Practicode: Practicode III (201-300)
Latest Exam and All Correct Answers
2025-2026 Updated.
CaseID: OPD6918
Primary Diagnosis: N63.11
Secondary Diagnosis: N63.15
CPT: 19120-RT - Answer MEDICAL RECORD
OPERATION REPORTAGE: 22Sex: FDATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
RECURRENT RIGHT BREAST MASS.PROCEDURES: EXCISION RIGHT BREAST MASS X
2.POSTOPERATIVE DIAGNOSIS: RECURRENT RIGHT BREAST MASS.SURGEON:ANESTHESIA: LMA
AND LOCAL INFILTRATION.PROCEDURE: The patient is a female who has a recurrent mass that
was multilobulated in the entire right upper outer quadrant and also a separate mass which was
further away from the nipple at a 9 o'clock position. These two were identified. After skin local
infiltration anesthesia was given.A curvilinear incision was made around the nipple. The skin
flaps were raised, so that the entire large mass was exposed. This was about 2 to 3 cm. The
mass was identified below some of the glandula and fat tissue. It was completely excised using
sharp dissection knife and with possible margin around. The patient had smaller breast and
there was active gland tissue around the area of the excision. Once the entire mass was excised.
The superior margin was marked with a sharp silk suture and lateral with a long Prolene and the
deep margin with staple. Once this was done, on further palpation, there was discrete separate
mass in about 1 cm further lateral at the 9 o'clock position. This was exposed and then using
sharp dissection, this was about 1 cm and removed in total and sent for pathology separately.
The bed was irrigated and inspected. Hemostasis was achieved. The breast tissue was
approximated using 3-0 Vicryl. The skin was closed using 4-0 Monocryl and sterile dressings
were applied.The patient tolerated the procedure well.Electronically signed by 1/1/20XX
CaseID: OPD6919
Primary Diagnosis: Z41.1
Secondary Diagnosis: N64.82
CPT: 19325-50 - Answer MEDICAL RECORD
OPERATIVE NOTESex: FAGE: 38DOS: 1/1/20XXPHYSICIAN:PREOPERATIVE DIAGNOSIS: Bilateral
breast hypoplasia.POSTOPERATIVE DIAGNOSIS: Bilateral breast hypoplasiaOPERATIVE
PROCEDURE: Bilateral augmentation using Mentor moderate-plus profile silicone-filled
implants, volume 375 mL, serial number on the patient's left is xxx. Serial number on the
patient's right is xxx.SURGEON:ANESTHESIA: General.COMPLICATIONS: None.INDICATIONS: Ms.
Smith is a female, who is interested in bilateral breast augmentation for treatment of breast
hypoplasia. She understood the risks of breast asymmetry, capsular contracture, hematoma,
seroma, infection, breast pain, nipple anesthesia, and need for further surgery. Understanding
these risks and possible outcomes, she agreed and wished to proceed with surgery.PROCEDURE:
The patient was brought to the operating room, where she was placed in supine position. She
was placed under general anesthesia without incident. She had been marked for augmentation
in the preoperative holding area. Her chest was sterilely prepped and draped in usual fashion. I
,first started on the patient's left. A periareolar incision of 4 cm length was made along the
inferior border. The skin flap was elevated inferiorly towards the inferior mammary crease. The
breast parenchyma in the midline was then incised and carried down to the chest wall. The
inferior border of the pectoralis major muscle was identified and incised along its border. A
submuscular pocket was developed bluntly. Muscle fiber was released medially to reach the
sternal border. The pectoralis major muscle insertion along the sternum was left intact. The
inferior insertion of the pectoralis major muscle was released. After creation of a submuscular
pocket, I irrigated the pocket out well with saline. With adequate retraction, I then placed a
375-mL mo
CaseID: OPD6920
Primary Diagnosis: T85.79XA
Secondary Diagnosis: Z85.3, Z92.21
CPT: 11971-LT - Answer MEDICAL RECORD
OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. History of left breast cancer, status
post-first-stage breast reconstruction with placement of tissue expander.2. Left breast
cellulitis.POSTOPERATIVE DIAGNOSES:1. History of left breast cancer, status post-first-stage
breast reconstruction with placement of tissue expander.2. Left breast cellulitis, with infected
tissue expander.OPERATIVE PROCEDURE: Removal of left breast tissue expander with light
pocket debridement and irrigation.SURGEON:ANESTHESIA: Monitored anesthesia care and IV
sedation.INDICATIONS: Ms. Smith is a female who underwent immediate first-stage breast
reconstruction with placement of tissue expander and AlloDerm. Shortly after surgery, she
developed erythema consistent with cellulitis. She was started on oral antibiotics and after not
improving, she was treated with six weeks of IV antibiotics. Her erythema had resolved and she
had no pain or evidence of significant edema or seroma or abscess. The patient then started
chemotherapy and has finished the chemo. Shortly afterwards she developed some recurrent
hyperemia. There was a concern for possible recurrent infection and she was started on oral
antibiotics. She seemed to improve, but continued to have persistent hyperemia concerning for
cellulitis and possibly deeper infection. After discussing the situation with Dr. Andrews, we
decided that the most appropriate action would be to remove the expander and to obtain
cultures to prevent any overwhelming infection. The patient agreed and wished to proceed with
the surgical procedure.DESCRIPTION OF PROCEDURE: The patient was brought to the operating
room, where she was placed in a supine position. She was placed under IV sedation. The
patient's surgical scars were infiltrated with 1% lidocaine with epinephrine. The patient's lateral
chest w
CaseID: OPD6923
Primary Diagnosis: S22.080A
Secondary Diagnosis: W19.XXXA
CPT: 22513, 22515, 99152, 99153 - Answer MEDICAL RECORD
PATIENT: Smith, SandyAGE: 67SEX: MPrivate Payer (Medicare rules for 65 and older)DATE OF
OPERATION: 01/28/20XXPREOPERATIVE DIAGNOSIS: COMPRESSION FRACTURES OF T11 AND
T12.PROCEDURES: T11 AND T12 VERTEBRAL KYPHOPLASTIES.POSTOPERATIVE DIAGNOSIS:
BILATERAL WEDGE COMPRESSION FRACTURES OF T11 AND T12.ESTIMATED BLOOD LOSS: NO
MORE THAN 1 OR 2 CC.COMPLICATIONS: NONE.SURGEON: Neil Kramer, M.D.FIRST
,ASSISTANT:ANESTHESIA: Conscious sedation. Intraservice time 45 mins. The patient was given a
total of 200 mg of propofol intravenously for conscious sedation by MD and supervised an
observing nurse anesthetist for the duration of the procedure. Periodic assessments were made
and patient's vitals were monitored throughout. The pulse was 54, saturations 98, blood
pressure 118/69.
INDICATIONS: The patient is an elderly man with a history of back pain after having suffered a
fall. He underwent a workup that included x-rays and an MRI of the spine. This workup revealed
the presence of acute wedge compression fractures at the level of T11 and T12 and his pain
corresponded to the area of these wedge compression fractures. He was referred to
neurosurgery for further care. In my clinic, I evaluated the patient's x-rays and made the
recommendation to proceed with a vertebroplasty as a modality due to his pain and to prevent
further compression. The procedure along with its risks, possible benefits and possible
complications were explained to the patient and his family to their understanding and their
questions were answered to their satisfaction. He consented to the operation as
described.PROCEDURE: The patient brought into the operating room and while on the stretcher
general anesthesia was induced and he was endotracheally intubated. He was subsequently
transferred to the Jackson table in the prone position where the surgical
CaseID: OPD6925
Primary Diagnosis: S52.571A
Secondary Diagnosis: V29.99XA
CPT: 25608-RT - Answer MEDICAL RECORD
PREOPERATIVE DIAGNOSIS: RIGHT DISTAL RADIUS COMMINUTED INTRAARTICULAR
FRACTURE.PROCEDURES: ORIF RIGHT WRIST.POSTOPERATIVE DIAGNOSIS: RIGHT DISTAL RADIUS
COMMINUTED INTRAARTICULAR FRACTURE.SURGEON:ANESTHESIA: GENERAL VIA
ENDOTRACHEAL TUBE.ESTIMATED BLOOD LOSS: MINIMAL.TOURNIQUET TIME: 63
MINUTES.ANTIBIOTICS: 1 GM ANCEF PREOP AND 1 GM ANCEF POSTOP.COMPLICATIONS:
NONE.INDICATIONS: The patient is a right-hand dominant male who sustained a 2-fragment
closed right distal radius comminuted intraarticular fracture due to motorcycle accident. It was
displaced and unable to adequately close reduced. Options, risks and benefits were discussed
with the patient. He agreed with open reduction internal fixation.PROCEDURE: The patient was
brought to the operating room and anesthesia was induced via endotracheal tube. The right
upper extremity was prepped and draped in sterile fashion. It was exsanguinated, and the
tourniquet was inflated to 250.A longitudinal incision was made over the flexor carpi radialis
tendon and taken down through subcutaneous tissue to the tendon. The sheath was opened,
and the tendon was retracted radialward. The bottom of the sheath was opened, and the
severed tendinous space was exposed. The pronator quadratus was reflected ulnarward. The
fracture was subperiosteally dissected, irrigated out and curetted. Anatomic reduction was
performed, held by hand and an Acumed plate was placed along the volar surface and adjusted
and seemed to be in good position. The oblong hole was drilled in place and final adjustments
were made in the plate. The distal holes were then drilled, measured and a combination of
locking and unlocking lag screws and plates were placed including the styloid screws.C-arm
imaging was used throughout to ensure good position of the fracture fragments and hardware.
The most proxim
CaseID: OPD6926
, Primary Diagnosis: M17.0
CPT: 27447-LT - Answer MEDICAL RECORD
OPERATION REPORTPREOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT DISEASE, LEFT
KNEE.PROCEDURES: LEFT TOTAL KNEE ARTHROPLASTY.POSTOPERATIVE DIAGNOSIS: PRIMARY
DEGENERATIVE JOINT DISEASE, LEFT KNEE.SURGEON:ANESTHESIA: GENERAL.ESTIMATED BLOOD
LOSS: MINIMAL.DRAINS: HEMOVAC, LEFT KNEE.IMPLANTS: ZIMMER NEXGEN KNEE
COMPONENTS AS FOLLOWS, NEXGEN LEGACY POSTERIOR STABILIZED LPS-FLEX FEMORAL
COMPONENT SIZE G, NEXGEN STEMMED TIBIAL COMPONENT SIZE 6, ALL POLYETHYLENE
PATELLA COMPONENT OF SIZE 38 9.5-MM THICKNESS, LPS-FLEX TIBIAL ARTICULAR SURFACE 10-
MM HEIGHT AND TAPER STEM PLUG FOR THE TIBIAL COMPONENT.COMPLICATIONS:
NONE.POSTOPERATIVE CONDITION: STABLE.INDICATIONS: The patient is a male with past
medical history of hypertension, hepatitis-C and history of left ankle/foot triple arthrodesis ten
years ago, has had chronic history of bilateral knee primary DJD for approximately ten years left
greater than right. The patient has severe pain. The patient had no relief with conservative
therapy including anti-inflammatory pain medications, exercises, rehab, knee braces and steroid
injections. The patient was indicated for a total knee arthroplasty. Surgical option was explained
to patient at length. Risks, benefits and alternatives of surgery were discussed with the patient
at length. Risks explained included but were not limited to infection, bleeding, nerve vessel
damage, possible need for transfusion, knee stiffness, risks of deep venous thrombosis,
pulmonary embolism, risks of pneumonia myocardial function, risk of anesthesia, need for
temporary blood thinners, possible need for prolong rehab after surgery and possible need for
revision of surgery in the future.The patient understood and accepted all the risks. Surgical
consent was signed. Correct surgical site was marked.PROCEDURE: The patient was brought into
th
CaseID: OPD6927
Primary Diagnosis: E11.52
CPT: 28820-T7 - Answer MEDICAL RECORD
SEX: FEMALE Age: 78DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS: A GANGRENE
OF RIGHT THIRD TOE.PROCEDURES: OPEN AMPUTATION OF RIGHT THIRD TOE.POSTOPERATIVE
DIAGNOSIS: A GANGRENE OF RIGHT THIRD TOE.SURGEON: Stephanie Andrews MDANESTHESIA:
LOCAL WITH ANESTHESIA STANDBY.ESTIMATE BLOOD LOSS: LESS THAN 5 CC.COMPLICATIONS:
NONE.INDICATIONS: This patient is a Type II diabetic female with chronic lower extremity
arterial insufficiency. She has developed a progressive gangrene of the right third toe. Open
amputation of the gangrenous right third toe has been recommended and in addition to
intravenous antibiotics and further evaluation and treatment of her lower extremity arterial
insufficiency.PROCEDURE: The patient was taken to the operating room and placed in the supine
position on the operating room table. The patient's right foot, ankle and toes were prepped and
draped in the usual sterile fashion. A 1% lidocaine mixed with 0.25% Marcaine was used to
perform a digital block of the right third toe.An elliptical incision was then made at the base of
the right third toe circumferentially. This was carried down through the subcutaneous tissues.
The flexor and extensor tendons of the toe were sharply divided using a #15 scalpel. The
proximal phalanx was then transected using a bone cutting device. Specimen was removed from
the operative field and sent to pathology for examination. The operative site was inspected for
hemostasis and satisfactory hemostasis was obtained using sparing electrocautery. The wound
was then irrigated with saline solution and reinspected for hemostasis which was found to be
satisfactory. A single subcuticular dermal suture of 5-0 Vicryl was used to loosely reapproximate
Latest Exam and All Correct Answers
2025-2026 Updated.
CaseID: OPD6918
Primary Diagnosis: N63.11
Secondary Diagnosis: N63.15
CPT: 19120-RT - Answer MEDICAL RECORD
OPERATION REPORTAGE: 22Sex: FDATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS:
RECURRENT RIGHT BREAST MASS.PROCEDURES: EXCISION RIGHT BREAST MASS X
2.POSTOPERATIVE DIAGNOSIS: RECURRENT RIGHT BREAST MASS.SURGEON:ANESTHESIA: LMA
AND LOCAL INFILTRATION.PROCEDURE: The patient is a female who has a recurrent mass that
was multilobulated in the entire right upper outer quadrant and also a separate mass which was
further away from the nipple at a 9 o'clock position. These two were identified. After skin local
infiltration anesthesia was given.A curvilinear incision was made around the nipple. The skin
flaps were raised, so that the entire large mass was exposed. This was about 2 to 3 cm. The
mass was identified below some of the glandula and fat tissue. It was completely excised using
sharp dissection knife and with possible margin around. The patient had smaller breast and
there was active gland tissue around the area of the excision. Once the entire mass was excised.
The superior margin was marked with a sharp silk suture and lateral with a long Prolene and the
deep margin with staple. Once this was done, on further palpation, there was discrete separate
mass in about 1 cm further lateral at the 9 o'clock position. This was exposed and then using
sharp dissection, this was about 1 cm and removed in total and sent for pathology separately.
The bed was irrigated and inspected. Hemostasis was achieved. The breast tissue was
approximated using 3-0 Vicryl. The skin was closed using 4-0 Monocryl and sterile dressings
were applied.The patient tolerated the procedure well.Electronically signed by 1/1/20XX
CaseID: OPD6919
Primary Diagnosis: Z41.1
Secondary Diagnosis: N64.82
CPT: 19325-50 - Answer MEDICAL RECORD
OPERATIVE NOTESex: FAGE: 38DOS: 1/1/20XXPHYSICIAN:PREOPERATIVE DIAGNOSIS: Bilateral
breast hypoplasia.POSTOPERATIVE DIAGNOSIS: Bilateral breast hypoplasiaOPERATIVE
PROCEDURE: Bilateral augmentation using Mentor moderate-plus profile silicone-filled
implants, volume 375 mL, serial number on the patient's left is xxx. Serial number on the
patient's right is xxx.SURGEON:ANESTHESIA: General.COMPLICATIONS: None.INDICATIONS: Ms.
Smith is a female, who is interested in bilateral breast augmentation for treatment of breast
hypoplasia. She understood the risks of breast asymmetry, capsular contracture, hematoma,
seroma, infection, breast pain, nipple anesthesia, and need for further surgery. Understanding
these risks and possible outcomes, she agreed and wished to proceed with surgery.PROCEDURE:
The patient was brought to the operating room, where she was placed in supine position. She
was placed under general anesthesia without incident. She had been marked for augmentation
in the preoperative holding area. Her chest was sterilely prepped and draped in usual fashion. I
,first started on the patient's left. A periareolar incision of 4 cm length was made along the
inferior border. The skin flap was elevated inferiorly towards the inferior mammary crease. The
breast parenchyma in the midline was then incised and carried down to the chest wall. The
inferior border of the pectoralis major muscle was identified and incised along its border. A
submuscular pocket was developed bluntly. Muscle fiber was released medially to reach the
sternal border. The pectoralis major muscle insertion along the sternum was left intact. The
inferior insertion of the pectoralis major muscle was released. After creation of a submuscular
pocket, I irrigated the pocket out well with saline. With adequate retraction, I then placed a
375-mL mo
CaseID: OPD6920
Primary Diagnosis: T85.79XA
Secondary Diagnosis: Z85.3, Z92.21
CPT: 11971-LT - Answer MEDICAL RECORD
OPERATIVE NOTEPHYSICIAN:PREOPERATIVE DIAGNOSES:1. History of left breast cancer, status
post-first-stage breast reconstruction with placement of tissue expander.2. Left breast
cellulitis.POSTOPERATIVE DIAGNOSES:1. History of left breast cancer, status post-first-stage
breast reconstruction with placement of tissue expander.2. Left breast cellulitis, with infected
tissue expander.OPERATIVE PROCEDURE: Removal of left breast tissue expander with light
pocket debridement and irrigation.SURGEON:ANESTHESIA: Monitored anesthesia care and IV
sedation.INDICATIONS: Ms. Smith is a female who underwent immediate first-stage breast
reconstruction with placement of tissue expander and AlloDerm. Shortly after surgery, she
developed erythema consistent with cellulitis. She was started on oral antibiotics and after not
improving, she was treated with six weeks of IV antibiotics. Her erythema had resolved and she
had no pain or evidence of significant edema or seroma or abscess. The patient then started
chemotherapy and has finished the chemo. Shortly afterwards she developed some recurrent
hyperemia. There was a concern for possible recurrent infection and she was started on oral
antibiotics. She seemed to improve, but continued to have persistent hyperemia concerning for
cellulitis and possibly deeper infection. After discussing the situation with Dr. Andrews, we
decided that the most appropriate action would be to remove the expander and to obtain
cultures to prevent any overwhelming infection. The patient agreed and wished to proceed with
the surgical procedure.DESCRIPTION OF PROCEDURE: The patient was brought to the operating
room, where she was placed in a supine position. She was placed under IV sedation. The
patient's surgical scars were infiltrated with 1% lidocaine with epinephrine. The patient's lateral
chest w
CaseID: OPD6923
Primary Diagnosis: S22.080A
Secondary Diagnosis: W19.XXXA
CPT: 22513, 22515, 99152, 99153 - Answer MEDICAL RECORD
PATIENT: Smith, SandyAGE: 67SEX: MPrivate Payer (Medicare rules for 65 and older)DATE OF
OPERATION: 01/28/20XXPREOPERATIVE DIAGNOSIS: COMPRESSION FRACTURES OF T11 AND
T12.PROCEDURES: T11 AND T12 VERTEBRAL KYPHOPLASTIES.POSTOPERATIVE DIAGNOSIS:
BILATERAL WEDGE COMPRESSION FRACTURES OF T11 AND T12.ESTIMATED BLOOD LOSS: NO
MORE THAN 1 OR 2 CC.COMPLICATIONS: NONE.SURGEON: Neil Kramer, M.D.FIRST
,ASSISTANT:ANESTHESIA: Conscious sedation. Intraservice time 45 mins. The patient was given a
total of 200 mg of propofol intravenously for conscious sedation by MD and supervised an
observing nurse anesthetist for the duration of the procedure. Periodic assessments were made
and patient's vitals were monitored throughout. The pulse was 54, saturations 98, blood
pressure 118/69.
INDICATIONS: The patient is an elderly man with a history of back pain after having suffered a
fall. He underwent a workup that included x-rays and an MRI of the spine. This workup revealed
the presence of acute wedge compression fractures at the level of T11 and T12 and his pain
corresponded to the area of these wedge compression fractures. He was referred to
neurosurgery for further care. In my clinic, I evaluated the patient's x-rays and made the
recommendation to proceed with a vertebroplasty as a modality due to his pain and to prevent
further compression. The procedure along with its risks, possible benefits and possible
complications were explained to the patient and his family to their understanding and their
questions were answered to their satisfaction. He consented to the operation as
described.PROCEDURE: The patient brought into the operating room and while on the stretcher
general anesthesia was induced and he was endotracheally intubated. He was subsequently
transferred to the Jackson table in the prone position where the surgical
CaseID: OPD6925
Primary Diagnosis: S52.571A
Secondary Diagnosis: V29.99XA
CPT: 25608-RT - Answer MEDICAL RECORD
PREOPERATIVE DIAGNOSIS: RIGHT DISTAL RADIUS COMMINUTED INTRAARTICULAR
FRACTURE.PROCEDURES: ORIF RIGHT WRIST.POSTOPERATIVE DIAGNOSIS: RIGHT DISTAL RADIUS
COMMINUTED INTRAARTICULAR FRACTURE.SURGEON:ANESTHESIA: GENERAL VIA
ENDOTRACHEAL TUBE.ESTIMATED BLOOD LOSS: MINIMAL.TOURNIQUET TIME: 63
MINUTES.ANTIBIOTICS: 1 GM ANCEF PREOP AND 1 GM ANCEF POSTOP.COMPLICATIONS:
NONE.INDICATIONS: The patient is a right-hand dominant male who sustained a 2-fragment
closed right distal radius comminuted intraarticular fracture due to motorcycle accident. It was
displaced and unable to adequately close reduced. Options, risks and benefits were discussed
with the patient. He agreed with open reduction internal fixation.PROCEDURE: The patient was
brought to the operating room and anesthesia was induced via endotracheal tube. The right
upper extremity was prepped and draped in sterile fashion. It was exsanguinated, and the
tourniquet was inflated to 250.A longitudinal incision was made over the flexor carpi radialis
tendon and taken down through subcutaneous tissue to the tendon. The sheath was opened,
and the tendon was retracted radialward. The bottom of the sheath was opened, and the
severed tendinous space was exposed. The pronator quadratus was reflected ulnarward. The
fracture was subperiosteally dissected, irrigated out and curetted. Anatomic reduction was
performed, held by hand and an Acumed plate was placed along the volar surface and adjusted
and seemed to be in good position. The oblong hole was drilled in place and final adjustments
were made in the plate. The distal holes were then drilled, measured and a combination of
locking and unlocking lag screws and plates were placed including the styloid screws.C-arm
imaging was used throughout to ensure good position of the fracture fragments and hardware.
The most proxim
CaseID: OPD6926
, Primary Diagnosis: M17.0
CPT: 27447-LT - Answer MEDICAL RECORD
OPERATION REPORTPREOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT DISEASE, LEFT
KNEE.PROCEDURES: LEFT TOTAL KNEE ARTHROPLASTY.POSTOPERATIVE DIAGNOSIS: PRIMARY
DEGENERATIVE JOINT DISEASE, LEFT KNEE.SURGEON:ANESTHESIA: GENERAL.ESTIMATED BLOOD
LOSS: MINIMAL.DRAINS: HEMOVAC, LEFT KNEE.IMPLANTS: ZIMMER NEXGEN KNEE
COMPONENTS AS FOLLOWS, NEXGEN LEGACY POSTERIOR STABILIZED LPS-FLEX FEMORAL
COMPONENT SIZE G, NEXGEN STEMMED TIBIAL COMPONENT SIZE 6, ALL POLYETHYLENE
PATELLA COMPONENT OF SIZE 38 9.5-MM THICKNESS, LPS-FLEX TIBIAL ARTICULAR SURFACE 10-
MM HEIGHT AND TAPER STEM PLUG FOR THE TIBIAL COMPONENT.COMPLICATIONS:
NONE.POSTOPERATIVE CONDITION: STABLE.INDICATIONS: The patient is a male with past
medical history of hypertension, hepatitis-C and history of left ankle/foot triple arthrodesis ten
years ago, has had chronic history of bilateral knee primary DJD for approximately ten years left
greater than right. The patient has severe pain. The patient had no relief with conservative
therapy including anti-inflammatory pain medications, exercises, rehab, knee braces and steroid
injections. The patient was indicated for a total knee arthroplasty. Surgical option was explained
to patient at length. Risks, benefits and alternatives of surgery were discussed with the patient
at length. Risks explained included but were not limited to infection, bleeding, nerve vessel
damage, possible need for transfusion, knee stiffness, risks of deep venous thrombosis,
pulmonary embolism, risks of pneumonia myocardial function, risk of anesthesia, need for
temporary blood thinners, possible need for prolong rehab after surgery and possible need for
revision of surgery in the future.The patient understood and accepted all the risks. Surgical
consent was signed. Correct surgical site was marked.PROCEDURE: The patient was brought into
th
CaseID: OPD6927
Primary Diagnosis: E11.52
CPT: 28820-T7 - Answer MEDICAL RECORD
SEX: FEMALE Age: 78DATE OF OPERATION: 1/1/20XXPREOPERATIVE DIAGNOSIS: A GANGRENE
OF RIGHT THIRD TOE.PROCEDURES: OPEN AMPUTATION OF RIGHT THIRD TOE.POSTOPERATIVE
DIAGNOSIS: A GANGRENE OF RIGHT THIRD TOE.SURGEON: Stephanie Andrews MDANESTHESIA:
LOCAL WITH ANESTHESIA STANDBY.ESTIMATE BLOOD LOSS: LESS THAN 5 CC.COMPLICATIONS:
NONE.INDICATIONS: This patient is a Type II diabetic female with chronic lower extremity
arterial insufficiency. She has developed a progressive gangrene of the right third toe. Open
amputation of the gangrenous right third toe has been recommended and in addition to
intravenous antibiotics and further evaluation and treatment of her lower extremity arterial
insufficiency.PROCEDURE: The patient was taken to the operating room and placed in the supine
position on the operating room table. The patient's right foot, ankle and toes were prepped and
draped in the usual sterile fashion. A 1% lidocaine mixed with 0.25% Marcaine was used to
perform a digital block of the right third toe.An elliptical incision was then made at the base of
the right third toe circumferentially. This was carried down through the subcutaneous tissues.
The flexor and extensor tendons of the toe were sharply divided using a #15 scalpel. The
proximal phalanx was then transected using a bone cutting device. Specimen was removed from
the operative field and sent to pathology for examination. The operative site was inspected for
hemostasis and satisfactory hemostasis was obtained using sparing electrocautery. The wound
was then irrigated with saline solution and reinspected for hemostasis which was found to be
satisfactory. A single subcuticular dermal suture of 5-0 Vicryl was used to loosely reapproximate
