CPCA Reading Comprehension 4 — Questions and Answers
Question 1: A progress note reads: 'Patient presents for follow-up of her Type 2 DM. HbA1c returned at 9.2%. Patient reports adherence to diet but admits to missing metformin doses frequently.' What does an HbA1c of 9.2% indicate?
- Well-controlled blood sugar over the past 3 months
- Poorly controlled blood sugar over the past 2-3 months (Correct answer)
- Acute hypoglycemic episode within the past week
- Normal fasting glucose levels
Correct answer: Poorly controlled blood sugar over the past 2-3 months
HbA1c reflects average blood glucose over 2-3 months; a level of 9.2% is significantly above the target of <7% for most diabetics, indicating poor control.
Question 2: An operative report states: 'The patient underwent arthroscopic debridement of the right knee with partial medial meniscectomy. The chondral surfaces were inspected and found to be intact.' What does 'debridement' mean in a surgical context?
- Reconstruction of damaged tissue with grafts
- Removal of damaged, necrotic, or foreign tissue to promote healing (Correct answer)
- Closure of a wound using sutures or staples
- Injection of anti-inflammatory agents into a joint
Correct answer: Removal of damaged, necrotic, or foreign tissue to promote healing
Debridement is the surgical removal of devitalized, damaged, or contaminated tissue to allow healthy tissue to heal.
Question 3: A lab report reads: 'WBC 14.2 K/uL (ref: 4.5–11.0), Neutrophils 88% (ref: 50–70%), Bands 12% (ref: 0–5%).' A coder reviewing this for sepsis criteria notes a 'left shift.' What does a 'left shift' indicate?
- A decrease in total white blood cell count
- An increase in immature neutrophils (bands), suggesting acute infection or inflammation (Correct answer)
- A shift in red blood cell morphology indicating anemia
- An elevation in lymphocytes indicating a viral infection
Correct answer: An increase in immature neutrophils (bands), suggesting acute infection or inflammation
A left shift refers to the release of immature neutrophils (bands) into circulation, indicating the bone marrow is working overtime during infection or sepsis.
Question 4: A consultation note reads: 'I reviewed the patient's echocardiogram which demonstrates an ejection fraction of 35% with global hypokinesis and moderate mitral regurgitation.' What does an ejection fraction of 35% indicate?
- Hyperdynamic cardiac function above normal range
- Normal cardiac output for a patient over 65
- Reduced cardiac function, indicating systolic heart failure (Correct answer)
- Diastolic dysfunction without systolic impairment
Correct answer: Reduced cardiac function, indicating systolic heart failure
Normal ejection fraction is 55-70%; an EF of 35% indicates the heart is pumping poorly, consistent with systolic (reduced EF) heart failure.
Question 5: A physician documents: 'The patient was seen for an annual wellness exam. She is a G3P2 female with LMP 6 weeks ago. Urine hCG is positive.' What does 'G3P2' mean in obstetric notation?
- 3 gynecological visits, 2 prior pregnancies
- Gravida 3 (3 total pregnancies), Para 2 (2 deliveries after 20 weeks) (Correct answer)
- 3 gestational weeks, 2nd trimester
- 3 prior births, 2 currently living children
Correct answer: Gravida 3 (3 total pregnancies), Para 2 (2 deliveries after 20 weeks)
In obstetric notation, G (Gravida) = total number of pregnancies including the current one, and P (Para) = number of deliveries at or beyond 20 weeks.
Question 6: An emergency note reads: 'Patient presents with sudden onset severe headache described as the worst headache of his life, neck stiffness, and photophobia. Non-contrast CT head is negative.' What diagnosis must be urgently excluded?
- Migraine with aura
- Tension-type headache
- Subarachnoid hemorrhage (Correct answer)
- Cluster headache
Correct answer: Subarachnoid hemorrhage
A 'thunderclap' headache (worst of one's life) with meningismus signs requires immediate exclusion of subarachnoid hemorrhage, even with a negative CT.
Question 7: A discharge summary reads: 'Patient was started on DVT prophylaxis with subcutaneous enoxaparin during the hospital stay. Sequential compression devices were applied bilaterally to lower extremities.' What is the primary goal of DVT prophylaxis in a hospitalized patient?
- To treat an existing deep vein thrombosis identified on imaging
- To prevent the formation of blood clots in immobilized patients (Correct answer)
- To reduce inflammation from a prior pulmonary embolism
- To manage atrial fibrillation and reduce stroke risk
Correct answer: To prevent the formation of blood clots in immobilized patients
DVT prophylaxis (anticoagulants and compression devices) is used preventively to reduce the risk of deep vein thrombosis in patients with limited mobility during hospitalization.
CPCA Reading Comprehension 4
A progress note reads: 'Patient presents for follow-up of her Type 2 DM.
HbA1c returned at 9.2%.
Patient reports adherence to diet but admits to missing metformin doses frequently.' What does an HbA1c of 9.2% indicate?