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Homework answers / question archive / OPERATIONS: 1


Health Science

1. Flexible bronchoscopy
2. Cervical mediastinoscopy with biopsy and thyroid isthmusectomy


PROCEDURE: This otherwise normally healthy patient was brought to the operative suite and placed in supine position. After satisfactory induction of general endotracheal anesthesia, a flexible Olympus bronchoscope was passed through the endotracheal tube visualizing the distal trachea, carina, and right and left main stem bronchi of the primary and secondary divisions. No evidence of any endobronchial tumor was noted. The scope was then withdrawn.


     The patient was then prepped and draped in the usual sterile fashion. A shoulder roll was placed. A curvilinear incision was made above the suprasternal notch in the line of a skin crease. Dissection was carried down through the subcutaneous tissue down through the platysma muscle. The strap muscles were next identified and laterally retracted. We continued our dissection down to the pretracheal space. A partial left thyroid lobectomy with isthmusectomy was done without any problems; this gave me clear access to the pretracheal space. A pretracheal plane was next developed. A mediastinoscope was placed. I saw multiple, firm right paratracheal lymph nodes. After first aspirating these structures to make sure they are not vascular in nature, generous biopsies were taken and sent to pathology for examination. Frozen section analysis revealed these to be consistent with lymphoma. Excellent hemostasis was obtained. The wound was irrigated using warm antibiotic saline solution. The wound was then closed in layers using Vicryl sutures. Dressings were applied. Marcaine 0.25% was used as a regional block. The patient tolerated the procedure and was sent to the recovery room in stable condition.



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Determine the most accurate procedure codes, using the CPT code set and modifier(s), if appropriate.

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