Larry is a 77-year-old male who has a history of HTN, restless leg syndrome, DVT, and essential tremor. He presented to the hospital complaining of bloody diarrhea and LLQ pain. He also c/o nausea. He is dehydrated. CT scan of the abdomen showed diverticular disease of the ascending colon with a likely abscess. Hgb and Hct were low normal, though there are concerns they could go lower once he is rehydrated. The patient is being admitted for antibiotic treatment and rehydration. Will address any other concerns as needed.
Admitting diagnoses: Diverticulitis with abscess and hemorrhage; HTN, restless legs syndrome, history of DVT on Coumadin; essential tremor.
What will be an ideal response?
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Q. 2) John is a 36-year-old Asian male who was admitted to the hospital after complaining of significant LUQ pain that radiates to the left flank. He indicated the pain was constant and worse when he lies down. He has also had occasional vomiting over the last three days. Initially, it was thought he may have a kidney stone, but further testing and labs proved otherwise. He is being discharged from this critical access hospital and transferred to a tertiary medical center up north.
His physical exam showed abdominal distention, increasing LUQ pain on palpation. Sclera were jaundiced.
Labs: serum amylase and lipaseextremely elevated.
CT of abdomen with contrast showed peripancreatic inflammation and fluid.
What will be an ideal response?
Impression: Acute pancreatitis vs. pancreatic pseudocyst
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Q. 3) Dani is a 19-year-old female who is seen in the office complaining of problems with my bowels. She is having frequent abdominal cramping, flatulence, and feels bloated most of the time. She describes alternating bouts of constipation and diarrhea, though more diarrhea than constipation. On questioning, she did acknowledge mucus in her stools, though she denied any blood.
On physical exam, her abdomen was, indeed, bloated. Digital rectal examnegative. Hyperactive bowel sounds on auscultation.
I explained to Dani, that based on her symptoms and exam, she most likely has irritable bowel syndrome and I would like to start out with a conservative approach. I would like her to keep a food diary for the next seven days and document what she eats and when. I also want her to document her mood and activity for each day. She was also instructed to keep a record of each bowel movement, by day, and to indicate if it was constipated, diarrhea, normal, etc. I would also like her to increase her fiber.
Plan: See her back in the office in 10 days and then I will decide whether to start her on medications or do further work up.
Dx: IBS
What will be an ideal response?
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Q. 4) Crohn's disease of the small intestine, with SBO:
Select the correct code for each of the diagnoses:
a. K50.012.
b. K50.112.
c. K50.119.
d. E10.349, K50.019.
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Q. 5) Barrett's esophagus with high grade dysplasia:
Select the correct code for each of the diagnoses:
a. K22.719.
b. K22.718.
c. K22.710.
d. K22.711.
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Q. 6) Postcholecystectomy syndrome: ________
Fill in the Blanks with correct ICD-10 code.
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Q. 7) Epstein's pearl: ________
Fill in the Blanks with correct ICD-10 code.
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Q. 8) Pancreatic pseudocyst: ________
Fill in the Blanks with correct ICD-10 code.
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Q. 9) Melena: Answer: ________
Fill in the Blanks with correct ICD-10 code.
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Q. 10) Colostomy hemorrhage: ________
Fill in the Blanks with correct ICD-10 code.
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