Chapter-10

1: Acute laryngitis with airway obstruction-

2. Hypertrophy of tonsils and adenoids-

3. Maxillary sinus polyps-

4. Acute exacerbation of chronic obstructive pulmonary disease-

5. Postoperative pneumothorax.

6.The patient has increasing shortness of  breath, weakness, and ineffective cough.  
Treatment included oxygen therapy and  advice for smoking cessation.  Diagnoses 
listed as acute respiratory insufficiency  due to acute exacerbation of COPD and 
tobacco dependence.  What diagnosis  codes are assigned?

7. Smoking related chronic bronchitis

8. A 45 year old was admitted with worsening wheeze and chest pain. He was investigated
with ECG which was normal and chest x ray which showed consolidation of the left upper
lobe. A diagnosis of left upper lobe pneumonia was made.

9. The patient, a 51-year-old woman with acute respiratory failure secondary to an acute
exacerbation of chronic obstructive bronchitis, was brought to the emergency department
by emergency medical services. In the emergency department, she was intubated and
placed on mechanical ventilation. On admission, it soon became apparent that she had
suffered severe, irreversible hypoxic encephalopathy. On day 5, she was weaned from the
ventilator and extubated; however, significant neurological function was never regained. In
accordance with her advance directive, tube feedings were discontinued. She became febrile
and dyspneic. Antibiotics were started to provide comfort and relief of her pneumonia. She
expired on day 13. Discharge diagnoses: (1) Acute respiratory failure with hypoxia secondary
to chronic obstructive bronchitis, (2) pneumonia, (3) encephalopathy.

10. The elderly patient came to the emergency department complaining of shortness of breath and
nausea. It was apparent that she was suffering from congestive heart failure and respiratory failure,
and she was admitted for immediate treatment of the acute respiratory failure. Before any
diagnostic work could be accomplished, she died. Discharge diagnoses: (1) Acute respiratory failure,
(2) congestive heart failure.

11. The patient was admitted after visiting the emergency department for shortness of breath, chest
pain, hypoxia, and a white cell count of 32,600. The patient had a history of chronic obstructive
pulmonary disease. Interstitial infiltrate at the right middle and lower lobes of the lung was seen on
chest X-ray. Sputum culture grew Streptococcus pneumoniae. He tolerated the antibiotics, and the
symptoms improved significantly. Discharge diagnoses: (1) Right lower lobe pneumonia due to
Streptococcus pneumoniae, (2) acute exacerbation of chronic obstructive lung disease.

12. The patient, a young man, came to the emergency department after being ill for at least three
weeks. He initially had a head cold and sore throat, followed by fever, difficulty swallowing, chills,
and brown sputum. Because of severe lymphadenopathy in the neck, as well as other stated
symptomatology, he was admitted. A huge left tonsil confluent with the surrounding tissues and
covered with exudate was also noted on the physical examination. This appeared to represent a
peritonsillar abscess and severe tonsillitis. A throat culture showed a heavy growth of beta-
Streptococcus group C. Intravenous antibiotics were given with success, and he was discharged.
Discharge diagnoses: (1) Severe tonsillitis with beta-Streptococcus group C, (2) probable left
peritonsillar abscess.

13. The type 1 diabetic patient was admitted with a right heel ulcer that had failed a number of
outpatient therapies. Also, because the patient was hypoxic on admission with a history of COPD, he
was given supplemental oxygen. He coughed up sputum, and a chest X-ray showed a mild increase in
interstitial markings. Consequently, he was treated for acute bronchitis with erythromycin, which
provided good results. Gradually, the foot ulcer healed. But the hypoxia persisted, and an increase in
his oxygen therapy was helpful. He was to be followed by home health services. Discharge
diagnoses: (1) Diabetic foot ulcer, right heel; (2) acute bronchitis; (3) diabetes mellitus; (4) history of
COPD.

14.The patient was admitted with high fever, stiff neck, chest pain, and nausea.  A lumbar puncture
was performed and results were positive for meningitis. Chest x-ray revealed pneumonia. Sputum
cultures grew pneumococcus. Patient was treated with IV antibiotics. The established diagnoses
were pneumococcal meningitis and pneumococcal pneumonia.

 Code the diagnoses for this case only.

15.A 5-year –old child was seen with a high fever, cough, and chest pain. Diagnosis of diffuse
bronchopneumonia was made. Gram stain of the sputum showed numerous small gram-negative
coccobacilli. Diagnosis : H.influenza pneumonia.-

16.This 85-year-old man is admitted to the nursing facility following hospitalization for dehydration
due to pneumonia. Resident is admitted for multiple therapies due to weakness because of
infiltrates.  He will complete the antibiotics in the nursing home for the Pseudomonas pneumonia.
Resident also had progressing dementia resulting from Parkinson's disease and he realized that it
was getting more difficult to remain in his own home and agreed to admission.  His past medical
history includes mitral valve regurgitation, kyphosis, mild asthma, and type 2 diabetes.

17.A 16-year –old student was treated for cough, fever,body aches, and headache. Diagnosis: Upper
respiratory tract infection due to novel influenza A virus, What diagnosis codes are assigned?

18. This 11-year old female child is being seen because of severe persistent asthma with acute
excerbation. What diagnosis codes are assigned?

19. The patient has increasing shortness of breath, weakness, and ineffective cough. Treatment
inclused oxygen therapy and advive for smoking cessation. Diagnoses listed as acute respiratory
insufficiency due to acute exaacerbation of the COPD and tobacco dependance. What diagnosis
codes are assigned?

20. This 70-year-old female was brought to the ER with severe difficulty in breathing. She was
intubated and started on mechanical ventillation and admitted. Diagnosis for this patient. Acute
respiratory failure, acute infectious bronchitis with acute exacerbation of COPD. What diagnosis
codes are assigned?

21. The patient is a 54-year-old female who presents today with an infected cuticle on her left
thumbnail. The patient states this started about one week ago. She denies any discharge from the
nail but throbbing pain at night. She does work as a bartender where she is frequently having her
hands immersed in water.She denies any trauma to her hand. No possibility of a fracture. No
nausea, vomiting or diarrhea, fever or chills. The patient does have a cough. She is a smoker for the
past 20+ years.She smokes a pack of cigarettes a day. The cough is typical and sometimes productive
of whitish clear sputum. Allergies: Penicillin and iodine both which produce hives. Social History:
Admits to drinking two beers a day. No illicit drug use. Review of Systems:The patient has never had
a chest x-ray done. She is up to date on her Pap smears and mammogram.Physical Exam: Blood
pressure is 118/66. Pulse 70. Respiration 12. Temp is 98.5. Lungs are clear to auscultation. No rales,
rhonchi, or wheezing. Heart is RRR. Abdomen is soft, nontender, and nondistended.To the lateral
aspect of the left thumbnail bed there is increased swelling and erythema with no discharge noted.
There is exquisite tenderness on palpation.Impression:1. Paronychia left thumbnail - levaquin 750
mg once a day for five days 2. Smokers' cough - chest x-ray ordered, CMP, lipids, TSH and CBC
ordered.3. Tobacco abuse Assign the correct diagnostic code(s).

22. Resident has vancomycin-resistant acute respiratory infection. A PICC line has been placed to
administer IV antibiotics which the physician has noted will be used indefinitely. Orders include IV
antibiotics and flushing of the PICC line. What diagnosis code(s) are assigned?
23. The patient was admitted with diagnoses of probable rib fractures and pneumonia. She slipped
and fell in the bathtub of her single-family home while taking a shower about four days before
admission and had experienced increasingly severe upper back and neck pain. Just prior to
admission, she began running a fever, felt short of breath, and developed inspiratory chest wall pain.
No rib fractures were identified on chest X-ray, but right upper lobe pneumonia was evident.
Sputum culture grew Klebsiella. The patient was started on antibiotics and the pneumonia improved.
Back pain was relieved by pain medication and bed rest.

Discharge diagnoses: (1) Right upper lobe pneumonia, (2) cervical and thoracic back sprain.