| Post Name | Medical Records Librarian GrII - Health Services |
|---|---|
| Question Paper Code | 002/2021 |
| Category Code | 240/2018, 337/2018, 002/2019, 040/2019 |
| Date of Test | 1 January 2021 |
| Medium of Question | ENGLISH |
| Exam Type | OMR Examination |
| Total Questions | 100 |
1
The lymphatic system contains four organs :
Answer
A. Spleen, tonsils, bone marrow and thymus
2
Which coding and classification system is primarily used by dentists ?
Answer
C. CDT
3
The process of simply taping the small items to a larger sheet of paper (especially lab
reports) and then filing that paper in the patient’s medical records is called
Answer
D. shingling
4
Medical records of patients who are deceased or moved away, probably never to be seen
again by the provider, are under what status ?
Answer
B. Inactive
5
MAR refers to
Answer
B. Medication Administration Record
6
Which of the following may be used in telemedicine ?
Answer
A. “Store and forward” technology
7
Important uses of the medical record include all of the following Except :
Answer
D. information to pharmaceutical companies
8
Documentation in a medical record that supports the skilled services that are medically
reasonable and necessary are called
Answer
C. medical necessity
9
The standard of care in cases of medical negligence is measured against
Answer
B. What is expected of a reasonable doctor
10
Which term describes a best way to organize and chart patient progress ?
Answer
A. SOAP
11
Which of the following standards are used to create standardized nomenclature within an
electronic health record program ?
Answer
D. SNOMED CT
12
If a patient is in the prone position, he is :
Answer
B. Lying flat on his stomach.
13
When you see the symbol # in front of a CPT code, what does it mean ?
Answer
A. That the code is listed out of numerical order.
14
What is removed by a pneumonectomy ?
Answer
C. The lung
15
The Hospital Management Committee is concerned about the growing number of history
and physical examination reports that are not being completed in a timely manner. Which
monitoring process will the Medical records department implement to correct this
problem ?
Answer
A. Concurrent analysis
16
In ICD _____ symbol is used in listing of inclusion and exclusion terms when the words
that precede it are not complete terms for assignment to the rubric.
Answer
B. : Colon
17
_____ is defined as the symptom of disease (such as rash or fever) which appear before
and signal the onset of approaching more severe illness.
Answer
C. Prodrome
18
_____ is the defined as the number of hospital beds, exclusive of newborn bassinets,
normally available for use by Inpatients.
Answer
B. Bed compliment
19
What is one advanced method used to input data into an EMR ?
Answer
C. Use of voice recognition system
20
Chiropractors are complementary and alternative healthcare professionals who focus on
the diagnosing and treating of what body part ?
Answer
B. Spine and musculoskeletal system
21
What type of code is assigned when the provider documents reason for a patient seeking
healthcare that is not an injury or disease ?
Answer
A. Z code
22
The process of moving an active file to inactive status is called
Answer
C. purging
23
Who ultimately decides whether a medical record can be released for
insurance/reimbursement ?
Answer
D. Patient
24
Which of the following is NOT considered as part of the integumentary system ?
Answer
D. Teeth
25
A condition occurring without a clearly identified cause is known as :
Answer
A. Idiopathic
26
Which of the following guards against duplication of patients records ?
Answer
D. Master patient index
27
MRD files the records as follows :
13-40-05, 14-40-05, 14-41-05, 15-41-05 and 16-41-05.
Which system is being used ?
Answer
A. Terminal digit
28
In which chapters of the ICD 10 could the following diagnostic statement have their
codes ? They are : pulmonary tuberculosis, ebola virus and disease and malarial fever.
Answer
B. Diseases of the respiratory system and certain infectious and parasitic
diseases.
29
Sequela describes a condition that is
Answer
B. Late effect of a previous condition
30
What would be the best process to follow if Patient’s records and information in hospital
information systems is discovered to have duplicated during the patient care or after the
care of patient ?
Answer
A. Merging of Medical Records
31
A method to quickly assess the health of newborn children immediately after birth is
named after this physician
Answer
C. Apgar
32
A patient who receives ambulatory care services in a hospital based clinic or department
is statistically considered as a/an :
Answer
A. Outpatient
33
As per the guidelines of ICD 10, when Acute and Chronic Conditions are noted :
Answer
C. Code both and sequence the acute (sub-acute) code first
34
How should an unanticipated death of a full-term infant be reported in a hospital
mortality committee by the Medical Records Department ?
Answer
A. As a sentinel event
35
Which of the following Qualitative analysis method is done by medical records
department after an Inpatient has been discharged ?
Answer
C. Retrospective Analysis
36
Why is an open-ended query preferred to a closed-ended query format by coding
professionals ?
Answer
A. Allows physicians to communicate their medical expertise describing the
diagnosis and treatment of the patient.
37
Which key clinical document is essential in outlining a patient’s course of treatment
while submitting the claims for reimbursement ?
Answer
D. Discharge summary
38
Protected health information may be disclosed to law enforcement officials :
Answer
D. Upon written request for essential government functions.
39
________ is the use of medical information transmitted from one site to another via
electronic communication to improve a patient’s health status.
Answer
A. Telemedicine
40
A storage solution based on digital scanning technology in which Medical record
documents are scanned to create digital images of the documents that can be stored
electronically ?
Answer
C. Electronic Document Management System (EDMS)
41
What is the proper way to destroy medical records ?
Answer
D. Shredding
42
Which medical record format is arranged in chronological order with documentation
from various sources intermingled ?
Answer
C. Integrated
43
________ is a late entry added to a Medical record to provide additional information in
conjunction with a previous entry. The late entry should be timely and bear the current
date and reason for the additional information being added to the health record.
Answer
A. Addendum
44
Which of the following activities is not a traditional medical records function ?
Answer
D. Data administration
45
An incomplete record not finished or made complete within the time frame determined
by the medical records department of the hospital is called
Answer
B. Delinquent record
46
What would you term a situation in which a patient is issued a medical record number
that has been previously issued to a different patient ?
Answer
A. Overlay
47
Which of the following is considered as ‘impersonal’ use of a medical record ?
Answer
D. Used for academic/research purpose
48
Which of the following is “True” regarding “Copying and pasting notes from a patient’s
previous visit into the current progress notes” ?
Answer
D. All of these
49
In which of these records you normally would not find physician documentation ?
Answer
B. Triage forms
50
The method by which records with medico-legal implications are secured in such a
manner as to prevent loss and to ensure that no alteration after the fact can occur is called
Answer
B. Sequestering of medical records
51
________ is the process of withdrawing samples of fluid from a joint.
Answer
A. Arthrocentesis
52
Find the correctly spelled word.
Answer
B. Acetaminophen
53
Which form of medication administration involved a liquid or ointment that is rubbed
into the skin ?
Answer
B. Topical application
54
Which term describes the surgical incision of the eardrum to create an opening for the
placement of tympanostomy tubes ?
Answer
C. Myringotomy
55
The abbreviation ________ means left eye, especially used in lens prescriptions.
Answer
C. OS
56
Which term describes the surgical repair of the tube extending from the kidney to the
bladder ?
Answer
D. Ureteroplasty
57
A medical condition that coexists with the primary cause of hospitalization and affects
the patients treatment and length of stay is known as
Answer
D. comorbidity
58
A legal term referring to a patient’s right to make his or her own treatment decisions
based on the knowledge of the treatment to be administered or the procedure to be
performed
Answer
A. Informed consent
59
What is the most common type of tracking system used to track paper-based medical
records ?
Answer
C. Outguide
60
The process of assuring that all records of discharged patients have been received by the
Medical records department for processing is called :
Answer
B. record reconciliation
61
Process that determines which individuals or groups should be granted permission to
make entry in medical records, what portions of the medical record should be made
available and what right should be granted related to his or her job requirements, is
referred to as
Answer
C. Access control
62
In a paper-based system, individual Medical records are organized in a pre-established
order. This is called
Answer
B. Assembly
63
Right of individuals to control access to their personal health information is
Answer
A. privacy
64
Final event in the causal sequence that occurred closest to the time of death. Filled in as
top line diagnosis on Medical Certification for Cause of Death form. It is
Answer
C. Immediate Cause of Death
65
According to rules and guidelines for mortality & morbidity coding; If there is no
reported sequence terminating in the condition first entered on the certificate, select this
first-mentioned condition. State the selection rule for selection of the underlying cause of
death for mortality tabulation.
Answer
B. Rule 2
66
The certifier’s report in Medical Certificate of cause of death is stated as below :
Cause of death
Part I
Answer
C. Cirrhosis of liver 2 years K74.6
Part II Large bowel obstruction K56.6
Which is the underlying cause of Death ?
67
A surgical patient develops a wound infection during hospitalization. How is this type of
infection classified ?
Answer
D. Nosocomial
68
Which of the following is not a benefit of EMR ?
Answer
A. Little or no training necessary
69
Which of the following terms refers to the ability to breathe comfortably only when in an
upright position ?
Answer
D. Orthopnea
70
Which of the following is the master gland of the endocrine system ?
Answer
C. Pituitary
71
Blood flows from the right ventricle of the heart into which of the following structures ?
Answer
C. Pulmonary arteries
72
The anatomic location of the spinal canal is
Answer
B. Dorsal
73
The term, “iatrogenic” refers to :
Answer
B. Occurring because of the patient’s medical treatment
74
Which rate is based on the presence of a pre-existing condition at the time of admission ?
Answer
A. Comorbidity rate
75
Medico legal autopsy required the permission of
Answer
C. Police
76
Information required for an informed consent generally does not include :
Answer
D. anticipated charges for treatment.
77
The year in which Supreme Court of India legalized passive euthanasia is
Answer
C. 9th March, 2018
78
Before release of patients medical records the following conditions must be met, except :
Answer
D. Duration of use of the records must be stated.
79
The disadvantage of chronological documentation is
Answer
D. medical problems may go undiscovered.
80
Who can make a correction in the medical record ?
Answer
C. The author of the incorrect information
81
Which of the following is the medical term for hair loss ?
Answer
D. Alopecia
82
Which of the following allows gas exchange in the lungs ?
Answer
A. Alveoli
83
Calcium, potassium and sodium are classified as which of the following ?
Answer
C. Electrolytes
84
Diagnosis coding under ICD 10-CM uses how many digits ?
Answer
D. 3-7
85
The abbreviation “PRN” means :
Answer
A. as required
86
This lab test measures the level of oxygen and carbon dioxide in the blood to determine
how well your lungs are working ?
Answer
B. ABG
87
Which of the following represents the most common cancer staging system used to
indicate the tumor size and whether it has spread to lymph nodes or other sites in the
body ?
Answer
B. TNM staging
88
What does the medical abbreviation “a.c.” mean ?
Answer
B. Before Meals
89
Which is not a best practice for the document imaging process ?
Answer
C. Use of highlighters is recommended to enhance and portion of the document
that is difficult to read.
90
In which type of record format would SOAP notes most likely be found ?
Answer
D. POMR
91
Which of the following procedures would be the best process to follow when a charting
error has been discovered in the EMR ?
Answer
A. Make the correction as an addendum.
92
In cases where patient care is questioned, the patient medical record will provide legal
protection to which of the following parties ?
Answer
D. All of the above
93
A document keyed by a medical transcriptionist is introduced into a patient’s clinical
record. Which of the following statements regarding this information is correct ?
Answer
D. The practitioner who dictated the information must authenticate the
transcribed entry.
A 13 002/2021
94
A patient statement “feels queasy, especially when standing up quickly.” This is an
example of which SOAP format component ?
Answer
A. S
95
The disease or condition that was present on admission, was the principal reason for
admission and received treatment or evaluation during the hospital stay or visit or the
reason established after study to be chiefly responsible for occasioning the admission of
the patient to the hospital for care is known as
Answer
B. Principle diagnosis
96
The process that provides a means of addressing requests for additional information from
physicians as part of the coding and reimbursement process is called
Answer
B. Physician query process
97
________ is a procedure used by Joint Commission surveyors in the accreditation
process for assessment of operational systems and processes in relation to the actual
experiences of selected patients who are currently under the organization’s care. This
allows the surveyor to identify performance issues.
Answer
A. Tracer Methodology
98
An unexpected occurrence involving death or serious physical or psychological injury or
risk thereof in a hospital setting is called
Answer
B. sentinel event
99
Inappropriate timing of dose, transcription errors, missed doses and extra doses are all
examples of this type of medication error
Answer
D. administration
100
Which of the following is an accessory organ of the gastrointestinal system that is
responsible for secreting insulin ?
Answer
C. Pancreas
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