1. Which of the following does not qualify for drug therapy requiring intensive monitoring for toxicity?

2. A 77 yo former smoker-COPD patient presents to see you due to SOB and worsening cough with purulent sputum production of six days duration. Saturations on RA are 89% with ambulation, 93% at rest (96% baseline).  CBC, CMET are normal.  The CXR is negative (read and documented by you), but given the presentation, you recommend a short stay in the hospital to get “tuned up”.  He refuses, but agrees to follow-up with his PCP in the morning or call tonight if things worsen.  You agree with the plan and prescribe appropriate medications.  The total time for the encounter, including chart documentation, is 54 minutes.  You bill

3. Regarding the DATA component of MDM, true statements about the categories used to delineate the “moderate” and “high” MDM. ALL of the following are correct EXCEPT:

4. An “independent historian” as defined by the 2023 Evaluation and Management Guidelines includes all the below EXCEPT:

5. You are seeing a patient due to IBS and abdominal pain. You review the PCP office note from 3 weeks ago, the GI note from 6 months ago and you ordered a CBC and CMET today.  You decide to call the GI provider to make sure you coordinate a “next step”.  Regarding the DATA part of MDM (select ALL that are correct)

6. A patient comes in with abdominal pain with dysuria, frequency, and slight nausea. She is 63, on a single antihypertensive medication, sees her PCP regularly, has a BMI of 28, is vegetarian, and a fitness instructor.  Temp is 99.0, BP 133/77, other vitals normal.  CBC shows a WBC count of 4,900 and her CMET is normal.  UA shows TNTC WBCs and bacteria.  Urine culture is pending.  Her exam shows mild suprapubic tenderness but no CVA tenderness.  Lungs and CV exam are benign and mental status is normal.  A KUB (which you read as “no acute findings and normal bowel gas pattern”) is also performed.  You assess her as “(1) Abdominal Pain, (2) cystitis, and (3) Hypertension.  You prescribe nitrofurantoin and phenazopyridine.  You recommend compliance with the medication and give her instructions regarding return to the ED for re-evaluation if “symptoms persist as complications, though rare, may occur and progress to pyelonephritis and merit in-house care”.  72 minutes of care was delivered in the ED for this patient.  You code this visit (choose the BEST answer)

7. A patient comes in with abdominal pain with dysuria, frequency, and slight nausea now but emesis earlier today x2. She is 63, on a single diabetic medication (metformin), sees her PCP infrequently, is an administrative assistant, and sedentary.  BMI is 31.  Temp is 99.0, BP 133/77, other vitals normal.  CBC shows a WBC count of 4,900 and her CMET is normal and her A1c is 7.3%.  She never checks her sugars at home.  UA shows TNTC WBCs and bacteria.  Urine culture is pending.  Her exam shows mild suprapubic tenderness but no CVA tenderness.  Lungs and CV exam are benign and mental status is normal.  A KUB (which you read as “no acute findings and normal bowel gas pattern”) is also performed.  You assess her as “(1) Abdominal Pain, (2) cystitis, and (3) Diabetes Mellitus, Type 2.  You prescribe nitrofurantoin and phenazopyridine.  You recommend compliance with the medication and give her instructions regarding return to the ED for re-evaluation if “symptoms persist as complications, though rare, may occur and progress to pyelonephritis and merit in-house care”.  You also recommend she start checking her blood sugars and that she should see her PCP within one week to get re-established.  72 minutes of care was delivered in the ED for this patient.  You code this visit (choose the BEST answer)

8. Prescribing a prescription medication, telling a patient to stop a medication, or recommending continuation of a prescription medication, all merit what level of medical decision-making pertaining to RISK of patient management?

9. A 67-year-old with hypertension and diabetes presents with a mild frontal headache. She is on metformin and her sugars at home range fasting 70-110 and 100-125 pre-meal.  Blood pressures at home over the past week have ranged 145-156/88-95.  In the ED today, the pressure is 155/92 with a HR of 77 (reg).  She is on lisinopril 10mg only for blood pressure which she started 2 months ago.  CMET (glucose 110 non-fasting, eGFR 88) and CBC are normal.  You suggest she take two lisinopril (20mg) daily and you set her up for a follow-up visit within one week to the PCP with instructions to check her blood pressure closely and bring in numbers to the PCP for review.  You bill

10. A 69-year-old presents with cough, congestion, purulent sputum, with an apparent COPD exacerbation. No wheezing is noted and he has an oxygen saturation of 97% on RA.  He is compliant with his maintenance inhaler but ran out of his rescue MDI two months ago.  He is in no distress.  Exam shows mild rales, no accessory muscle use, and normal mentation.  This is a common occurrence for him, but it is after hours, and his pulmonologist is closed.  Assume you are going to treat with a prescription medication at discharge.  Even without labs or x-rays, you feel comfortable that this patient could compliantly be charged