CCS ICD practice questions Part 2
1. A patient was brought to the emergency department following a burn injury experienced in a
fire at the garage where he works. He was admitted and treated for first-degree and second-
degree burns of the forearm and third-degree burn of the back.
2. A patient was admitted because of suspected carcinoma of the colon. Exploratory laparotomy
was carried out, and a significant mass was discovered in the sigmoid colon. The sigmoid colon
was resected and end-to-end anastomosis accomplished. Small nodules were noted on the liver,
and a needle biopsy of the liver was performed during the procedure. The pathology report
confirmed adenocarcinoma of the sigmoid colon with metastasis to the liver.
3. A patient was discharged following prostate surgery with an indwelling urethral catheter in
place. He was readmitted with urinary sepsis due to methicillin-resistant Staphylococcus aureus
(MRSA) due to the presence of the catheter. The physician confirmed the diagnosis of sepsis due
to MRSA. The catheter was removed and the patient started on antibiotic therapy. The patient’s
condition improved over several days, and he was discharged without an indwelling catheter.
4. A patient 25 weeks pregnant was diagnosed as having an iron-deficiency anemia and was
admitted for transfusion of nonautologous packed red blood cells (via peripheral vein).
5. A patient was admitted with occlusion (due to plaque) of the right common carotid artery, and
open carotid endarterectomy was carried out with extracorporeal circulation (continuous
cardiac output) used throughout the procedure.
6. A patient was admitted in a coma due to acute cerebrovascular thrombosis with cerebral
infarction; the coma cleared by the fourth hospital day. Aphasia and hemiparesis were also
present. The aphasia had cleared by discharge, but the hemiparesis was still present.
7. A patient was admitted with severe abdominal pain that began two days prior to admission and
progressed in severity. Esophagogastroduodenoscopy (EGD) revealed an acute gastric ulcer, but
no signs of hemorrhage or malignancy were noted. The provider documented acute gastric
ulcer, and the patient was put on a medical regimen, including a bland diet, and was advised not
to take aspirin.
8. A patient with type 1 diabetes mellitus with hyperglycemia was admitted for regulation of
insulin dosage. The patient had been in the hospital three weeks earlier for an acute ST
elevation myocardial infarction of the inferolateral wall, and an EKG was performed to check its
current status.
9. A patient who was treated seven weeks ago at Community Hospital for an acute anterolateral
myocardial infarction is now admitted to University Hospital for surgical repair of an atrial septal
defect resulting from the recent infarction. Following thoracotomy, the defect was repaired with
a nonautologous tissue graft; cardiopulmonary bypass (extracorporeal circulation, continuous
cardiac output) was used during the procedure. The patient was discharged in good condition,
to be followed as an outpatient.
10. A patient with bilateral mixed conductive and sensorineural hearing loss was admitted for
cochlear implantation. Bilateral multiple channel implants were inserted through an open
approach and the patient was discharged, to be followed as an outpatient.
11. A patient who underwent a right kidney transplant three months ago is admitted for biopsy
because of an increased creatinine level discovered on an outpatient visit. Percutaneous biopsy
revealed chronic rejection syndrome. The patient was discharged on a modified medication
regimen, to be followed closely as an outpatient.
12. A patient was admitted with a displaced fracture of the shaft of the right femur. Closed
reduction was carried out and a cast was applied.
13. A patient who has had recurrent attacks of angina was seen in his physician’s office because he
felt that the anginal attacks seemed to be occurring more frequently and to be more severe and
more difficult to control. He had not had a thorough evaluation previously, and bypass surgery
had not been recommended in the past. He was admitted to the hospital for diagnostic studies
to determine the underlying cause of this unstable angina. He underwent combined right- and
left-heart catheterization, which revealed significant atherosclerotic heart disease. He was
advised that coronary artery bypass surgery was indicated, but he did not want to make a
decision without further discussion with his family. He was discharged on antianginal medication
and will be seen in the doctor’s office in one week.
14. The patient discussed in the preceding case returned to the hospital for bypass surgery. His
angina is under control with the antianginal medications he was prescribed. Reverse right
greater saphenous vein grafts were brought from the aorta to the obtuse marginal and the right
coronary artery; the left internal mammary artery was loosened and brought down to the left
anterior descending artery to bypass this obstruction. The gastroepiploic artery was used as a
pedicled graft to bypass the circumflex. Extracorporeal circulation (continuous cardiac output)
and intraoperative pacemaker were used during the procedure and discontinued afterward.
15. A patient was brought to the hospital by ambulance after a fall from the scaffolding while
working on the construction of a new bank building. He had struck his head and experienced a
brief period of unconsciousness (approximately 45 minutes). On examination, he was found to
have an open skull fracture with cerebral laceration and contusion. The skull fracture was
reduced after debridement, and the patient was transferred to the intensive care unit, where he
stayed for four days. He was discharged on the 10th day in good condition and advised to avoid
any strenuous activity and to see his physician in one week.