Instructions: After reading the clinical description, assign words or phrases from the paragraph to the term that best describes that concept. Note: Not all terms will have a match. IMPORTANT: As you review and identify items, please note you are not coding the scenario; coding has many rules associated with how an encounter is coded. This exercise is purely about your ability to recognize the pathophysiology and pharmacology concepts that are found within the excerpts. Contents Excerpt 1 2 Excerpt 2 3 Excerpt 3 4 Excerpt 4 5 Excerpt 5 6 Excerpt 6 7 Excerpt 7 8 Excerpt 8 9 Excerpt 9 10 Excerpt 10 11 Excerpt 1 Kimberly is a 37-year-old white female who presented to her family doctor and was referred to radiation oncology department for consultation. While with the oncologist, Kimberly reported that both her mother and sister had breast cancer. She describes feeling heartburn for “a long time” and difficulty swallowing during the past 4 or 5 months. She feels like food occasionally seems to ‘catch’ in her throat, and describes pain immediately below the sternum that feels like a gnawing or burning. Other complaints include weight loss of 30 lbs. in the past 6 or 7 months, weakness and coughing at night. After performing an endoscopy and a biopsy of the esophageal tract, a cancerous tumor was identified and staged, and plans for radiation and an esophagectomy are underway. Diagnos(es) Prognosis Etiology Signs Symptoms Complications Sequelae Nosocomial Treatment Procedure Examination of living tissue Medical History Excerpt 2 Jane is a 12 year old female who presents is being treated today for hypertension related to Congenital Adrenal Hyperplasia (CAH), which was discovered when a biopsy done of Jane’s mother’s placenta for genetic screening showed that both her parents were carriers for the gene. Fetal blood work completed confirmed an enzyme deficiency blocking gluticosteriod and mineralocorticoid hormones. Jane regularly receives hormonal treatment and future genitoplasty is being considered. Normal sexual functioning is anticipated with continued treatment. Diagnos(es) Prognosis Etiology Signs Symptoms Complications Sequelae Nosocomial Treatment Procedure Examination of living tissue Medical History Excerpt 3 James is a 43 y.o. male who complains of chest congestion and dry cough for 30 days. He has had a history of similar problems, but was not exhibiting symptoms when he went to Buffalo to visit brother who has dogs. Patient reports experiencing shortness of breath while sleeping in the guest room bed; reports that brother is a smoker. Unsure if he has seasonal allergies. On ordering a CBC with differential, the higher presence of lymphocytes suggested an allergic reaction. The doctor prescribed oral steroids and an albuterol inhaler and recommended him to return if the cough didn’t decrease. Diagnos(es) Prognosis Etiology Signs Symptoms Complications Sequelae Nosocomial Treatment Pr.

1. Instructions: After reading the clinical description, assign
words or phrases from the paragraph to the term that best
describes that concept. Note: Not all terms will have a match.
IMPORTANT: As you review and identify items, please note
you are not coding the scenario; coding has many rules
associated with how an encounter is coded. This exercise is
purely about your ability to recognize the pathophysiology and
pharmacology concepts that are found within the excerpts.
Contents
Excerpt 1 2
Excerpt 2 3
Excerpt 3 4
Excerpt 4 5
Excerpt 5 6
Excerpt 6 7
Excerpt 7 8
Excerpt 8 9
Excerpt 9 10
Excerpt 10 11
Excerpt 1
Kimberly is a 37-year-old white female who presented to her
family doctor and was referred to radiation oncology department
for consultation. While with the oncologist, Kimberly reported
that both her mother and sister had breast cancer. She describes
feeling heartburn for “a long time” and difficulty swallowing
during the past 4 or 5 months. She feels like food occasionally
seems to ‘catch’ in her throat, and describes pain immediately
below the sternum that feels like a gnawing or burning. Other
complaints include weight loss of 30 lbs. in the past 6 or 7

2. months, weakness and coughing at night. After performing an
endoscopy and a biopsy of the esophageal tract, a cancerous
tumor was identified and staged, and plans for radiation and an
esophagectomy are underway.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 2

3. Jane is a 12 year old female who presents is being treated today
for hypertension related to Congenital Adrenal Hyperplasia
(CAH), which was discovered when a biopsy done of Jane’s
mother’s placenta for genetic screening showed that both her
parents were carriers for the gene. Fetal blood work completed
confirmed an enzyme deficiency blocking gluticosteriod and
mineralocorticoid hormones. Jane regularly receives hormonal
treatment and future genitoplasty is being considered. Normal
sexual functioning is anticipated with continued treatment.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

4. Excerpt 3
James is a 43 y.o. male who complains of chest congestion and
dry cough for 30 days. He has had a history of similar problems,
but was not exhibiting symptoms when he went to Buffalo to
visit brother who has dogs. Patient reports experiencing
shortness of breath while sleeping in the guest room bed;
reports that brother is a smoker. Unsure if he has seasonal
allergies. On ordering a CBC with differential, the higher
presence of lymphocytes suggested an allergic reaction. The
doctor prescribed oral steroids and an albuterol inhaler and
recommended him to return if the cough didn’t decrease.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue

5. Medical History
Excerpt 4
“Michelle” was admitted to the hospital because of facial
swelling, fever and hypotension. She has relapsing and
remitting multiple sclerosis associated with severe fatigue. Her
neurologist prescribed modafinil to treat the fatigue. One week
later, periorbital erythema and a clear conjunctival discharge
developed on her face and scalp. She discontinued the modafinil
and used over-the-counter diphenhydramine, but the rash did
not improve. Elevated steroid presence lowered the patient’s
immunity and she contracted MRSA while in the hospital.
Diagnoses
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue

6. Medical History
Excerpt 5
Betty, a 29 y.o. female was given a PillCAM to swallow after
she presented to her gastroenterologist with continued stomach
pains after her cholecystectomy in order to rule out Crohn’s
Disease. She was born with infantile hypertrophic pyloric
stenosis which was corrected with a pyloromyotomy when she
was 3 weeks old. Review of images showed no identified
pathological changes within the intestine, and a laparoscopy
was planned to review the original surgical site.
Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue

7. Medical History
Excerpt 6
Frank is a 73-year-old white male with history of multiple
hospital admissions for COPD exacerbation and pneumonia who
presented to the emergency room on 09/03/2015, complaining of
severe shortness of breath and difficulty swallowing. He
received 3 nebulizers at home without much improvement.
Frank’s chest x-ray on admission revealed some vascular
congestion and bilateral pleural effusions. There was also
patchy alveolar opacity, which appeared to be, "mass like" in
the right suprahilar region. After three days, Frank was
discharged to home health on a dysphagia diet, with ample thin
liquids use. Frank’s discharge provider also ordered a dietary
and speech therapy evaluation, to treat for chronic dysphagia
and aspiration pneumonia in the setting of severe chronic
obstructive pulmonary disease.
Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae

8. Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 7
Peter, a 63 year old obese male, was eating breakfast when he
experienced the sudden onset of weakness and numbing in his
left arm and leg. Brushing off his symptoms, the next morning
he felt worse and noticed his vision begin to blur. Noticing her
husband’s confusion, his wife quickly phoned 911 and he was
taken by ambulance to the nearest Emergency Department.
Peter’s history was notable for a 30-year, half-pack a day
smoking habit. A CT scan confirmed a cerebrovascular event
(Ischemic stroke) and interarterial t-PA was given. Peter was
admitted to the hospital, and several days into his care he began
treatment for paralysis.
Diagnosis
Prognosis
Etiology
Signs
Symptoms

9. Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 8
“A 27 year old male of Middle Eastern-descent diagnosed with
hemophilia when he was 4 or 5 years old, who presented to the
Emergency Department due to excessive bleeding from an
accidental knife cut. He reports a history of prolonged bleeding
episodes post-teeth extraction and excessive bruising since
childhood, and has a sister that reports similar excessive
bleeding issues. Because of poor continuity of care, his disease
has not been monitored or treated on an outpatient basis, and is
uncertain which of the hemophilia types he may have. The
results of the coagulation studies, the clinical presentation, and
the family history for the patient described in this case indicate
F5F8D as the most likely diagnosis. Molecular genetic testing
would be needed to absolutely confirm this diagnosis. For
treatment purposes, however, fresh frozen plasma is sufficient.”
Diagnosis
Prognosis

10. Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 9
“Zoe” was brought in by her husband, who reports that she has
had slowly progressive cognitive decline for around 2 years.
The initial symptoms were memory loss, forgetting
conversations, repeating herself, and asking the same question
within a short period. She had been working as a mortgage
underwriter for 20 years and was laid off from her job 18
months ago. Zoe has had difficulty remembering names of
characters in the TV shows she watches and is having problems
looking things up on the Internet. She is no longer able to write
checks, and her husband has taken over the bills and finances.
She is taking over-the-counter vitamin supplementation and is
not on any prescription medications. She denies any focal
neurologic symptoms and has not had any headaches, fevers, or

11. seizures. She is alert and afebrile. Her blood pressure is 121/70
mm Hg, and her pulse is regular, with a rate of 70 beats/min. On
cognitive testing, she scores a 24/30 on the Folstein Mini-
Mental State Examination, missing 4 points on orientation, 1
point on recall, and 1 point on intersecting pentagon drawing.
The physician began a laboratory panel workup to include a
CBC and a B-12 review to rule out any hematologic reasons for
the problems.
Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 10

12. “Donald,” a 46-year-old man went in for a follow-up visit after
being discharged from hospital after a 35 day stay, after falling
from a ladder approximately 20 feet high and landing on a
concrete apron. During the follow-up visit, the patient was
noted to have a serum sodium concentration of 128 mEq/L and
was referred to nephrology for evaluation for hyponatremia.
During his visit to the nephrology clinic, the patient complained
of occasional dizziness and continued pain in the neck area but
had no other complaints. The patient declined hospital
admission for investigation and treatment of his hyponatremia
because he had urgent personal matters to attend to, however, 2
days later, the patient is brought to the emergency department
because of increased confusion and seizure. A workup involving
a serum Na+ and Plamsa osmolality confirmed hyponatremia
associated with measured serum hypo-osmolality, (SIADH). A
corrective saline infusion was started after consult with a
nephrologist.
Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment

13. Procedure
Examination of living tissue
Medical History
Case Sources
Excerpt 1
Blabac, L. (2015). Kimberly.
Excerpt 2
Blabac, L. (2015). Jane.
Excerpt 3
Blabac, L. (2015). James.
Excerpt 4
Cabot, R. C., Harris, N. L., M.D., Shepard, J. O., M.D.,
Rosenberg, E. S., M.D., Cort, A. M., M.D., Ebeling, S. H., . . .
Frosch, M. P., M.D. (2007). Case 36-2007. The New England
Journal of Medicine, 357(21), 2167-2178.
doi:http://dx.doi.org/10.1056/NEJMcpc079030
Excerpt 5
Blabac, L. (2015). Betty
Excerpt 6
Blabac, L. (2015). Frank.
Excerpt 7
Blabac, L. (2015). Peter.

14. Excerpt 8
Khani, F. & Roshil, M. (2012). 24 year old man previously
diagnosed with hemophilia. Clinical Chemistry. 58:7 Retrieved
from: http://www.clinchem.org/content/58/7/1086.full.pdf
Excerpt 9
Sibert, L.C. & Erten-Lyons, D. (2015, September 3). A 51-Year-
Old Woman With Cognitive and Functional Decline. Medscape.
Retrieved from
http://reference.medscape.com/viewarticle/850363 .
Excerpt 10
Teran, F., Simon, E., & Batuman, V. (2015, March 10).
Hyponatremia in a 46-Year-Old Man After Head Trauma.
Medscape. Retrieved from
http://reference.medscape.com/viewarticle/840976