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NR511 MIDTERM ACTUAL EXAM COMPLETE |
QUESTIONS ND DETAILED ANSWERS|ALREADY
GRADED
A red tongue with enlarged papillae, sometimes seen with strep throat is called a _____ tongue Raspberry Sandpaper Strawberry Blackberry Correct Ans- Strawberry Age-related hearing loss (presbycusis) is classified as which type of hearing loss? Correct Ans- Sensorineural Characteristics of AGE: Correct Ans- Nausea Vomiting Diarrhea Fever Abd pain/cramping Fatigue Malaise Anorexia Tenesmus Rectal burning d/t frequent diarrhea
Rectal abrasion Rectal bleeding Passing stool w/blood and mucus Severe dehydration Increased HR Dizziness Clinical characteristics of GERD: Correct Ans- Heartburn Regurgitation Water brash (reflex salivation) Dysphagia Sour taste in mouth in the morning Odynophagia (painful swallowing) Belching Coughing Hoarseness Wheezing usually at night Substernal or retrosternal chest pain Aggravating: reclining after eating, eating large meal, alcohol, chocolate, caffeine, fatty/spicy food, nicotine, constrictive clothes, heavy lifting, straining, bending over. Alleviating: antacids, sitting upright after meal, eating small meals
Clinical presentation: OE Subjective: acute, severe otalgia that may worsen at night. Worsens with pulling pinna or applying pressure to tragus. Chewing may exacerbate pain in severe cases. Initially ear may feel full/obstructed with temporary conductive hearing loss. May be pruritic. Systemic symptoms may be present with infectious etiology. Chronic illness may include dryness and pruritis of ear canal. OE Objective: tenderness on traction of pinna, pain w/pressure of tragus. Purulent drainage may be present w/bacterial infection. Canal may be reddened and edematous. Usually lacks cerumen. Auditory canal appears edematous/erythemat Compare and contrast the two coding classification systems that are currently used in the US healthcare system. Correct Ans- ICD: International classification of disease codes are used to provide payer info on necessity of visit or procedure performed. Shorthand for pt's dx. CPT: common procedural terminology codes offer the official procedural coding rules and guidelines required when reporting medical services and procedures performed by physician and non-physician providers. Must have corresponding ICD. Correctly ID a pt as a new or established given historical info. Correct Ans- Pt status: whether or not pt is new or established. New: has not received professional service from provider in same group within past 3 years. Established: has received professional service from provider in same group in last 3 years.
Correctly order the E&M office visit codes based on complexity from least to most complex. Correct Ans- New pt:
- Minimal/RN visit: 99201
- Problem focused: 99202
- Expanded problem focused: 99203
- Detailed: 99204
- Comprehensive: 99205 Established pt:
- Minimal/RN visit: 99211
- Problem focused: 99212
- Expanded problem focused: 99213
- Detailed: 99214
- Comprehensive: 99215 Crohn's disease is the: Correct Ans- Inflammation of any or all of the bowel wall and any portion of the GI tract from the mouth to the anus. Can result in "skipped lesions." Define and describe chronic cough. Correct Ans- Lasts 8wks or more in adults Lasts 4wks or more in kids Can be caused by various factors including, but not limited to, post-nasal drip, COPD, asthma, acute bronchitis.
A: assessment Global assessment of pt including differentials in order from most to least likely Combination of subjective and objective info List of dx addressed and billed for at the visit P: plan What you will Rx When to come back Diagnostic tests Pt education Describe classes of asthma. Correct Ans- Mild intermittent: Less than once weekly Brief exacerbations lasting few hrs to few days Nighttime symptoms <2/wk PEFR or FEV1: >80% predicted PFT variability >20% Mild persistent: Symptoms >2/wk but <daily. May be several times at night/month
May effect sleep PEFR or FEV1 >80% PFT variability 20-30% Moderate persistent: Daily but not continual Nighttime, but not every night More than once weekly Exacerbations affect activity/sleep Daily use of short-acting beta-2 agonist PEFR or FEV1 60-80% PFT variability >30% Severe persistent: Continuous daily Frequent nighttime Frequent exacerbations Physical activity limited PEFR or FEV1 < or = 60% PFT variability >30% Describe the characteristics of acute diverticulitis. Correct Ans- Subjective:
Describe the component of the H&P that should be done for a pt with abd pain. Correct Ans- OLDCARTS Upper abd pain: ask about chronic/recurring and related symptoms (bloating, fullness, heartburn, n/v) Lower abd pain: if acute, is pain sharp, intermittent continuous? If chronic, is there a change in bowel habits (alternating diarrhea/constipation)? Radiation? Describe the components of medical decision making in E&M coding. Correct Ans- Risk, data, diagnosis The more time and consideration involved in dealing with a pt, the higher the reimbursement from the payer. Documentation must reflect MDM Describe the differences between medical billing and medical coding. Correct Ans- Medical billing: process of submitting and following up on claims made to a payer in order to receive payment for medical services rendered by a healthcare provider Medical coding: the use of codes to communicate with payers about which procedures were performed and why.
Differentiate between atopic and contact dermatitis. Give examples of each. Correct Ans- Contact: allergic reaction to substance that produces immune reaction in skin resulting in pruritic and erythemic rash. Common causes: nickel, abx creams, cosmetics, soaps, fragrances, jewelry, plants (poison ivy). Usually occurs in same area that was directly exposed to reaction within minutes to hours of exposure. Not contagious, cannot be spread from one area of body to another by touching. Tx: removal of substance causing reaction; mostly symptomatic; topical antihistamines; steroid creams; PO antihistamines to combat itching; mores severe cases or if reaction is on face, esp around eyes: taper dose of PO steroids. Can lead to secondary infection if area is repeatedly scratched. Atopic: disorder that is result of gene variation that affects skin's ability to retain moisture and protection from irritants. Often associated in people with asthma or hay fever. Patches of itchy, dry skin; red to brownish-gray; may have small raised vesicles that leak when scratched. Usually starts before age 5, persists into adulthood. Tx: symptomatic, much like contact derm. Topical steroid creams, PO antihistamines. Moisturize skin at least BID. Avoid triggers that worsen rash.
Skin rash: rose-pink macules and papules, first on head, travel down body. Fades in 1-2 days in same order they appeared. Clinical diagnosis. Tx: symptomatic (apap, NSAIDs, rest). Rubella vaccination. Infectious 4-7 days before rash, can return to work/school after rash gone. Varicella: chicken pox. Highly contagious. Caused by varicella zoster virus (VZV). Malaise, fever, chills, HA, arthralgia, then 1-2 days later urticarial erythematous macules and papules appear, quickly turning into vesicles and pustules. Rash starts on face/chest, spreads quickly over entire body. Blisters can be in ear canal or mouth. Dry up in 1wk. Clinical diagnosis. Tx: symptomatic (oral antihistamines, NSAIDs, cool compresses, oatmeal baths). Varicella vaccination. Contagious 2-3 days before rash, can return to work/scho Differentiate between tinea pedis, cruris, corporis, and unguium. What are the appropriate treatments for each? Correct Ans- Tinea pedis: aka athlete's foot. Erythematous, scaly, possible inflammation/itching.
Tx: antifungal cream, vinegar soak/Burrow solution to decrease itch. Ketoconozole is topical treatment of choice, used for at least 4wks if not longer to resolve. OTC anti-fungal spray for all shoes during/after treatment. Terbanifine sometimes for prolonged/severe cases. Tinea cruris: aka jock itch. Rash presents on inner thighs, butt, groin. Well-demarcated erythematous/tan plaques with raised scaly borders. Tx: topical antifungal; if repetitive infections, OTC zeabsorb powder can help prevent breakout. Tinea corporis: aka ringworm On the extremities or trunk Erythematous annular lesion with scaly macules and papules, well- defined edges. May be itchy. Edge of lesion is raised, center of lesion is flattened. Can be small or cover large body surface area. Tx: antifungal topical cream or PO antifungal (Terbanafine) if widespread. Follow-up 3-4wks. Tinea unguium: aka anychomycosis. Fingernails or toenails. Very common.
Enlarged tender preauricular lymph nodes on affected side. Red throat, nasal drainage, ear infection, etc. Self-limiting, resolve on their own from few days to few weeks. Highly contagious Current recommendation is stay home until redness/tearing resolved. Allergic: usually caused by environmental allergen (pollen, grass, trees, etc.). Can be seasonal and can be isolated to eyes or include upper resp allergy symptoms such as rhinitis. Hallmark characteristic: itching Diffuse, milky, conjunctival hyperemia Swollen conjunctiva Tearing Almost always bilat Uniquely identifying bumps on conjunctiva ("follicles") Tx: symptomatic. Artificial tears, anti-allergy drops. Toxic: due to overuse of topical ocular meds (Visine), but abx drops most common (usually from using abx drops for longer than prescribed or for viral infections). Clear, watery discharge and red conjunctiva Dx usually from history Tx: stop the drops
HSV: spread by contact w/persons who have visible, infected lesions and w/persons symptomatically shedding the virus. Pt may be experiencing prodrome of ill-related symptoms (malaise, low grade fever, pain/tingling near site of lesions but lesions not yet visible). Skin vesicles Conjunct Discuss minimum of three purposes of the written history and physical in relation to the importance of documentation. Correct Ans- Important reference document that gives concise info about the pt's hx and exam findings Outlines a plan for addressing issues that prompted the visit. Info should be presented in a logical fashion that prominently features all data relevant to the pt's condition. Is a means of communicating info to all providers involved in pt's care Is a medical-legal document Is essential in order to accurately code and bill for services Discuss the elements that need to be considered when developing a plan. Correct Ans- Pt's preferences and actions
to correctly detect a specific condition. If a pt has a condition but test is negative, it is a false negative. If pt does NOT have condition but test is positive, it is false positive. Sensitivity: test that has few false negatives. Ability of a test to correctly identify a specific condition when it is present. The higher the sensitivity, the lesser the likelihood of a false negative. Predictive value: The likelihood that the pt actually has the condition and is, in part, dependent upon the prevalence of the condition in the population. If a condition is highly likely, the positive result would be more accurate. Diagnostic tests can be used to confirm or rule out hypotheses. Diagnostic tests may be used to screen for conditions. Diagnostic tests may be used to monitor the progress in managing a chronic condition. How is an appropriate differential developed? Correct Ans- List of possible diagnoses in order of priority. Consider "skin in:" after complaint is given, clinician begins to consider all possible causes beginning with skin level and visualizing all structures in that area inward.
How is the diagnosis of streptococcal pharyngitis made clinically based on the Centor criteria? Correct Ans- Fever >38C (100.5F) Tender anterior cervical lymphadenopathy No cough Pharyngotonsillar exudate Presence of all 4 strongly suggest GABHS infection. 3 or more present: empirically dx and treat w/out further testing IBS is a: Correct Ans- Disordered sensation or abnormal function of the small and large bowel. Can lead to abd pain and alteration in bowel habits. Identify at least two disorders that are considered to be disorders related to conductive hearing loss. Correct Ans- Cerumen accumulation/impaction FB in ear canal Otitis externa Chronic otitis media Middle ear effusion Tosclerosis Vascular anomaly Cholesteatoma
