Final Exam

Question 1

What medical specialty treats diseases of the bones, joints, and muscles?

Answer 1

Orthopedics

Question 2

What term refers to the excision of part of the colon?

Answer 2

Colectomy

Question 3

What specialist focuses on the diseases and conditions of the foot and ankle?

Answer 3

Podiatrist

Question 4

What is the outer layer of the meninges?

Answer 4

Dura mater

Question 5

Which system controls the body’s response to internal and external changes?

Answer 5

Nervous System

Question 6

Medical treatment can be divided into how many categories?

Answer 6

Three

Question 7

Which service is not specific to a medical specialty or one body system or anatomical area?

Answer 7

Evaluation and management

Question 8

What statement is true regarding a chief complaint?

Answer 8

It is a description of why the patient is presenting for healthcare services.

Question 9

What is the term to determine the source of an illness?

Answer 9

Etiology

Question 10

What is a stethoscope used for?

Answer 10

To listen to heart and lungs sounds

Question 11

What is palpation?

Answer 11

Examination of the body by touch

Question 12

What is the term for creating sounds from tapping on body areas to examine body organs and body cavities?

Answer 12

Percussion

Question 13

Which component of a medical record provides a brief history outlining the reasons for the procedure?

Answer 13

Indication

Question 14

Which membrane is composed of epithelium?

Answer 14

Mucous membranes

Question 15

Which organ system houses white blood cells?

Answer 15

Lymphatic system

Question 16

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.

Answer 16

Assessment

Question 17

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.

Answer 17

Radiology report

Question 18

What does this documentation represent? CC: Jaundice.

Answer 18

Chief complaint

Question 19

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.

Answer 19

A physical exam including the range of motion

Question 20

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.

Answer 20

Head, eyes, ears, nose, throat; physical examination

Question 21

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.

Answer 21

A physician exam requiring a stethoscope

Question 22

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.

Answer 22

Name of the surgeon

Question 23

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.

Answer 23

Brief history outlining the reasons for the procedure

Question 24

What type of documentation is the following?

Const: Appears obese. No signs of apparent distress present.

Musculo: Walks with a normal gait.

Answer 24

A general and musculoskeletal exam

Question 25

What type of documentation is the following?

CV: Denies chest pain and palpitations.

Answer 25

Cardiovascular system review

Question 26

What is the term for the space inside the skull?

Answer 26

Cranial cavity

Question 27

What is the linear strand made of DNA called?

Answer 27

Chromosome

Question 28

What space contains the spinal cord?

Answer 28

Vertebral canal

Question 29

What is the membrane that covers the interior walls of the organs and tubes opening to the outside of the body?

Answer 29

Mucous membranes

Question 30

Which one is NOT a serous membrane?

Answer 30

Synovial

Question 31

What cavities are included in the ventral cavity?

Answer 31

Thoracic, abdominal, and pelvic cavities

Question 32

The term hemic specifically refers to what bodily fluid?

Answer 32

Blood

Question 33

Which type of treatment requires an antibiotic?

Answer 33

Curative

Question 34

What option is true regarding pathophysiology?

Answer 34

It enables us to understand what occurs in a healthy body in normal life and what goes wrong when someone becomes ill.

Question 35

What is another term for skin tags?

Answer 35

Acrochordons

Question 36

What is another term for hives?

Answer 36

Urticaria

Question 37

Which statement is true regarding sarcomas?

Answer 37

Sarcomas grow in connective tissues.

Question 38

Which of the following best describes psoriasis?

Answer 38

A chronic condition characterized by red, dry, elevated lesions covered by silvery scales.

Question 39

Which type of cancer forms in the cells at the base of the epidermis?

Answer 39

Basal cell carcinoma

Question 40

What type of cancer is known as human herpes virus 8?

Answer 40

Kaposi’s sarcoma

Question 41

Second-degree burns involve which of the following?

Answer 41

Epidermis and dermis

Question 42

What are the characteristics of eczema?

Answer 42

It makes skin inflamed, scaly, and dark.

Question 43

Which cells make melanin?

Answer 43

Melanocytes

Question 44

What option is true regarding primary skin lesions?

Answer 44

Present at birth or acquired over a person’s lifetime.

Question 45

Which is NOT a function of the skin?

Answer 45

Acts as a gland by synthesizing vitamin A

Question 46

What type of dermatitis is a reaction to irritants in the form of itchy rashes?

Answer 46

Allergic contact dermatitis

Question 47

What is commonly known as a boil of the skin?

Answer 47

Furuncle

Question 48

The classification of burns is determined by how many criteria?

Answer 48

Two

Question 49

What is another term for connective tissue in the breast?

Answer 49

Fibrous stroma

Question 50

Which option describes the following documentation?
Postoperative diagnosis: Fibroadenoma

Answer 50

Noncancerous growth found in the breast tissue

Question 51

Which option describes the following documentation?
Procedure: Radical mastectomy

Answer 51

All of the breast tissue, the underarm lymph nodes, and the chest muscle that lies underneath the affected breast are removed.

Question 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.

Answer 52

A circular instrument is used to remove a sample of the lesion.

Question 53

Which option describes the following documentation?

Operation performed: Advancement flap

Answer 53

Undermining or freeing up tissue surrounding a defect.

Question 54

Which option describes the following documentation?

Diagnosis: Ecchymosis

Answer 54

Condition in which blood seeps into the skin, causing discoloration

Question 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.

Answer 55

Debridement

Question 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.

Answer 56

Mohs micrographic surgery

Question 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.

Answer 57

Incision and drainage

Question 58

Which option describes the following documentation?

Diagnosis: Venous stasis ulcers

Answer 58

Develop in the skin of the lower leg as a result of poor venous circulation

Question 59

Which option describes the following documentation?

Diagnosis: Third-degree burns

Answer 59

Effect on epidermis, dermis, and fat

Question 60

What layer of tissue contains subcutaneous fat?

Answer 60

Hypodermis

Question 61

What statement is TRUE regarding the stratum germinativum?

Answer 61

It lies on top of the dermis and has access to a rich supply of blood.

Question 62

The suffix =rrhea means which of the following?

Answer 62

Excessive discharge

Question 63

What does the root word mamm/o mean?

Answer 63

Breast

Question 64

What percentage is assigned for genitals in the burn rule of nines?

Answer 64

1%

Question 65

Which is NOT an exocrine gland?

Answer 65

Thyroid glands

Question 66

What term describes clogging of hair follicles and oil glands with dirt and oil?

Answer 66

Acne vulgaris

Question 67

What term best describes a mass of hypertrophic scar tissue?

Answer 67

Keloid

Question 68

Which structure is responsible for raising the level of the skin slightly and causing hair to stand up in the cold?

Answer 68

Arrector pili

Question 69

What is the meaning of osteochondritis?

Answer 69

Inflammation of bone and cartilage

Question 70

Which bones are named for their elongated shape?

Answer 70

Long bones

Question 71

What is a transverse fracture?

Answer 71

Breaks in the shaft of a bone across the longitudinal axis

Question 72

What is the thick triangular muscle covering the soulder joint called?

Answer 72

Deltoid

Question 73

What is removed in a hallux valgus correction surgery?

Answer 73

Bunion

Question 74

Which procedure is done to treat a spinal compression fracture?

Answer 74

Vertebroplasty

Question 75

Which procedure is required to first reach the heart in open heart surgery?

Answer 75

Sternotomy

Question 76

Which of the following is commonly caused by arthritis or wearing ill-fitting shoes?

Answer 76

Hammer toe

Question 77

What is the term for cartilage break down or deterioration?

Answer 77

Chondrosis

Question 78

Which joints connect the vertebrae to each other, above and below?

Answer 78

Facet joint

Question 79

Which of the following is NOT another term used for osteoarthritis?

Answer 79

Rheumatoid arthritis

Question 80

A positive FABER test is diagnostic of which disorder?

Answer 80

Sacroiliac dysfunction

Question 81

When a fracture occurs through both the metaphysis and the growth plate, which Salter-Harris classification is it?

Answer 81

Type II

Question 82

Which structure reduces friction between bones?

Answer 82

Bursa

Question 83

Which test is done to check for Achilles tendon rupture?

Answer 83

Thompson test

Question 84

Diagnosis: Comminuted intra-articular distal radial Colles’ fracture, left wrist.

Which bone is involved in the fracture?

Answer 84

Radius

Question 85

The patient is a 66-year-old female who sustained a traumatic severe comminuted proximal humerus fracture.

What type of fracture is this?

Answer 85

Bone is broken into more than two fragments

Question 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?

Answer 86

Fasciotomy

Question 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?

Answer 87

Comminuted

Question 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.

Answer 88

Kyphoplasty

Question 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.

Answer 89

Closed reduction of the elbow is being performed

Question 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.

Answer 90

Vertebroplasty

Question 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?

Answer 91

Trigger finger release

Question 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?

Answer 92

Fluoroscopy system

Question 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?

Answer 93

Percutaneous endoscopic

Question 94

What does the suffix -ooraphy mean?

Answer 94

Surgical repair with suture

Question 95

What does the root word myel(o) mean?

Answer 95

Bone marrow and spinal cord

Question 96

Hallux rigidus affects what part of the body?

Answer 96

Toe

Question 97

What is the primary function of the bicep muscle?

Answer 97

Flex the elbow and rotate the forearm

Question 98

How are Le Fort II fractures described?

Answer 98

Pyramidal

Question 99

Which procedure is for tendon release of the A1 pulley?

Answer 99

Trigger finger release

Question 100

What is the term for stiffening of a joint?

Answer 100

Ankylosis

Question 101

Arthritis is inflammation of which of the following?

Answer 101

Joint

Question 102

Which of the following types of stroke is most prevalent?

Answer 102

Ischemic strokes

Question 103

Which one of the following is not true for amyotrophic lateral sclerosis?

Answer 103

It impairs a person’s intellectual reasoning

Question 104

Which is the most common disability following stroke?

Answer 104

Hemiplegia

Question 105

How many bones make up the skull?

Answer 105

22

Question 106

Where are burr hole surgeries performed?

Answer 106

In the skull

Question 107

Which part of the cerebrum processes visual information?

Answer 107

Occipital lobe

Question 108

Schizophrenia usually occurs in which age?

Answer 108

Average age of onset is late teens to the early 20s for men.

Question 109

What is amyotrophic lateral sclerosis (ALS) also known as?

Answer 109

Lou Gehrig’s disease

Question 110

Which age group is most vulnerable and likely to use addictive substances?

Answer 110

Adults between the ages of 18 and 25

Question 111

What procedure is an excision of the vertebral posterior arch or spinal process?

Answer 111

Laminectomy

Question 112

Cerebrospinal fluid (CSF) shunt is a standard treatment for which of the following?

Answer 112

Hydrocephalus

Question 113

How many fontanels are there in an infant’s skull?

Answer 113

6

Question 114

In which of the following is abnormal electrical activity in the brain seen?

Answer 114

Epilepsy

Question 115

Which one of the following is not a function of the frontal lobe of the cerebrum?

Answer 115

Visual memory

Question 116

Which one of the following is not a function of the temporal lobes of the cerebrum?

Answer 116

Balance

Question 117

Which of the following is responsible for involuntary movements?

Answer 117

Autonomic nervous system

Question 118

Which one of the following innervates the thumb?

Answer 118

Median nerve

Question 119

One of the diabilities that may follow stroke is hemiparesis. What does hemiparesis mean?

Answer 119

Weakness on one side of the body

Question 120

What controls the neurological functions necessary for survival (breathing, digestion, heart rate, blood pressure)?

Answer 120

Brain stem

Question 121

Which one of the following is a center for coordinating reflexes?

Answer 121

Spinal cord

Question 122

Which of the following is responsible for voluntary movements?

Answer 122

Somatic nervous system

Question 123

Most of the cranial nerves come from which part of the brain?

Answer 123

Brainstem

Question 124

Which one of the following is TRUE for coccygeal nerves?

Answer 124

Three to five coccygeal vertebral segments fuse to form the coccyx with one pair of coccygeal nerves.

Question 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.

Answer 125

Craniotomy

Question 126

Which option describes the following documentation?

Postoperative Diagnosis: Post-hemorrhagic hydrocephalus.

Answer 126

Prior bleeding on the brain resulting in excessive fluid accumulation in the brain

Question 127

In which of the following do the symptoms of psychosis, such as hallucinations or delusions, occur?

Answer 127

Schizophrenia

Question 128

What does the root word encephal/o mean?

Answer 128

Brain

Question 129

Which cells make the myelin sheath?

Answer 129

Schwann cells

Question 130

Which of the following is not a risk factor for stroke?

Answer 130

Anxiety

Question 131

What does subdural hematoma refer to?

Answer 131

Leakage of blood between the dura and arachnoid membranes

Question 132

The common peroneal nerve is a branch of?

Answer 132

Sciatic nerve

Question 133

What is the direction of flow of signals at a synapse?

Answer 133

Axon terminals (synaptic bulbs) of a transmitting neuron and dendrites of a receiving neuron.

Question 134

What is the function of the ventricles of the brain?

Answer 134

Contain CSF that baths and cushions the spinal cord

Question 135

What does the root word gloss/o mean?

Answer 135

Tongue

Question 136

What is the term for the inflammation of the labyrinth?

Answer 136

Labyrinthitis

Question 137

Which of the following is another term for earwax?

Answer 137

Cerumen

Question 138

What is the term for excision of a portion of the temporal bone?

Answer 138

Apicectomy

Question 139

What is the term for ear lobe?

Answer 139

Auricle

Question 140

What is the term for ingesting toxins that damage the inner ear?

Answer 140

Ototoxic hearing loss

Question 141

What option is true regarding sensorineural hearing loss?

Answer 141

It can be caused by a lesion on the cochlea

Question 142

Which structure(s) connect the middle ear to the pharynx?

Answer 142

Eustachian tubes

Question 143

What is the term for inflammation of the cornea?

Answer 143

Keratitis

Question 144

What is the term for perception of pain?

Answer 144

Nociception

Question 145

What causes vertigo?

Answer 145

Increased hydraulic pressure

Question 146

What option is true regarding ageusia?

Answer 146

Lack of taste

Question 147

Where are the vallate papillae located?

Answer 147

On the anterior dorsum of the tongue

Question 148

What is the term for distorted sense of taste?

Answer 148

Dysgeusia

Question 149

What option is true regarding cholesteatoma?

Answer 149

Fatty tumor that forms in the middle ear

Question 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?

Answer 150

Ageusia and anosmia

Question 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.

Answer 151

Open angle glaucoma

Question 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?

Answer 152

Semicircular ducts

Question 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?

Answer 153

Placement of nucleus cochlear implant

Question 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?

Answer 154

Middle ear

Question 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.

Answer 155

This is a procedure on a large tear of the retina since scleral buckle is used on large tears

Question 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?

Answer 156

Nuclear cataract

Question 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?

Answer 157

Swimmer’s ear

Question 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?

Answer 158

Phacoemulsification

Question 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?

Answer 159

Myringitis

Question 160

What are bony overgrowth(s) in the ear canal called?

Answer 160

Exostosis

Question 161

What are the three small bones in the middle ear called?

Answer 161

Ossicles

Question 162

Which cells detect the taste of the food?

Answer 162

Gustatory cells

Question 163

What does the root word myring/o- mean?

Answer 163

Tympanic membrane

Question 164

What does the suffix -esthesia mean?

Answer 164

Feeling or sensation

Question 165

What is the term for lack of sense of smell?

Answer 165

Anosmia

Question 166

What anatomical structure detects the movement and position of the body?

Answer 166

Proprioceptors

Question 167

Which structure is called the hammer bone?

Answer 167

Malleus

Question 168

For what condition can antihistamines can be used?

Answer 168

Vertigo

Question 169

What is the term for noninfectious inflammation of the middle ear?

Answer 169

Serous otitis media

Question 170

What is the term for a distorted sense of smell?

Answer 170

Dysosmia

Question 171

Hypophysis is a part of which endocrine gland?

Answer 171

Pituitary gland

Question 172

What is the location of the thymus gland?

Answer 172

In front of the heart

Question 173

What is the diagnosis when adrenal glands do not produce enough cortisol and aldosterone?

Answer 173

Addison’s disease

Question 174

Which of the following is NOT a lymphoid organ?

Answer 174

Kidney

Question 175

Which of the following is NOT a type of tonsil?

Answer 175

Maxillary

Question 176

An excess of cortisol, caused either by an overactive adrenal gland or glucocorticoid medications causes which of the following?

Answer 176

Cushing’s Syndrome

Question 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?

Answer 177

Acromegaly

Question 178

Which of the following hormone over production causes Cushing’s syndrome?

Answer 178

Cortisol

Question 179

Which of the following hormones is NOT secreted by adrenal medulla?

Answer 179

Cortisol

Question 180

Which of the following statements is FALSE regarding the pituitary gland?

Answer 180

Posterior pituitary produces growth hormone and luteinizing hormone

Question 181

Which of the following zones is not part of the adrenal cortex?

Answer 181

Zona muscularis

Question 182

Which organ is responsible for T-lymphocyte maturation, enabling them to function against specific pathogens in the immune response?

Answer 182

Thymus

Question 183

The procedure orchiopexy is related to which part of the endocrine system?

Answer 183

Testes

Question 184

What is the test used for diagnosing Addison’s disease?

Answer 184

ACTH stimulation test

Question 185

What is the meaning of the term Euthyroid?

Answer 185

Normal thyroid gland activity

Question 186

Which of the following organ atrophies gradually after puberty?

Answer 186

Thymus

Question 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?

Answer 187

Thyroidectomy

Question 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?

Answer 188

Polycystic ovarian syndrome

Question 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?

Answer 189

Bilateral Orchiopexy

Question 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?

Answer 190

Pelvic lymphadenectomy

Question 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?

Answer 191

Patient has type 2 DM controlled with oral medications.

Question 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?

Answer 192

Laparoscopic left oophorectomy

Question 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?

Answer 193

Parathyroidectomy and partial thyroid lobectomy

Question 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?

Answer 194

Endoscopic removal of sinus contents with polypectomy

Question 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?

Answer 195

Hypothyroidism

Question 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?

Answer 196

Spleen

Question 197

Thyrotoxicosis is _______

Answer 197

Overactivity of thyroid gland

Question 198

What does the root word insul/o mean?

Answer 198

Pancreatic islets

Question 199

What is the main function of parathyroid glands?

Answer 199

Regulate the body’s phosphorous metabolism

Question 200

Which of the following terms indicate excess glucose in the blood?

Answer 200

Hyperglycemia

Question 201

What are the hormones released from islets of Langerhans?

Answer 201

Insulin, Glucagon

Question 202

Glucagon:

Answer 202

accelerates liver glycogenolysis

Question 203

What procedure is a graphical record of the heart’s electrical activity?

Answer 203

Electrocardiogram

Question 204

What does LAD stand for?

Answer 204

Left anterior descending

Question 205

What does the root word angi/o mean?

Answer 205

Vessel

Question 206

When does tachycardia occur?

Answer 206

The heart rate, at rest, goes above 100 beats per minute

Question 207

What is the term for the procedure in which transcutaneous sound waves (ultrasonography) are used to produce images of the heart?

Answer 207

Echocardiogram

Question 208

What is a flutter?

Answer 208

Organized and regular irregularity of heartbeat

Question 209

Which is the function of a ventricular assist device (VAD)?

Answer 209

To help pump blood from the left ventricle to the rest of the body

Question 210

Radiographic visualization of blood vessels following introduction of contrast material is called which of the following?

Answer 210

Angiography

Question 211

Which vessel brings oxygen-deficient blood into the right atrium?

Answer 211

Vena cava

Question 212

Which statement is true regarding cardioplegia?

Answer 212

Cardioplegia is stopping the heart to do a surgical procedure

Question 213

Which chamber of the heart is responsible for distributing oxygen rich blood throughout the body?

Answer 213

Left ventricle

Question 214

Which statement is TRUE regarding enhanced external counterpulsation (EECP)?

Answer 214

Stimulate the formation of small branches of blood vessels to create a natural bypass around narrowed or blockded arteries

Question 215

What is fibrillation?

Answer 215

A disorganized, irregular heartbeat which can occur in the atria or the ventricles

Question 216

What is the purpose of using a coronary stent?

Answer 216

To keep an artery open and prevent it from narrowing again

Question 217

Which of the following are the inlet valves of the heart?

Answer 217

Tricuspid and mitral valves

Question 218

Which option describes the following documentation?

Preoperative Diagnosis: Pericardial effusion

Answer 218

Fluid accumulation within the membrane surrounding the heart

Question 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?

Answer 219

Creating a connection of right internal mammary artery to LAD

Question 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.

Answer 220

Thrombectomy

Question 221

Which option describes the following documentation?

Preoperative Diagnosis: Coronary artery disease

Answer 221

Blockage of the coronary arteries

Question 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?

Answer 222

It stimulates cardiac contractions at a certain rate by electrical impulses.

Question 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?

Answer 223

Loss of blood flow and oxygen to the heart and weakened heart muscle

Question 224

Diagnosis: Heart Failure

What option is true regarding the diagnosis mentioned above?

Answer 224

Heart cannot pump enough blood to supply the body’s other organs

Question 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?

Answer 225

Placement of leads for the pacemaker

Question 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?

Answer 226

Aortic valve replacement

Question 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.

Answer 227

Complete pacemaker replacement

Question 228

What procedure is used to check blood flow through arteries at pulse points in the arms, legs, hands, and feet?

Answer 228

Doppler ultrasound

Question 229

What is the term for the divider between the heart chamber walls?

Answer 229

Septum

Question 230

What is the layer of the wall of the heart below the epicardium called?

Answer 230

Myocardium