Question 1
SUBJECTIVE: The patient has no known allergies. She is diabetic since 2002. She takes 81 mg of aspirin daily. Medication list is noted. The patient is here for annual diabetic foot check. She does have diabetic shoes. She denies cigarette use or tobacco use.
OBJECTIVE: On examination, she has elongated thickened toenails 1 through 5 bilaterally, mycotic appearing. Finding is consistent with fungal toenails. We discussed diabetic foot care do’s and don’ts. She has intact sensation with 128 cycles per second tuning fork at the level of great toe. She has intact sensation with 5.07 monofilament plantar foot. No foot ulceration is seen. DP and PT pulses are palpable.
IMPRESSION:
1.Onychomycosis
2.Diabetes mellitus.
PLAN: I reduced toenails 1 through 5 manually and with electric grinder. I will see her back for followup in 10-12 weeks
What diagnoses would be reported?
A. E11.9, B35.1
B. E11.40, B35.1
C. B35.1, E11.9
D. B35.1, E11.621
The rationale for this question states Onychomycosis is sequenced first; However, that shows as incorrect when graded. When E11.9 is sequenced first followed by B35.1, the answer shows as correct. What is the correct sequencing for this question.
