CPCA Reading Comprehension 5 — Questions and Answers
Question 1: A pathology report reads: 'Sections show moderately differentiated adenocarcinoma with lymphovascular invasion. Surgical margins are negative. 3 of 12 regional lymph nodes are positive for metastatic disease.' What does 'negative surgical margins' mean?
- The tumor extended to the edge of the resected tissue
- No cancer cells were found at the cut edges of the removed tissue (Correct answer)
- The lymph nodes surrounding the tumor were cancer-free
- The tumor did not show lymphovascular invasion
Correct answer: No cancer cells were found at the cut edges of the removed tissue
Negative surgical margins mean the outer edges of the removed specimen are free of cancer cells, suggesting complete resection.
Question 2: A physician writes in a SOAP note: 'S: Patient reports sharp, 8/10 chest pain worsened by inspiration. O: Pleural friction rub auscultated at left lower base. A: Pleuritis. P: NSAIDs initiated.' What does the 'A' in a SOAP note represent?
- Action taken by the medical team
- Assessment — the physician's clinical diagnosis or impression (Correct answer)
- Allergy documentation for the visit
- Ancillary services ordered during the encounter
Correct answer: Assessment — the physician's clinical diagnosis or impression
In a SOAP note, 'A' stands for Assessment, which is the clinician's diagnosis or clinical impression based on the subjective and objective findings.
Question 3: An admission note documents: 'Neurological exam: Patient is alert and oriented x3. Cranial nerves II-XII grossly intact. Strength 5/5 in all extremities. DTRs 2+ bilaterally.' What does 'oriented x3' mean?
- The patient scored 3 points on the GCS motor scale
- The patient is aware of person, place, and time (Correct answer)
- The patient has intact sensation in 3 dermatomes
- The patient responded to 3 of 5 neurological reflex tests
Correct answer: The patient is aware of person, place, and time
Oriented x3 means the patient correctly identifies themselves (person), their location (place), and the current date/time (time).
Question 4: A procedure note reads: 'Under fluoroscopic guidance, a 22-gauge spinal needle was advanced into the L4-L5 interspace. CSF was clear and colorless. Opening pressure was 18 cmH2O. Three tubes of CSF were collected and sent for analysis.' What procedure was performed?
- Epidural steroid injection
- Lumbar puncture (spinal tap) (Correct answer)
- Intrathecal chemotherapy administration
- Myelogram contrast injection
Correct answer: Lumbar puncture (spinal tap)
A lumbar puncture (spinal tap) involves inserting a needle into the lumbar subarachnoid space to collect cerebrospinal fluid (CSF) for analysis.
Question 5: A clinical note reads: 'Review of systems is positive for fatigue, pallor, and exertional dyspnea. CBC shows Hgb 7.2 g/dL, MCV 72 fL, MCHC 28%. Peripheral smear demonstrates microcytic, hypochromic red cells.' What type of anemia does this presentation suggest?
- Vitamin B12 deficiency anemia (macrocytic)
- Hemolytic anemia with reticulocytosis
- Iron deficiency anemia (microcytic, hypochromic) (Correct answer)
- Anemia of chronic disease with normal MCV
Correct answer: Iron deficiency anemia (microcytic, hypochromic)
Microcytic (low MCV) and hypochromic (low MCHC) red cells are classic findings in iron deficiency anemia, the most common type globally.
Question 6: An operative report states: 'The patient underwent a Whipple procedure (pancreaticoduodenectomy) for a pancreatic head mass. The pancreatic duct-to-jejunum anastomosis was created in an end-to-side fashion.' What does 'anastomosis' mean in surgical terminology?
- The surgical incision used to access the abdominal cavity
- A surgical connection between two hollow structures (ducts, vessels, or bowel segments) (Correct answer)
- The removal of a diseased organ from the surgical field
- The placement of a stent within a narrowed duct
Correct answer: A surgical connection between two hollow structures (ducts, vessels, or bowel segments)
An anastomosis is a surgically created junction between two tubular structures, such as connecting the pancreatic duct to the jejunum.
Question 7: A coding scenario presents a physician note: 'I spent 40 minutes with this established patient, of which greater than 50% was devoted to counseling regarding her new diagnosis of breast cancer, treatment options, and prognosis.' What factor drives the level of E/M service selection in this note?
- The number of diagnoses documented in the assessment
- The total time spent, when more than 50% is counseling or coordination of care (Correct answer)
- The complexity of the medical decision-making only
- The number of body systems reviewed in the ROS
Correct answer: The total time spent, when more than 50% is counseling or coordination of care
When more than 50% of a face-to-face encounter is spent on counseling or coordination of care, total time may be used to select the E/M code level.
CPCA Reading Comprehension 5
A pathology report reads: 'Sections show moderately differentiated adenocarcinoma with lymphovascular invasion.
Surgical margins are negative. 3 of 12 regional lymph nodes are positive for metastatic disease.' What does 'negative surgical margins' mean?