Metastatic carcinoma to pancreas.

 

 

Question 1

Congestive cardiac failure and idiopathic hypertension.

 

 

 

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 2

Metastatic carcinoma to pancreas.

 

 

 

 

 

 

Value 12 marks

1.  
2.  
3.  
4.  
5.  

 

Question 3

Seronegative rheumatoid arthritis of shoulders, hands and ankles.

 

 

 

 

 

 

Value 4 marks

1.  
2.  
3.  
4.  
5.  

 

Question 4

Patient admitted for treatment of chronic crepitant synovitis of hands and fingers due to physical strain related to their occupation.

 

 

 

 

Value 7 marks

1.  
2.  

 

3.  
4.  
5.  

 

 

Question 5

Car occupant sustained bilateral Colles’ fractures due to collision with another car.

 

 

 

 

 

 

Value 7 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 6

Patient admitted at 30 weeks pregnant with vaginal thrush.

 

 

 

 

 

Value 9 marks

1.  
2.  
3.  
4.  
5.  

 

Question 7

Patient admitted with an acute transmural myocardial infarction of the anterior wall two weeks after the previous acute transmural myocardial infarction of the inferior wall.

 

 

 

Value 3 marks

1.  
2.  
3.  
4.  
5.  

Question 8

Patient admitted with complete heart block was transferred to hospital (B) for a pacemaker insertion and then transferred back to the original hospital (A) the same day for cardiac rehabilitation with the cardiac pacemaker in situ. Answer to include Code(s) required for Hospital A episode, i.e. the transfer back only.

Value 8 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 9

Patient admitted to maternity unit with spontaneous preterm labour and went on to deliver a preterm baby in the same episode of care.

 

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 10

Neutropenic sepsis due to anaerobic bacteria.

 

 

 

 

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

Question 11

Patient admitted with postviral fatigue syndrome (Myalgic encephalitis).

 

 

 

 

 

 

Value 3 marks

1.  
2.  
3.  
4.  
5.  

Question 12

First degree uterine prolapse with cystocele.

 

 

 

 

 

Value 3 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 13

Patient with cerebral atherosclerosis was admitted with suspected cerebral infarction. Investigations revealed stenosis of posterior cerebral artery not resulting in cerebral infarction.

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 14

Second degree burn of fingers (9% of body

surface). Patient deliberately burnt themselves on a fire at home.

 

 

 

 

 

Value 9 marks

1.  
2.  
3.  
4.  
5.  

 

 

 

 

 

 

 

 

 

 

 

 

Question 15

Coronavirus identified as the cause of severe acute respiratory syndrome [SARS].

 

 

 

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section A [2] 15%

Write your candidate number on every page

 

OPCS-4.6 codes are required for the next 15 questions [16 – 30]

[ICD-10 codes are NOT required]

 

Provide appropriate code(s) for the following interventions/procedures in the boxes alongside each question. If more than one code is required, please use separate boxes for each code to make sequencing clear, for example, box 1 should contain the primary procedure/intervention code. [The number of boxes is not necessarily indicative of the codes required].

 

Question 16

Ranibizumab (lucentis) High Cost Drug injection into vitreous body of right eye.

 

 

 

 

 

 

Value 7 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 17

First treatment within a course of Electroconvulsive Therapy.

 

 

 

 

 

 

 

Value 3 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 18

Right arthroscopic subacromial decompression with arthroscopic repair of a tear in the rotator cuff of shoulder.

 

 

 

 

 

Value 14 marks

1.  
2.  
3.  
4.  
5.  

 

Question 19

Endarterectomy and patch repair of inferior mesenteric artery. [6 Marks]

 

 

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 20

Patient admitted for a medical termination of pregnancy at 10 weeks gestation, by insertion of a prostaglandin pessary. She was discharged home prior to the fetus aborting.

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 21

Patient admitted for implantation of radioactive seeds in to the prostate to treat cancer.

 

 

 

 

 

Value 9 marks

1.  
2.  
3.  
4.  
5.  

 

 

 

 

 

 

 

 

 

 

 

Question 22

Endovascular repair of suprarenal aortic aneurysm, using a balloon angioplasty and insertion of one coated stent under image control.

 

 

 

 

Value 8 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 23

C14 urea breath test in outpatient clinic for helicobacter pylori.

 

 

 

 

 

 

Value 3 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 24

Oesophagogastrodudenoscopy (OGD) with snare resection of lesion of oesophagus and biopsy of pylorus performed at the same time.

 

 

 

 

 

Value 11 marks

1.  
2.  
3.  
4.  
5.  

 

 

 

 

 

 

 

 

 

 

 

 

Question 25

Patient previously admitted with open reduction and intramedullary fixation of fractured left tibia shaft. However, on this admission x-rays identified the fracture was not healing so the patient returned to theatre where the same procedure was repeated.

 

Value 8 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 26

Right side endoscopic

dacryocystorhinostomy (DCR) plus insertion of tube.

 

 

 

 

 

Value 9 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 27

A patient with Hodgkin Lymphoma is to receive the CHLVPP regimen as an outpatient. They are admitted for day 1 of treatment with Chlorambucil intravenously with saline solution. The patient is also given a 2 weeks course of Procarbazine and Prednisolone, both taken as tablets at home. On day 8 of each cycle, the patient will return as an outpatient to receive a second treatment with Chlorambucil.

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

 

 

 

 

 

 

Question 28

Electrodiagnostic evaluation of right retina.

 

 

 

 

 

 

 

Value 6 marks

 1.  
2.  
3.  
4.  
5.  

 

 

Question 29

Coronary artery bypass graft (CABG) of three coronary arteries using allograft, with allograft replacement of mitral valve.

 

 

 

 

 

Value 6 marks

1.  
2.  
3.  
4.  
5.  

 

 

Question 30

Successful trial without urethral catheter (TWOC).

 

 

 

 

 

 

Value 3 marks

1.  
2.  
3.  
4.  
5.  

 

 

 

 

 

 

 

 

 

 

 


Section B [70%]

Write your candidate number on every page

 

Answer all 7 questions in this Section using the Case Study Answer Sheets provided.

 

Case Study Number 1 [14 Marks]

Appropriate index trails are required for this Case Study only. To obtain full marks they must exactly replicate the full content of the ICD-10 and OPCS-4.6 Alphabetical Indexes.

 

 

Specialty Urology
Consultant Mrs Sykes
Date of Admission 17-11-2013
Date of Discharge 17-11-2013
 

Diagnosis

 

End stage chronic renal disease

 

Episode Summary

 

This 65 year old pleasant gentleman who is now in end stage renal disease (stage 5), with an estimated glomerular filtration rate (eGFR) of less than 15 which resulted in very severely reduced kidney function was admitted for the purpose of renal dialysis.

 

 

 

Procedure He received renal dialysis through his permanent port which was surgically installed for ease of access when regular dialysis became necessary 6 weeks ago.

 

 

 

 

Discharge

 

 

 

He tolerated the procedure well and his type II diabetes mellitus was well controlled so was discharged home later the same day.

 

 

 

 

 

 

 

   

 

Case Study Number 2 [18 Marks]

 

 

Specialty Oncology
Consultant Mr Scott
Date of Admission 30/10/2013
Date of Discharge 01/11/2013

 

 

Diagnosis

 

Liver cancer.

 

 

Episode Summary

 

This 54 year old man was diagnosed with hepatocellular carcinoma of the liver several months ago. He was admitted solely to receive interstitial radiotherapy via selective internal radiotherapy treatment (SIRT) on his liver using image control.

 

 

 

 

Procedure

 

 

 

Microspheres were inserted into the blood vessels that supply the liver (Hepatic artery) which will target the cancer cells directly.

 

 

 

Discharge

 

 

 

 

The procedure went well and the patient was encouraged to drink at least 3 pints of water over the following 24 hours to help clear the dye from his body. He was also advised that he may experience nausea which can last for a few days. The patient was discharged and will be seen in the outpatient

clinic in 2 weeks.

 

 

 

 

 

 

 

 

 

 

 

Case Study Number 3 [17

 

Specialty Surgical

 

Consultant Mr Louder

 

Date of Admission 05/11/2013
Date of Discharge 07/11/2013
 

Diagnosis

 

Thoracic Outlet Syndrome (TOS).

 

 

 

Episode Summary

 

This 45 year old lady was diagnosed with thoracic outlet syndrome (TOS) 12 months ago. She was electively admitted for surgery of the TOS due to continued pain in the neck radiating to her head, which over the past 2 months had become so severe she was unable to complete basic tasks such as brushing her hair and dressing.

 

She is tobacco dependent and currently smokes 10-20 cigarettes a day.

 

 

Procedure

 

 

She was taken to theatre and underwent both right sided wide excision of the scalene muscle of neck (Scalenectomy) and total excision of cervical rib.

 

 

Discharge

 

 

 

 

Patient recovered well and was discharged on the 7th November with a prescription for pain medication and instructions not to lift anything heavier than 5 pounds and to continue the gentle exercises taught prior to discharge until cleared by

the doctor. Outpatient appointment arranged for 4 weeks time.

 

 

 

 

 

 

 

 

 


Case Study Number 4 [15

 

Specialty Endoscopy Department

 

Consultant Mrs Robson

 

Date of Admission 26/10/2013

 

Date of Discharge 26/10/2013

 

 

Diagnosis

 

Pulmonary Tuberculosis

 

Episode Summary

 

This 60 year old male was referred by his General Practitioner for a diagnostic fibreoptic bronchoscopy as he has been experiencing a chronic cough with purulent sputum over the past 2 months.

He also suffers from myoclonic-astatic epileptic seizures but this is well controlled with anti-epileptic drugs (AEDs).

 

 

Procedure

 

The consent form was signed and he underwent a diagnostic bronchoscopy with biopsy and brushings taken from both left and right lungs. Histology confirmed Tuberculosis of lung.

 

Discharge

 

 

 

 

The procedure went well and he was monitored for 2 hours following which he was discharged with advice that he may experience a sore throat for a couple of days. He will be seen in the Endoscopy outpatient clinic in 2 weeks time.

 

 

 

 

 

 

 

 

 

 

 

Case Study Number 5 [18

 

Specialty Vascular Surgery

 

Consultant Mr Court
Date of Admission 19/12/2013
Date of Discharge 21/12/2013

 

Primary Diagnosis Femoral artery aneurysms

 

 

Relevant medical history/Comorbidities Non-insulin-dependent diabetic polyneuropathy

 

 

 

Episode Summary

 

This 54 year old lady was admitted for treatment of femoral artery aneurysms which were previously diagnosed from an ultrasound examination prior to this admission.

 

 

Management/Procedure

 

 

She underwent ultrasonically control percutaneous transluminal stent assisted coil embolisation of two aneurysms in the left common femoral artery.

 

Discharge

 

 

The procedure went well and she was discharged home 2 days later with an appointment to be seen in clinic in 2 weeks time.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case Study Number 6 [14

 

Specialty Trauma and Orthopaedic

 

Consultant Mr. Relton
Date of Admission 01/10/2013
Date of Discharge 04/10/2013

 

Diagnosis  Spine instability
 

Episode Summary

 

This 49 year old lady fractured her spine in a car accident 5 years ago. This has resulted in her spine being weakened and causing her severe pain. A decision was made to fuse areas of her lumbar spine in order to try to relieve the pain she experiences and provide a degree of stability.

 

 

Procedure

 

 

She was taken to theatre where primary posterior interbody fusion of L2/3 and L4/5 joints of her lumbar spine (PLIF) was performed.

 

 

Discharge

 

 

 

 

She tolerated the surgery well and was discharged home on the 4 th October with an appointment to be seen in clinic in 2 weeks time.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case Study Number 7 [16

 

 

Specialty

 

Ophthalmology

 

Consultant

 

Mrs Kaye

 

Date of Admission

 

17/11/2013

 

 

Date of Discharge

 

17/11/2013

 

 

Episode Summary

 

 

This 65 year old gentleman was admitted for bilateral cataract surgery. His cataracts are due to hypoparathyroidism. He also suffers from multiple sclerosis and actively manages this with diet, exercise and lifestyle.

 

Procedure/

Management

 

 

 

 

He underwent bilateral phacoemulsification and lens insertion.

 

Discharge

 

The procedure went well and he was allowed to go

home 3 hours after surgery. He will be seen in the Ophthalmology clinic in 6 weeks time for an eye test.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


required for case study 1

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.
ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  

National Clinical Coding Examination (UK)

March 2014

 

Index trails and/or notes (Index trails

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

 

required for case study 1

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.
ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  


 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

are only

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.
ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  


(Index trails

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.  

 

2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

(Index trails

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

Index trails and/or notes

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  


National Clinical Coding Examination (UK)

March 2014

 

Index trails and/or notes (Index trails

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

Index trails and/or notes required for case study

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

March 2014

 

required for case study

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  


required for case study

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

required for case study 1)

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

Candidate Number …………………………

are only required for case study 1)

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  


Candidate Number …………………………

are only required for case study 1)

 

Case Study: …………..

Only codes written in the boxes below will be marked, for example, row 1 should contain the primary diagnosis code and any relevant primary procedure/intervention code.

ICD-10 Codes OPCS-4.6 Codes
1.   1.  
2.   2.  
3.   3.  
4.   4.  
5.   5.  
6.   6.  
7.   7.  
8.   8.  
9.   9.  
10.   10.  

 

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