CCS ICD practice questions Part 5

1. Inpatient admission: The patient was admitted for an evaluation of her adrenal malfunction.
She had a four-year history of hypertension and hypokalemia with evidence of primary
aldosteronism. A non-contrast CT scan of the abdomen also suggested a left adrenal mass.
She was discharged and was to return for a left adrenalectomy the following week.

Discharge diagnoses: (1) Probable adrenal mass, left; (2) hypertension and hypokalemia
probably due to primary aldosteronism.

2. Inpatient admission: The patient was admitted for severe malnutrition and hematuria
secondary to amyotrophic lateral sclerosis. Because of her malnutrition, a nasogastric
feeding tube was placed under fluoroscopy and nutritional substance was administered
later. During her stay, the hematuria cleared spontaneously, and she was discharged to
home care.

Discharge diagnoses: (1) Malnutrition, (2) hematuria secondary to amyotrophic lateral

sclerosis.

3. Inpatient admission: The patient fell at his single-family home and was unable to get up.
Neighbors found him several hours later, and he does not remember any circumstances
surrounding the event. Blood sugars were monitored, and a diagnosis of diabetes mellitus
was given. It became rapidly evident to the attending physician that, even with dietary
restriction, the patient would need insulin therapy to lower his blood sugar level. Insulin
therapy was started. The only other positive finding was beta-Streptococcus group B, which
grew from the urine culture and was treated with oral antibiotics.

Discharge diagnoses: (1) New onset type 2 diabetes mellitus, out of control; (2) urinary tract
infection with beta-Streptococcus.

4. Outpatient clinic visit: The patient with type 2 diabetes was status post cadaveric kidney and
pancreatic transplants. He was being seen for follow-up of a recent amputation of the foot
due to a nonhealing, gangrenous ulcer on his left foot secondary to diabetic peripheral
vascular disease. The operative site was healing very nicely, and there was no evidence of
infection.

Diagnoses: (1) Status post left foot amputation, (2) status post kidney and pancreas
transplants, (3) diabetes mellitus.
5. Inpatient admission: The patient, an elderly woman with type 2 diabetes mellitus,
developed hypoglycemia at the nursing home and was symptomatic. In the emergency
department, her decreased blood sugar was treated with intravenous D5W. A urinary tract
infection was also present and was treated with antibiotics. The urine culture grew
Klebsiella, sensitive to Cipro. She then developed mild congestive heart failure, probably
secondary to the hypoglycemic reaction, which responded to oxygen and rest. Her Diabeta
regimen was restarted at a lower dosage.

Discharge diagnoses: (1) Congestive heart failure secondary to hypoglycemia, (2) type 2
diabetes mellitus, (3) urinary tract infection.

6. Inpatient admission: The patient, a young male with type 1 diabetes, was brought in a
comatose state to the emergency department by friends. He was admitted with ketoacidosis
and was resuscitated with saline hydration via insulin drip. After regaining consciousness, he
reported that the morning of admission he was experiencing nausea and vomiting and
decided not to take his insulin because he had not eaten. He was treated with intravenous
hydration and insulin drip. By the following morning, his laboratory work was within normal
range and he was experiencing no symptoms.

Discharge diagnoses: (1) Diabetic ketoacidosis, (2) juvenile-onset diabetes.

7. Inpatient admission: The patient with type 1 diabetes mellitus seriously out of control was
admitted for regulation of insulin dosage. He had a recently abscessed right molar, which
was determined, in part, to be responsible for the elevation of his blood sugar. The patient
had been in the hospital three weeks earlier for an acute myocardial infarction of the
inferoposterior wall, and an EKG was performed to check its current status.

Discharge diagnoses: (1) Myocardial infarction, (2) abscessed tooth, (3) uncontrolled type 1
diabetes mellitus.

8. Outpatient clinic visit: A 57-year-old Hispanic male presented to the Medical Eye Service
clinic for a retinal evaluation of diabetic retinopathy. He reported vision that fluctuated only
in the morning and poorer vision in the right eye. He was diagnosed with type 2 diabetes
mellitus 15 years ago and is currently taking Glucophage. He was diagnosed with diabetic
retinopathy and advised to schedule grid laser treatment at his earliest convenience.

Diagnosis: Severe nonproliferative diabetic retinopathy, OD greater than OS.

9. Outpatient clinic visit: The patient was seen to evaluate his progress in dealing with his long-
standing alcoholism. In addition, he had a passive-aggressive personality disorder and was
dependent on Librium. He was actively participating in Alcoholics Anonymous and stated he
would continue to participate. He apparently now had some alcoholic liver damage and was
referred to an internist for further investigation of that condition.

Diagnoses: (1) Alcohol dependence; (2) passive-aggressive personality disorder; (3) drug
dependence, Librium; (4) alcoholic liver damage.

10. Outpatient clinic visit: The patient, a young female, was brought in by her sister. She has had
periods of severe depression for many years. Her medications consisted of Lithium,
Synthroid, and Maxalt for depression, hypothyroidism, and migraine headaches,
respectively. During the past week, however, she became manic, running all her credit cards
to the limit, getting inappropriately involved in a woman’s suicide attempt, quitting her job,
and trying to take over the pulpit at church. On the day of the clinic visit, she threatened to
strike a neighbor with a lead pipe. She was to be admitted for Lithium adjustment.

Diagnoses: (1) Bipolar disorder, manic type; (2) hypothyroidism; (3) migraine headaches.

11. Inpatient admission: The woman was brought in by police for observation of a suspected
mental condition. They found her roaming the streets, and she seemed disoriented and
confused. She was treated for scabies, body lice, and cellulitis of the right foot. Her mental
status cleared rapidly. The only psychiatric disorder found was moderate intellectual
disability.

Discharge diagnoses: (1) Moderate intellectual disability; (2) scabies; (3) body lice; (4)
cellulitis, right foot.

12. Outpatient clinic visit: This 59-year-old male patient with a history of paranoid schizophrenia
has had constant conflict with his family and coworkers for years. His wife reported that he
was in danger of losing his job because he threatened his supervisor’s life. He recently spent
the night in jail after an altercation with a neighbor. Medication was prescribed, and he was
to return for follow-up in one week.

Diagnosis: Schizophrenia, paranoid type, chronic with acute exacerbation.

13. Outpatient clinic visit: An 18-year-old patient was described by his mother as recently having
periods of depression, throwing temper tantrums, and stealing from neighbors. He had a
history of type 1 diabetes and sometimes refused to take his insulin or follow his diet. His
speech, best described as “baby talk,” had also become worse during the previous two
months. A prescription was written for his depression.

Diagnoses: (1) Depression, (2) borderline personality disorder, (3) delayed speech
development, (4) type 1 diabetes mellitus.

14. Inpatient admission: The patient was brought to the emergency department by the police
and admitted to psychiatric service. Police requested an evaluation after the man was
disorderly and aggressive at the scene of an automobile accident in which he was involved.
He was admitted with a diagnosis of probable dementia.

Discharge diagnoses: (1) Organic brain syndrome with presenile dementia, (2) probably
Alzheimer’s disease with dementia.

15. Inpatient admission: The patient, with a four-year history of anorexia nervosa, was seen in
the physician’s office because of significant weight loss over the past three months, going
from 82 pounds down to 53 pounds. She was admitted to increase body weight and to be
given nutritional counseling because of her severe malnutrition.

Discharge diagnosis: Anorexia nervosa, severe malnutrition.

16. Inpatient admission: The patient was admitted with possible pyelonephritis. Her complaints
were bilateral flank pain and chills. A contrast intravenous pyelogram was normal. Within
two days of admission, the character of her pain changed somewhat in that it became
primarily in the right upper quadrant. The physician documented in the progress notes that
significant features of conversion hysteria were present and accounted for the patient’s
symptoms. On the third hospital day, the patient’s IV was discontinued, liver function tests
were rechecked, and antibiotics were discontinued. Later that day, she left abruptly, saying
she would not return.

Discharge diagnoses: (1) Right upper quadrant abdominal pain, (2) conversion disorder.
17. Psychiatry clinic visit: The HIV-infected patient, who had a long history of cocaine addiction,
started using cocaine again. Several months ago, he was admitted for treatment of
Pneumocystis carinii pneumonia. Presently, severe depression brought him to the clinic. He
and the physician had an extensive discussion about returning to Narcotics Anonymous and
also joining an AIDS support group. A prescription for Prozac was given for his depression.

Diagnoses: (1) Severe depression, (2) cocaine addiction, (3) HIV infection.

18. Outpatient clinic visit: Patient is a 34-year-old male who came back from a tour of duty in
Iraq. Since his return, his family has noticed he is often anxious, has a short temper, and has
been drinking excessively. His family persuaded him to seek professional counseling, during
which he was diagnosed with post-traumatic stress disorder, given a prescription for Paxil,
and scheduled for once-a-week therapy sessions at the mental health clinic.

Diagnoses: (1) Acute post-traumatic stress disorder, (2) anxiety disorder due to alcohol
abuse.