaneous Hematoma, Bump, Subgaleal Hematoma - correct answer Contusions Laceration - correct answer Tear or ripping apart of tissues resulting from blunt or penetrating force. Open Flesh Wound, Scrub Wound, Cut, chop Wound, Gash - correct answer Laceration Avulsion - correct answer Ripping or tearing away all of the layers of the skin in which a portion is separated from underlying tissues often creating a flap. Degloving - correct answer Traumatic removal of skin and subcutaneous tissue separating tissue planes from blood supply, especially from a limb.
