OPSX32SandallOscar MCCG240 Case Scenario OPSX32 Sandall, Oscar.html[10/21/2021 10:55:48 AM] Outpatient Surgery Patient Case Number: OPSX32-Sandall, Oscar Patient Name: Oscar Sandall DOB: 02-19-72 Sex: M Date of Service: 05-05-XX Surgeon: Sandra Cullman, MD Pre-Operative Diagnosis Right knee complex medial meniscus tear Post-Operative Diagnosis Right knee complex medial meniscus tear and medial plica Procedure Performed: Knee arthroscopy w/ partial medial meniscectomy, chondroplasty of medial femoral condyle, excision of medial plica Anesthesia: General Complications: None Indication for Procedure: The patient is a 46y/o male who was referred to me with complaints of right knee pain. He has had pain for several months and failed nonoperative treatment. I recommended a right knee arthroscopy with partial medial meniscectomy. The risks, benefits and possible complications from the surgery were discussed in detail and the patient wishes to proceed. The potential risks include: Infection, bleeding, neurovascular damage, residual pain and dysfunction, recurrence as well as the surgery possibly not improving the patient’s symptoms. If a meniscectomy is performed the patient understands that there is an increased chance of developing or accelerating any existing arthritis in that knee. The patient also understands the risks of anesthesia which include stroke, heart attack, aspiration, blood clot, pulmonary embolus and death. Description of Procedure: After consent was obtained the patient was taken to the operating room and was administered a general anesthetic and intubated. A well-padded tourniquet was applied to the right upper thigh. The extremity was then prepped and draped in the usual fashion. An Esmarch was used to exsanguinate the right lower extremity and the tourniquet inflated to 325 mmHg. a superomedial portal was made for the introduction of the inflow. An anterolateral portal was made for the introduction of the arthroscope. An anteromedial portal was made for the introduction of arthroscopic instruments. The findings are as follows: 1. Suprapatellar pouch: Normal 2. Medial plica: Frayed 3. Medial gutter: Normal 4. Lateral gutter: Normal OPSX32SandallOscar MCCG240 Case Scenario OPSX32 Sandall, Oscar.html[10/21/2021 10:55:48 AM] 5. Patella: Normal 6. Trochlea: Grade I Chondromalacia - Softening Articular Cartilage 7. Medial Femoral Condyle: Grade IIA Chondromalacia - Fissures/Fragmentation Articular Cartilage <50% and Grade 118 Chondromalacia -Fissures/Fragmentation Articular Cartilage >50% 8. Medial meniscus: Tear, Complex- Root, Posterior Horn, Body 9. Medial Tibial Plateau: Normal 10. ACL: Normal 11. PCL: Normal 12. Lateral Femoral Condyle: Normal 13. Lateral Meniscus: Normal 14. Lateral Tibial Plateau: Normal 15. Popliteus: Normal 16. Popliteal Hiatus: Normal A partial medial meniscectomy was performed. Using a combination of an upbiting basket, straight basket and a 4.2 mm Cuda shaver I removed 50 % of the ro.

1. OPSX32SandallOscar
MCCG240 Case Scenario OPSX32 Sandall,
Oscar.html[10/21/2021 10:55:48 AM]
Outpatient Surgery
Patient Case Number: OPSX32-Sandall, Oscar
Patient Name: Oscar Sandall DOB: 02-19-72 Sex: M
Date of Service: 05-05-XX Surgeon: Sandra Cullman, MD
Pre-Operative Diagnosis
Right knee complex medial
meniscus tear
Post-Operative Diagnosis
Right knee complex medial meniscus tear and medial plica
Procedure Performed: Knee arthroscopy w/ partial medial
meniscectomy, chondroplasty of medial
femoral condyle, excision of medial plica
Anesthesia: General Complications: None
Indication for Procedure:
The patient is a 46y/o male who was referred to me with
complaints of right knee pain. He has had pain

2. for several months and failed nonoperative treatment. I
recommended a right knee arthroscopy with
partial medial meniscectomy. The risks, benefits and possible
complications from the surgery were
discussed in detail and the patient wishes to proceed. The
potential risks include: Infection, bleeding,
neurovascular damage, residual pain and dysfunction,
recurrence as well as the surgery possibly not
improving the patient’s symptoms. If a meniscectomy is
performed the patient understands that there is
an increased chance of developing or accelerating any existing
arthritis in that knee. The patient also
understands the risks of anesthesia which include stroke, heart
attack, aspiration, blood clot, pulmonary
embolus and death.
Description of Procedure:
After consent was obtained the patient was taken to the
operating room and was administered a general
anesthetic and intubated. A well-padded tourniquet was applied
to the right upper thigh. The extremity
was then prepped and draped in the usual fashion. An Esmarch
was used to exsanguinate the right lower
extremity and the tourniquet inflated to 325 mmHg. a
superomedial portal was made for the introduction
of the inflow. An anterolateral portal was made for the
introduction of the arthroscope. An anteromedial
portal was made for the introduction of arthroscopic
instruments. The findings are as follows:
1. Suprapatellar pouch: Normal
2. Medial plica: Frayed
3. Medial gutter: Normal
4. Lateral gutter: Normal

3. OPSX32SandallOscar
MCCG240 Case Scenario OPSX32 Sandall,
Oscar.html[10/21/2021 10:55:48 AM]
5. Patella: Normal
6. Trochlea: Grade I Chondromalacia - Softening Articular
Cartilage
7. Medial Femoral Condyle: Grade IIA Chondromalacia -
Fissures/Fragmentation Articular Cartilage
<50% and Grade 118 Chondromalacia -Fissures/Fragmentation
Articular Cartilage >50%
8. Medial meniscus: Tear, Complex- Root, Posterior Horn, Body
9. Medial Tibial Plateau: Normal
10. ACL: Normal
11. PCL: Normal
12. Lateral Femoral Condyle: Normal
13. Lateral Meniscus: Normal
14. Lateral Tibial Plateau: Normal
15. Popliteus: Normal
16. Popliteal Hiatus: Normal
A partial medial meniscectomy was performed. Using a
combination of an upbiting basket, straight
basket and a 4.2 mm Cuda shaver I removed 50 % of the root,
75 % of the posterior horn, 25 % of the
body and 0 % of the anterior horn of the medial meniscus. The
rim was smoothed with a 4.2 mm Tiger
shaver. A 4.2 mm Cuda shaver was used to remove the medial
plica. A chondroplasty was performed of
the medial femoral condyle. A 4.2 mm tiger shaver was used to
debride the unstable, fibrillated articular
cartilage.

4. The portals were closed with 3-0 Prolene suture. The knee was
injected with 10 cc of 0.25% Marcaine
and 5 mg of Duramorph. A sterile dressing was applied with a
Polar Care pad incorporated into the
dressing. The tourniquet was deflated at 18 minutes. The patient
was awakened and extubated by
anesthesia and taken to the recovery room in stable condition.
The patient tolerated the procedure well
with no immediate
complications.
Post-op Condition of Patient: Stable
Electronically Signed By: Sandra Cullman, MD
Copyright © 2020 by The American Health Information
Management Association. All Rights Reserved.
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OPSX34ClerkSolomon
MCCG240 Case Scenario OPSX34 Clerk,
Solomon.html[10/21/2021 10:55:47 AM]
Outpatient Surgery
Patient Case Number: OPSX34-Clerk, Solomon
Patient Name: Solomon Clerk DOB: 08-08-74 Sex: M
Date of Service: 04-17-XX Surgeon: Adrian Michaels, MD
Pre-Operative Diagnosis

5. R/o torn rotator cuff, right shoulder
Post-Operative Diagnosis
Rotator cuff tear, right shoulder. Impingement syndrome w/
rotator cuff tear. Bursitis, right shoulder.
Procedure Performed: Arthroscopic acromioplasty w/ rotator
cuff repair
Anesthesia: General Complications: None
Operative Procedure:
The patient was identified in the preoperative area. Proper
surgical site protocol was followed. He was
subsequently taken to the operating suite where a general
anesthetic was administered by the department
of anesthesia. The patient was carefully positioned in the beach
chair position. All bony prominences
were well padded. The right shoulder and arm were sterilely
prepped and draped in the usual manner.
Bony landmarks were identified and arthroscopic portals
infiltrated with 1% Xylocaine with epinephrine.
Posterior portal to the glenohumeral joint was established in a
standard fashion. An accessory anterior
portal was established under triangulation techniques and a
probe and shaver inserted anteriorly. There is
some fraying of the biceps tendon, but the anchor itself was
intact. There is an area of erosion in the
glenoid, the anterior labrum is intact. The humeral head appears
satisfactory.
Examination of the rotator cuff demonstrates a large area of
tearing laterally. The bare spot is quite
evident.

6. At this point, the arthroscope was reinserted posteriorly into the
subacromial space. Moderate bursitis
was present and bursectomy performed through a lateral portal.
The rotator cuff tear was identified and
noted to be quite large, easily mobile. I then proceeded with a
standard anterior-inferior acromioplasty.
The patient does have an os acromiale and we did not disrupt
this area between the anterior process in
the body of the acromion. Following the completion of the
acromioplasty, all arthroscopic instruments
removed and I made a lateral incision extending from the lateral
aspect of the acromion laterally. The
deltoid fascia was incised and blunt dissection through the
deltoid muscle to the subacromial space was
performed. Retractors were inserted.
Excellent exposure of the cuff tear was present. There is a full-
thickness non-retracted supra and
infraspinatus tear. The footprint was identified and cleared of
all debris and soft tissue. I debrided the
lateral edge of the rotator cuff and utilized 3 medial row
Arthrex corkscrews followed by 2 lateral row
OPSX34ClerkSolomon
MCCG240 Case Scenario OPSX34 Clerk,
Solomon.html[10/21/2021 10:55:47 AM]
Push locks for double row fixation.
Excellent apposition of the repair was present and palpation on
the undersurface of the acromion and
clavicle was satisfactory for no evidence of impingement. The
wound was copiously irrigated of all debris
and closed in a routine fashion. Sterile compressive dressings
were applied. A sling and swathe was

7. applied. The patient returned to recovery cart in satisfactory
condition having tolerated the procedure
well.
Electronically Signed By: Adrian Michaels, MD
Copyright © 2020 by The American Health Information
Management Association. All Rights Reserved.
Local DiskOPSX34ClerkSolomon
OPSX38AndelLucinda
MCCG240 Case Scenario OPSX38 Andel,
Lucinda.html[10/21/2021 10:55:47 AM]
Outpatient Surgery
Patient Case Number: OPSX38-Andel, Lucinda
Patient Name: Lucinda Andel DOB: 05-20-62 Sex: F
Date of Service: 11-2-XX Surgeon: Michael Singleton, MD
Pre-Operative Diagnosis
Metastatic primary peritoneal cancer
Post-Operative Diagnosis
Metastatic primary peritoneal cancer
Procedure Performed: Insertion of single-lumen Infusaport
Anesthesia: General Complications: None
Description of Procedure:

8. After successful induction of general anesthesia, the patient was
placed in a steep Trendelenburg
position. The neck and the chest wall was prepped and draped in
the usual sterile fashion. An
infraclavicular subclavian puncture was then made to access the
subclavian vein. The catheter was
inserted into the right atrium via the subclavian vein. The
position of the catheter was checked. The
dilator introducer assembly was inserted over the guidewire into
the right atrium. The introducer was
removed. The catheter was inserted into the right atrium.
Through the introducer, the introducer set was
peeled away. A transverse incision was then made on the
anterior chest wall.
Subcutaneous tissue was incised. The reservoir of the Infusaport
was then placed in the subcutaneous
space. This was sutured in place. The catheter was then
tunneled subcutaneously to the site of the
reservoir. The catheter was pulled such that the tip of the
catheter was located in the right atrium. The
catheter was then connected to the reservoir with the help of a
small plastic screw meant for the above
purpose. The reservoir was sutured in place. The patient
tolerated the procedure well. A 3-0 Vicryl
sutures were used to approximate the subcutaneous tissues. The
skin was approximated with 3-0 Vicryl
subcuticular sutures. The patient tolerated the procedure well
and was transferred to the recovery room
under satisfactory condition.
Electronically Signed By: Michael Singleton, MD
Copyright © 2020 by The American Health Information
Management Association. All Rights Reserved.
Local DiskOPSX38AndelLucinda

9. OPSX29GradyKent
MCCG240 Case Scenario OPSX29 Grady,
Kent.html[10/21/2021 10:55:46 AM]
Outpatient Surgery
Patient Case Number: OPSX29-Grady, Kent
Patient Name: Kent Grady DOB: 07-13-70 Sex: M
Date of Service: 01-22-XX Surgeon: Mary Hollister, MD
Pre-Operative Diagnosis
Acute Pancreatitis
Post-Operative Diagnosis
Esophageal Varices
Procedure Performed: EGD & Endoscopic ultrasound
Anesthesia: Conscious sedation Complications: None
PROCEDURES:
1. EGD
2. Endoscopic ultrasound.
INDICATIONS:
1. Acute pancreatitis.
2. Abnormal CT scan, rule out pancreas head mass.
PROCEDURE #1 EGD:
The Olympus GIF-190 forward-viewing video-endoscope was

10. lubricated and advanced into the
hypopharynx. The scope passed into the esophagus.
Examination of the stomach was performed in
straight and retroflexion views. The scope was passed into the
second portion of the duodenum.
FINDINGS:
1. Grade 1 esophageal varices x1.
2. Food debris in the proximal stomach, otherwise, normal
stomach.
3. Normal duodenum.
4. Acute and chronic pancreatitis
PROCEDURE #2 ENDOSCOPIC ULTRASOUND:
The Olympus linear echoendoscope was lubricated and
advanced into the hypopharynx. The scope
passed through the esophagus, stomach, pylorus second portion
duodenum. With the water-filling
technique of the balloon and lumen, endoscopic ultrasound
examination performed. The pancreas
parenchyma appeared with diffuse inhomogeneity, hypoechoic
foci, lobulation, and a few calcifications in
the head of the pancreas. The main pancreatic duct was not
dilated, and it had thickened borders. Folds
features are suggestive of chronic pancreatitis. The common
bile duct was dilated measuring 9 mm.
There was free fluid around the pancreas body and tail. The
splenic vein was distended, consistent with
portal hypertension.
OPSX29GradyKent
MCCG240 Case Scenario OPSX29 Grady,
Kent.html[10/21/2021 10:55:46 AM]

11. RECOMMENDATIONS:
1. Alcohol abstinence.
2. Repeat EUS in 3 months.
Dictating Clinician: Mary Hollister, MD
Electronical Signed By: Mary Hollister, MD
Copyright © 2020 by The American Health Information
Management Association. All Rights Reserved.
Local DiskOPSX29GradyKent
OPSX31MayweatherCora
MCCG240 Case Scenario OPSX31 Mayweather,
Cora.html[10/21/2021 10:55:48 AM]
Outpatient Surgery
Patient Case Number: OPSX31-Mayweather, Cora
Patient Name: Cora Mayweather DOB: 03-01-66 Sex: F
Date of Service: 08-13-XX Surgeon: Matthew Bordelon, MD
Pre-Operative Diagnosis
Metastatic stage IIIC cancer of
ovary w/ involvement of the
rectosigmoid
colon and ovaries
Post-Operative Diagnosis
Metastatic stage IIIC cancer of ovary w/ involvement of the

12. rectosigmoid colon and ovaries
Procedure Performed: Insertion of single-lumen infusaport,
debridement of necrotic tissue around
stoma, removal of PICC line
Anesthesia: General Complications: None
PREOPERATIVE DIAGNOSES:
1. Metastatic stage IIIC cancer of the ovary with involvement of
the rectosigmoid, both the ovaries and
the cul-de-sac, status post ovarian cancer debulking.
2. Lack of vascular access.
POSTOPERATIVE DIAGNOSES:
1. Metastatic stage IIIC cancer of the ovary with involvement of
the rectosigmoid, both the ovaries and
the cul-de-sac, status post ovarian cancer debulking.
2. Lack of vascular access.
OPERATIVE PROCEDURE CARRIED OUT:
1. Insertion of a single-lumen infusaport.
2. Debridement of necrotic tissue around the stoma.
3. Removal of PICC line.
DESCRIPTION OF PROCEDURE:
After successful induction of general anesthesia, the patient was
placed in steep Trendelenburg position.
The neck and the chest wall was prepped and draped in the
usual sterile fashion. An infraclavicular
subclavian puncture was then made. Guidewire was inserted
into the right atrium. The needle was then
removed. The position of the guidewire was tested
radiographically. A dilator introducer kit was inserted
over the guidewire into the right atrium. The right guidewire
was removed. The catheter was inserted

13. into the right atrium under fluoroscopic guidance. A transverse
incision was then made on the anterior
chest wall. Subcutaneous tissue was incised along the line of the
incision. The catheter was tunneled
subcutaneously to the point on the anterior chest wall. The
catheter was connected to the reservoir such
that the tip of the catheter was located in the right atrium. The
catheter was then attached to the
OPSX31MayweatherCora
MCCG240 Case Scenario OPSX31 Mayweather,
Cora.html[10/21/2021 10:55:48 AM]
reservoir. The reservoir was then flushed. The reservoir was
sutured to the anterior chest wall. The
patient tolerated the procedure well. The skin was closed with
subcuticular suture. The skin was closed
with subcuticular sutures. The patient tolerated the procedure
well. The patient was transferred to the
recovery room under satisfactory conditions. The PICC line was
removed by gentle traction. The tip of
the catheter was intact. A sterile dressing was applied on the
right arm where the PICC line has been
taken out. The ostomy in the left lower quadrant was
revisualized. The tissue around the colostomy was
excised. A new colostomy bag was then placed over this site.
Minimal debridement of necrotic tissue
around the base of the stoma was carried out and by sharp
dissection.
Dictating Clinician: Matthew Bordelon, MD
Electronically Signed By: Matthew Bordelon, MD

14. Copyright © 2020 by The American Health Information
Management Association. All Rights Reserved.
Local DiskOPSX31MayweatherCora