Medical Coding MCQ (25 Question)

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Medical Coding 25 MCQ

1). A patient is admitted to undergo chemotherapy for cancer of the sigmoid colon that was previously treated with resection. Which code is sequenced first?

A. 153.3 B.153.9 C. V58.11 D. V10

2). A patient was admitted to the hospital for chest pain due to tachycardia. While in the hospital, the patient was also treated or type 1 diabetes. Upon further review, the coder noted that the documentation and EKG didn’t provide further evidence of the type of tachycardia or underlying cardiac condition(s).What should the coder report as the principal diagnosis?

A.Chest pain B.Tachycardia, NOS C.Insulin-dependent diabetes mellitus D.Cardiac disease, NOS

3). Dr. Smith recorded the following diagnoses on the patient’s discharge sheet: gastrointestinal bleeding due to acute gastritis and angiodysplasia. The principal diagnosis is coded as

A.GI bleeding. B.acute gastritis. C.angiodysplasia. D.either acute gastritis or angiodysplasia.

4. A patient was admitted with extreme fatigue and lethargy. Upon discharge, the physician documents: fatigue due to either depression or hypothyroidism. Which of the following are correct codes and sequencing for the scenario?

A. 780.79, 311, 244.9 B. 311, 249.9, 789.79 C. 249.9, 311 D. 789.79

5. Of the following, which code would take precedence over the other?

A. 072.0 over 033.0 B. 595.0 over 131.09 C. 486 over 480 D. 112.2 over 599.0

6. Upon discharge, the physician documents the following on the patient’s discharge sheet:?HIV infection. As the inpatient coder, your next step should be to

A. code the HIV infection as if it exists (according to UHDDS guidelines) and report it as the principal diagnosis.

B. review the UHDDS guidelines for assigning possible HIV infection codes versus AIDS codes.

C. query the physician and request that the statement be amended with a positive

(or negative) confirmation of the HIV infection.

D. wait to code the patient’s record until a positive finding on the serology report

confirms the HIV diagnosis.

7. For which of the following scenarios would it be appropriate to query the physician for more information before coding and/or sequencing?

A. A patient was admitted with severe abdominal pain. At discharge, the physician documents: abdominal pain due to either hiatal hernia or diverticula.

B. A patient was admitted with congestive heart failure (treated with IV furosemide) and unstable angina (treated with nitrates).

C. A patient has low potassium levels noted on the laboratory report (treated with orally administered potassium).

D. A patient is admitted with dysuria with no cause found.

8. Which of the following statements is true?

A. A patient has diabetes and an ulcer. Code the ulcer as diabetic.

B. A pregnant patient has diabetes. Code diabetes as complicating the pregnancy.

C. A patient has diabetes and cardiomyopathy. Code the cardiomyopathy as a diabetic complication.

D. A patient has diabetes and cataracts. Code diabetic cataracts.

9. A patient was admitted for metastatic carcinoma from the breast to several lymph node sites. Two years ago she had a double mastectomy. Which of the following is the correct code assignment for this case?

A. 196.8, V10.3 C. 196.8, 174.9, 85.42

B. 174.9, 196.8 D. 196.8, 174.9, V10.3

10. One of the secondary diagnoses listed on the patient’s discharge sheet is seizures. As a coder, your next step is probably

A. coding seizures to 780.39. B. coding seizures to 345.

C. not reporting the code because it’s a symptom.

D. querying the physician for more information/clarification.

11. A patient was discharged with the diagnosis of acute bronchitis with chronic obstructive asthma. Which of the following is the correctcoding and sequencing (if applicable) for this patient?

A.493.21 B. 493.21, 496 C. 466.0, 493.21 D. 493.91

12. Code 780.2 can be listed as principal diagnosis in which of the following cases?

A.For an outpatient encounter when the cause has been determined

B.For an inpatient encounter when the cause hasn’t been determined

C.When it’s listed with a contrasting diagnosis

D.It can never be listed as principal diagnosis.

13. Which of the following codes should not be listed as principal diagnosis?

A. 784.7 B.V30.00 C. E812.0 D. 307.81

14. Choose the correct code and sequencing for the following scenario: Reduction of right humerus fracture with cast.

A. 79.00 B.79.01 C. 79.00, 93.53 D. 79.01, 93.53

15. Read the following excerpt from medical record documentation and determine the correct code(s) for coding. The physician writes: “…noted burn on the arm skin with redness. Patient complained of tenderness to the touch.”

A. 943.01 B. 943.10 C. 943.21 D. 943.30

16. A patient was admitted in a coma from intentionally ingesting an entire bottle of sedatives. Which of the following is the correct coding and sequencing assignment?

A.780.01, 967.8 B. 780.01, 967.8, E950.2 C. 967.8, E950.2 D. 967.8, 780.01, E950.2

17. Which of the following situations would allow the assigning of a V code for a principal diagnosis?

A. Mother admitted for birth of infant, no complications

B. Patient admitted for dialysis

C. Patient admitted for metastatic breast cancer with a history of ovarian cancer

D. Patient admitted for poisoning has a history of alcoholism

18. A patient was admitted for nausea and vomiting due to gastroenteritis. Which of the following is thecorrect code reporting and sequencing?

A. 787.01, 787.02, 558.9 C. 558.9, 787.01

B. 787.02, 787.03, 558.9 D. 558.9

19. A physician lists positive findings on a purified protein derivative (PPD) test as a secondary diagnosis on the patient’s discharge sheet. How should this listing be coded?

A. 795.51 B. 010.95 C. 011.05 D. This listing shouldn’t be coded.

20. A physician lists urosepsis as a secondary diagnosis on a patient’s discharge sheet. How would you code this diagnosis?

A. Code it to 790.7. C. Code it to 599.0.

B. Code it to 038.9. D. Code 599.0, 038.9.

21. A patient is admitted for metastatic adenocarcinoma of the sacrum from the prostate. A prostatectomy was performed 11 months ago. Which of the following should be reported as the principal diagnosis for this patient?

A. V10 B. 185 C. 198.5 D. 170.6

22. A patient was discharged with a diagnosis of diabetes with nephropathy and chronic renal failure. How many codes would be reported for this patient?

A. One B. Two C. Three D. Need more information on the type of diabetes

23. If the physician describes the patient as presently in a manic phase, but has experienced depression in the past, this condition may be coded as

A. 296.4X B. 296.5X C. 296.6X D. Need more information

24. Codes 331.9, 332.0, are conditions affecting the

A. central nervous system. C. gastrointestinal system.

B. peripheral nervous system. D. cardiovascular system.

25. A patient was admitted with an acute exacerbation of chronic obstructive bronchitis and found to be in respiratory failure. Which of the following is the correct coding and sequencing for this case?

A. 518.81, 491.21 B. 491.21, 518.81 C. 518.81, 496 D. 493.91, 496, 518.81

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Biology Lab Gene Expression

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To delve a bit deeper into our topic this week, we are going to spend some time using Phet’s Gene Expression Simulation, as well as work through the effects of various mutations on gene expression.  To access the simulation, you can either click on the Gene Expression Simulation Link below (recommended) or use the version that is embedded in each of the parts below.

HERE IS THE LINK TO THE  Gene Expression Simulation (Links to an external site.)

https://phet.colorado.edu/sims/html/gene-expression-essentials/latest/gene-expression-essentials_en.html

Gene Expression Lab Simulation worksheet adapted by L. McPheron & Shannon Nixon; Phet Simulation by Elizabeth Hobbs; Mutation worksheet by Eliza Woo

Objectives:

â—Ź Identify the roles transcription factors, RNA polymerase, ribosomes, and mRNA destroyers have on transcription and translation.

â—Ź Distinguish between the location and function of regulatory regions compared to transcribed regions of DNA.

â—Ź Predict the effects of concentration, affinity, and degradation rates of transcription factors and RNA polymerase on gene expression.

● Identify the effects of mutations on gene expression. Background: Transcription​ is the process of making mRNA from DNA. This is a highly regulated process that our cells complete in preparation to make a protein. ​Translation​ is the process of making a protein from a piece of mRNA.

DNA ——————–> mRNA ——————–> protein transcription translation

Not all regions of DNA are used to make mRNA – only the parts of DNA that correspond to genes. Even then, not all gene regions are transcribed all the time. When genes are transcribed into mRNA depends on the needs of the cell. Once mRNA is made from DNA, it is translated into protein. Translation is an energy expensive process (it requires LOTS of ATP) which is one reason the cell only completes the process when the protein product is needed. This week’s “Reading and Lesson” explains many of the details of these highly complicated processes, transcription and translation. Please review the lesson for a deeper understanding of the concepts in this lab activity. Procedure: Click the Play arrow on this ​Gene Expression activity​ to complete the simulations. (The simulations are also embedded in the Canvas lab assignment page.) You will complete 3 simulations: 1) Expression, 2) mRNA, and 3) Multiple Cells.

Part 1: Expression Simulation

Click “Expression” to start that simulation. Notice the molecule that spans across the screen, from left to right. Answer the following 2 questions:

1. What is this molecule that spans across the page that is shown in red and blue?

2. What do you think the different colors (red and blue) of the molecule represent?

 

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Now, start the process of transcription.

For transcription, you need these things to happen. First, most genes require 1 or 2 “transcription factors” to bind to the area in front of the gene (called the “regulatory region”). Second, an RNA polymerase (an enzyme that makes mRNA from DNA) needs to be present in order for transcription to occur.

1. Drag one Positive Transcription Factor and one RNA Polymerase from the box called Biomolecule Toolbox to the regulatory region on the DNA molecule. This should start TRANSCRIPTION.

2. Now, drag a ribosome next to the mRNA, in order to do TRANSLATION. 3. The mRNA is eventually broken down by an mRNA destroyer protein. Drag one of these next to the

mRNA when it is done making a protein. 4. Put the protein in Your Protein Collection. 5. Stop the gene from working by dragging the Negative Transcription Factor to the Regulatory Area, and

remove the Positive Transcription Factor by dragging it out of the way.

After you have made 1 protein, answer these 5 questions. HINT: Think about what/where things are at the start, and what/ where things are at the end of the process.

1. What does the “Positive Transcription Factor” do?

 

 

2. What does the “RNA Polymerase” do?

 

3. What does the “Ribosome” do?

 

4. What does the “mRNA destroyer” do?

 

5. What does the “negative transcription” factor do?

 

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Click the yellow “Next Gene” box to begin working on the second gene. Can you remember the steps in order from your first trial? Try to see if you can! (HINT: There is one small difference between the transcription of gene 2 versus gene 1 – the difference is not in the order of steps but in the amount of something!) If not, not to worry, we are still learning… As a reminder, the steps are:

1. Drag Positive Transcription Factors and one RNA Polymerase from the box called Biomolecule Toolbox to the regulatory region on the DNA molecule. This should start TRANSCRIPTION!

2. Now, drag a ribosome next to the mRNA, in order to do TRANSLATION! 3. The mRNA is eventually broken down by an mRNA destroyer protein. Drag one of these next to the

mRNA when it is done making a protein. 4. Put the protein in Your Protein Collection. 5. Stop the gene from working by dragging the Negative Transcription Factor to the Regulatory Area, and

remove the Positive Transcription Factors by dragging them out of the way.

After you have made the second protein, answer these 2 questions.

1. What is one difference you noticed that was required to initiate the transcription of gene 2 versus gene 1?

2. What could be an advantage of multiple positive transcription factors versus only one?

 

 

Now, put all of your items back in the Biomolecule Toolbox and begin again, and answer the following 2 questions.

1. What happens if you add 2 RNA Polymerases (one after the first, before transcription is complete), and then 2 ribosomes (one for each mRNA)?

 

 

2. What would be the benefit of working this way versus adding RNA Polymerase one at a time?

 

 

Click the yellow “Next Gene” box to begin working on the third gene. Can you remember the steps in order from your first trial? Try to see if you can!

 

 

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Additional 4 Questions from the Expression Simulation:

1. What is gene expression?

 

 

2. What molecules are involved in gene expression? List them all and state the role of each.

 

 

 

 

 

 

3. What is the difference between the “regulatory region” and the “transcribed region”?

 

 

4. A student says that “ALL DNA codes for proteins.” Do you agree with her? Why or why not? Give evidence to support your answer.

Part 2: mRNA Simulation

At the bottom of the simulation page, click on the next simulation (it’s greyed out) called mRNA.

You should see a strand of DNA with a bunch of RNA Polymerases floating around. (If the RNA Polymerases are not moving, click the Play button.) Answer the following 7 questions.

1. Is mRNA being made?

 

2. In the Positive Transcription Factor box, slide the Concentration slider from NONE to just a tad (a couple millimeters or so) away from NONE. What do you notice is happening in the simulation now?

 

 

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3. Move the Concentration slider all the way to HIGH. How does this affect what is happening in the simulation?

 

 

4. Leave the Concentration slider on HIGH but move the Affinity slider all the way to LOW. What happens? Move the Affinity slider to a midway setting? What happens now? Based on these observations, what do you think ​affinity​ means in this simulation?

 

 

 

 

 

 

5. Place both sliders in the Positive Transcription Factor box on the HIGH setting. ​Predict ​what will happen to the simulation if you were to move the RNA Polymerase affinity slider to the LOW position. Record your prediction.

 

 

 

6. Now, move the RNA Polymerase affinity slider to the LOW position and record your observations. Was your prediction correct?

 

7. Place all the sliders in the HIGH position. Check the box to add Negative Transcription Factors and place the concentration and affinity sliders on HIGH. How does this change transcription compared to without Negative Transcription Factors?

 

 

 

Continue to play around with the sliders until you can accurately predict how the change will affect transcription each time.

 

 

5

 

 

 

Additional 3 Questions from the mRNA Simulation:

1. What circumstances make the most mRNA? (What slider positions?)

2. What circumstances make the least mRNA? (What slider positions?)

 

3. Why would a cell need the option to make or not make a protein?

 

 

 

 

Part 3: Multiple Cells Simulation

At the bottom of the simulation page, click on the next simulation (it’s greyed out) called Multiple Cells.

Watch the generation of the graph called Average Protein Level vs. Time when one cell is working. If the graph does not automatically begin, then click the Play button at the bottom of the page. Answer the following 4 questions.

1. On the right side of the page, there are controls for Concentration, Affinity, and Degradation. (You need to click the green + to see the sliders.) Predict where you need to place each of the 3 sliders to achieve lots of protein. Record your predictions here:

a. The Concentration slider should be on LOW or on HIGH to achieve lots of protein?

 

b. The Affinity slider should be on LOW or on HIGH to achieve lots of protein?

 

c. The Degradation slider should be on LOW or on HIGH to achieve lots of protein?

 

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2. Now, move the sliders into the positions you predicted to see if your predictions were correct. (NOTE: Each time you click “Refresh” to restart the graph, all of the sliders reset themselves to their original setting.) Then, explain why each setting – concentration, affinity, and degradation – makes sense for making lots of protein.

 

 

3. Why would a protein need to be degraded?

 

 

 

4. Think back to last week’s lab – Lactase Enzyme Lab. Give an example from that lab of a time when it would be necessary to make a lot of one type of protein.

 

Part 4: Effects of Mutations on Gene Expression You have learned this week that cells use the two-step process of transcription and translation to transform a protein-coding DNA sequence into a chain of amino acids that makes up a protein. The resulting chain of amino acids will fold into a three-dimensional protein structure that defines the phenotype. Imagine that the following DNA sequence is part of a protein-coding gene. Use this sequence to answer the questions that follow.

… G G A T G C C G C T C T G C A A C T A C…

A) What is the ​complementary DNA sequence​ to the DNA sequence above? ​Hint: look back to your reading and lesson notes to recall the pairing rules for nucleotides A, T, G, and C if you need to!

 

 

B) What is the ​mRNA sequence​ transcribed from the DNA sequence from ​Part A​? ​Hint: your answer below should start with the letter ​G​ and not ​C​!

 

 

C) What ​corresponding amino acid sequence​ is translated from the mRNA sequence from ​Part (B)​? Use the genetic code from the lesson or the one posted in the lab. ​Remember that your amino acid sequence should always start with the ​START codon​!

 

D) For the following scenarios (i)-(iii), identify the type of mutation that has occurred (single base-pair substitution or frameshift mutation) to our original sequence AND the new amino acid chain that results

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from such a mutation. Complete the same sequence from complementary DNA sequence, then mRNA sequence, and then corresponding amino acid sequence like what you did in Parts A, B, and C above!

(i) The 4​th​ C in the original sequence is mutated to a T:

… G G A T G C C G C T ​T​ T G C A A C T A C …

Type of mutation:

New amino acid chain:

 

(ii) An extra C is inserted into the original sequence:

… G G A T G C C G C ​C​ T C T G C A A C T A C …

Type of mutation:

New amino acid chain:

 

(iii) The 5​th​ C in the original sequence is mutated to A:

… G G A T G C C G C T C T G ​A​ A A C T A C …

 

Type of mutation:

New amino acid chain:

 

E) At the end of translation, an amino acid chain will subsequently fold into a protein with a specific structure and function.

 

(i) Of the three mutations described in part (D), which mutation will cause the ​least ​change to protein function? Briefly explain your reasoning.

 

(ii) Which mutation would you expect to significantly alter protein function? Briefly explain your reasoning.

 
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Food Safety Report

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Lab Report Directions for SPHP Courses

Please refer to any additional directions within your course that may address specific directions for your experiment and report.

 

Sections

 Description
Title Page · Experiment number and/or title

· Your name

· Date and time experiment was performed

· Location if work was performed in the field

· Course name and section
Section 1: Abstract · One paragraph that summarizes the report (no longer than a paragraph)

· Belongs at the very beginning of the paper, but should be written last

· Concise description of the experimental objectives, results, and conclusions

· Includes why the experiment was performed; what problems were addressed; what major conclusions were found; and what major conclusions were drawn.

· Does not include general background information.

· Uses proper terminology for your course (examples include: pH, dominant, nucleotide, contamination, X or Y-linked, etc.)
Section 2: Introduction and Background · Includes the reason the study is being done, relevant background information about the organism, chemical, or process being examined, and the hypothesis or questions being asked in the study.

· Briefly explain any specific and relevant theories and research (3 sources expected – see section 7)

· Briefly summarize of what was done in the experiment, what was observed and/or what you expected to find, and what, if any, problems were encountered.

· Briefly summarize the laboratory techniques and equipment you used to collect and analyze the data upon which the conclusions are based.

· Photos and graphic illustrations in this section with graphics in .jpg, .tif, or .gif format to minimize electronic file size.
Section 3: Materials and Methods · Lists the materials and/or equipment used to conduct the experiment

· States what was done by you with enough detail to allow the reader to repeat the experiment step-by-step.

· Describes in detail the laboratory techniques and equipment you used to collect and analyze the data upon which the conclusions are based.

· Lists the steps of the procedure in order and the reasons for each. Includes all calculations or formulas needed to obtain the final results.

· Write this section with the audience in mind; for example, most people do not need to be told how to find the mean or standard deviation of the data, but will need to know the formula used to find the rate of oxygen consumption of an organism
Section 4: Results · Results section is written in paragraph form and is one or two pages long

· Do not offer any explanation for the results in this section

· Presents the results in text and graphic form (figures, tables, graphs)

· Describes the general trends seen in the data in narrative form (paragraphs).

· All figures and tables should be referenced in the narrative.

· Do not redraw the graph in words; let it do the work for you. For example, Temperature had a pronounced effect on seedling growth rate (Figure 6). In particular, seedlings at 25 degrees Celsius consistently grew more rapidly than those at 20 degrees Celsius.
Section 5: Discussion · The discussion is the meat of the lab report.

· Tries to answer the question “Why?” Explains what was expected and what was found.

· Do the data support the original hypothesis? Why or why not?

· This section presents reasons for the results obtained in the experiment and references related studies.

· What trends were noticed; why did they occur?

· What is the theory or model behind the experiment and is it substantiated by your results?

· This section also includes potential sources of error. What recommendations might improve the procedure and results?

 

Consideration is given to:

· What is the connection between the experimental measurements taken and the final results and conclusions? How do your results relate to the real world?

· What were the results of observations and calculations?

· What trends were noticed?

· What is the theory or model behind the experiment?

· Do the experimental results substantiate or refute the theory? Why? Be sure to refer specifically to the results you obtained.

· Were the results consistent with your original predictions of outcomes or were you forced to revise your thinking?

· Did errors occur (for example, environmental changes or unplanned interference in the procedure)? If so, how did these errors affect the experiment?

· Did any errors occur due to the equipment used (for example, contamination due to a lack of aseptic technique)?

· What recommendations might improve the procedures and results?
Section 6: Conclusion · Consists of a single paragraph.

· Restates the objective, the results, and important discussion findings; Does NOT introduce new material.

· Conclusion should be supported by at least 3 reasons and/or pieces of data obtained from the experiment.
Section 7: Citations and Presentation

 

 For Citations:

· Presents complete citations for all factual material referred to in the text of the report.

· Each citation should include the names of all authors, the year of publication, and the full title

· Be sure that all sources are accurately documented in the desired AMA format (see UNE library for resources on this; i.e. RefWorks).

· At least 3 sources are expected, three of which are from the scientific peer-reviewed literature, unless told otherwise by your instructor.

· The rest of these may be non-internet sources (books, magazines, newspapers, journals, etc.).

· Avoid the citation of blogs, Facebook, or other non-scientific sites. WebMD, Wikipedia, Mayo Clinic, etc. summary sites are not accepted as references.

For Presentation:

· The text for each section is in a narrative format using standard English and using complete sentences

· The text displays proper grammar, spelling, punctuation, and word-choice
 
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Lab 8 SCIN130

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Go to: http://media.hhmi.org/biointeractive/click/elephants/dna/index.html

And Click on Case Two

Part 1: Case Two

1. Watch the crime scene video and read the Case Two introduction on the first slide.

a. In Case One, you were looking for a match with an individual elephant. How does

Case Two differ from Case One?

2. Click on Building a Reference Map.

a. Watch the short video. Elephant populations differ from one another. These differences are due to geographic distance and the length of time since their ancestors separated from one another. Explain how this relationship affects their relatedness.

3. Click on Technique in the Building a Reference Map section.

a. How does this gel differ from the gels you studied in Case One?

4. Click on the Application section.

a. Study the gel. Why does the ivory sample contain only two bands while the other lanes (samples A and B) have multiple bands?

b. If an ivory sample has two alleles that are also found in a population sample, does that tell you with certainty that the ivory sample came from that population? Explain your answer.

5. Click on the Review Section.

a. If the scientist had collected 20 dung samples, would you expect more bands, fewer bands, or the same number of bands on the gel? Explain your answer.

6. Proceed to the Finding a Location section.

a. Forest elephants and savanna elephants diverged over 2.5 million years ago, so some researchers think they should be classified as different species. Knowing this information, which genetic profiles would you predict would be more similar to one another: those of a forest elephant and a savanna elephant that are geographically close to one another, or those of two forest elephants that live far apart from one another? Explain your reasoning.

b. On the Eliminating North, East, or South page, which population did you eliminate? Which marker(s) allowed you to make this choice?

c. On the next elimination, which population did you choose? Which marker(s) helped you make this choice?

d. By analyzing many more markers and all the populations, Dr. Wasser linked these seized ivory tusks to which country?

Part 2: Ivory Trade

1. Watch the video on the Stopping Illegal Poaching slide.

a. Name two reasons elephant populations are threatened.

b. In summary, elephants are a keystone species. Based on your knowledge from this lab (Case 1 and Case 2), explain in your own words why it is important to the ecology and ecosystems of Africa to save the elephant populations.

Adapted from: Click and Learn “CSI Wildlife” (2016). CSI Wildlife Explorer Worksheet. HHMI Biointeractive Teaching Materials.

 
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