Question 74 hpi comments this is an 86 year old aaf

Question 74
HPI Comments: This is an 86-year-old AAF with medical hx remarkable
for Alzheimer’s with dementia, HTN, depression and DM presenting via
EMS from his nursing home for PEG tube replacement. Peg has been
replaced three times in past three days because patient repeatedly
removes it at nursing home. History is limited secondary to patient's
mental status.
a. G30.9, I63.9, I10, F32.9, E11.9, Z43.1
b.G30.9, F02.80, I10, F32.9, E11.9, Z43.1
c. G30.9, I10, F32.9, E11.9, Z43.1
d.I10, E11.9, Z43.1
Question 75
ASSESSMENT
1. Coronary Artery Disease: status post CABG
2. Benign essential hypertension: Blood pressure would normally be
adequately controlled on his current regimen except that we are
finding a mildly enlarged aortic root on his most recent echo (4.2
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4. Hyperlipidemia: He has reached his target LDL reduction below 70
with his current therapy.
Question 76
SUBJECTIVE:
An 86-year-old male here in the office in follow up. Having troubles
with neuropathic symptoms, numbness, tingling, burning in his feet. He
tried Nortriptyline. It did not seem to help much at all. Still on
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simvastatin 20 for hyperlipidemia, aspirin for his history of old MI, and
COPD. Patient having no coughing, or shortness of breath right now
continue with Symbicort. No chest pain or palpitations. No back pain.
OBJECTIVE:
He is afebrile. Blood Pressure is 128/74. LUNGS: Clear. CARDIAC
EXAM: Regular rate and rhythm.
ASSESSMENT AND PLAN:
1. Peripheral neuropathy. Nonresponsive to Nortriptyline. Try
Lyrica 50 mg. If causes dizziness advised him to stop. The only other
option would be to try Cymbalta or Neurotin.
2. Hyperlipidemia. Continue Simvastatin.
3. Gastroesophageal Reflux disease. Continue Rantidine.
4. Healthcare maintenance. Flu shot given. Follow up two weeks.
a. G62.9, E78.5, K21.9, Z79.82
b.G58.9, E78.5, K21.9, J44.9, Z79.82
c. G62.9, E78.5, K21.9, I25.2, J44.9, Z79.82
d.G58.9, E78.00, K21.9, I25.2, J44.9, Z79.82
Question 77
HPI: 65-year-old female in for follow up of CHF, controlled on meds,
diabetes, stable/controlled and HTN.
Vials: BP 140/80 left arm sitting, P 86 R16 T 98.7 BMI 50.6
Exam unchanged form visit one month ago:
Heart sounds wnl, Resp clear no wheeze, bowel sounds wnl, capillary
refill of toes wnl. No numbness or tingling or pain complaints.
Assessment/ Plan:
1. CHF- continue meds, diuretic and potassium replacement
working well for her
2. DM – continue Metformin
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3. HTN- no change in beta blocker
4. Morbid obesity- referred to dietary 5 months ago- but patient has
not kept appointment
a. I11.0, I50.9, E11.9, E66.9, Z79.84
b.I11.0, E11.9, E66.9, Z68.43, Z79.84
c. I50.9, E11.9, I11.0, E66.01, Z68.43, Z79.84
d.I50.9, E11.9, I11.0, E66.9, Z68.43, Z79.84
Question 78
Oncology Center
Diagnosis: MS. F is a 68-year-old female with a diagnosis of recurrent,
poorly differentiated, papillary carcinoma of the thyroid gland, initial
stage unclear. The patient completed 3,000 cGy in 10 treatments five
months ago with significant improvement, due to the patient’s condition
and performance status, split-course radiotherapy was offered. The
patient will continue to be treated with chemotherapy.