Assisting with Highly Specialized Examinations

CHAPTER

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40Assisting with Highly

Specialized Examinations


40-2

Learning Outcomes40.1 Discuss the medical specialties of allergy, cardiology,

dermatology, endocrinology, gastroenterology, neurology, oncology, ophthalmology, orthopedics, otology, surgery, and urology.

40.2 Describe the types of examinations and diagnostic tests performed in each of these specialties and the medical assistant’s role in these examinations and tests.

40.3 Identify the most common diseases and disorders seen in these medical specialties and typical treatments for them.


40-3

Learning Outcomes (cont.)

40.4 Carry out the procedure for assisting the physician in performing a scratch test.

40.5 Carry out the procedure for assisting with a sigmoidoscopy.

40.6 Prepare the ophthalmoscope for use.

40.7 Carry out the procedure for assisting with a needle biopsy.


40-4

Introduction • Many physicians choose to specialize

• The medical assistant working for a specialist will– Assist with the examinations – Assist with diagnostic testing and processing

specimens


40-5

The Medical Assistant’s Role in Specialized Examinations

• Physicians that specialize focus on one body system, a single type of disease, or medical intervention

• Medical assistant role– General administrative and

clinical tasks– Assist with examinations

and procedures– Communicate with and

educate patients


40-6

Allergy• Allergist – diagnoses and treats allergies

• Allergies – inappropriate immune system responses to normally harmless substances

• Allergen – substance that causes an allergic reaction

• Allergic reactions may be localized or systemic

• Anaphylaxis – life-threatening allergic reaction


40-7

Allergy Examinations• Involves a medical history and diagnostic

testing

• You must understand the function of the immune system and how allergies are treated– Allergen avoidance– Medications– Desensitization to a substance


40-8

Allergy Testing• Scratch test

– Used to test for specific allergies

– May cause discomfort and itching

• Intradermal test– A dilute solution of

allergen into the skin– More sensitive than

the scratch test

• Patch test– A linen or paper patch

is soaked with an allergen

– Contact dermatitis

• RAST– Measures blood levels

of antibodies to specific allergens


40-9

Apply Your Knowledge1. How does the medical assistant participate in specialty

examinations?ANSWER: The medical assistant performs general administrative and clinical tasks, assists with examinations and procedures, and communicates with and educates patients.

2. Match the following:

___ May be localized or systemic response A. Allergen

___ Substances causing an allergic reaction B. Anaphylaxis

___ Inappropriate immune responses C. Allergic reaction

___ Diagnoses and treats allergies D. Allergies

___ Life-threatening reaction E. Allergist

ED

B

AC

ANSWER:


40-10

Cardiology• Cardiologist – specializes in heart disease and

disorders• Medical assistant must be familiar with

– The structure of the cardiovascular system – Typical examination and measurements – Tests performed

• Electrocardiography• Stress testing• Echocardiography


40-11

Cardiology Examination• Auscultation

– Blood pressure

– Overall cardiac health

• Palpation– Chest wall– Vessels in

extremities

• Electrocardiogram (EKG or ECG) – Measures the

electrical activity of the heart


40-12

Cardiology Examination (cont.)

• Stress test – Measures the response to

a constant or increasing workload

– Stress thallium ECG• Patient is injected with

radioisotope

• Holter monitor – records ECG over a period of time


40-13

Radiography and Imaging Techniques

• Chest x-ray

• Radionuclide studies – Contrast medium

ingested or injected– Angiography


40-14

Radiography and Imaging Techniques (cont.)

• Ultrasound

• Echocardiography– Tests structures and function of heart

• Heart MRI– Provides detailed pictures of heart and

vessels


40-15

Radiography and Imaging Techniques (cont.)

• Cardiac catheterization – catheter is threaded through a vein into the heart– Obtain blood samples– Measure pressure in the heart’s chambers– View the heart’s motion– Perform a balloon angioplasty– Insert a stent


40-16

Diseases and DisordersCategory Condition/Description

Arterial/vascular Disorders of arteries or veins

Cardiomyopathy Disease of heart muscle causing fatigue and breathing problems and leading to heart failure

Coronary artery disease

Partial or complete blockage of major coronary arteries

Dysrhythmias Disorders of heart rhythm

Heart failure Inability of heart to pump blood effectively, resulting in fluid buildup in tissues and lungs

Inflammations Infections of heart tissueValvular diseases Heart valves do not open or close fully


40-17

Apply Your Knowledge

True or False:

___ An ECG tests the function of the heart through sound waves.

___ Angiography is an x-ray of a blood vessel after injection of a

contrast medium.

___ Managing heart conditions often involves lifestyle changes.

___ A Holter monitor is only done in an inpatient setting.

___ A stress test measures the patient’s response to an increasing workload.

___ An endocardiography is a form of ultrasound.

T

F

T

T

T

most often done on an outpatient basis.

echocardiogramF

ANSWER:


40-18

Dermatology• Dermatologists –

diagnose and treat skin diseases and disorders

• Disorders – Some involve only

the skin– Others are a sign

of disease elsewhere

• Medical assistant assists by– Positioning and

draping during skin exams

– Taking skin scrapings or wound cultures

– Educating patients


40-19

Dermatology Examinations• Whole-body skin

examination – Top layer of the

entire surface of the skin

• Magnifying lens and bright light

• Photograph or sketch a lesion

• Wood’s light examination– Skin inspected

under ultraviolet lamp in a darkened room

– Highlights abnormal skin characteristics


40-20

Skin Lesions

MaculeNodule

Papule


40-21

Skin Lesions (cont.)

Bulla

Pustule

Ulcer


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Conditions and DisordersCondition/Disorder Description

Acne vulgaris Inflammation of the follicles of the skin’s sebaceous (oil) glands

Contact dermatitis Skin inflammation caused by irritants

Psoriasis Characterized by patches of red, thickened skin with silver scales; itching

Eczema Skin inflammation

Ringworm Tinea; fungal infections; dry and scaly or moist and crusty


40-23

Conditions and Disorders (cont.)

Condition/Disorder Description

Moles (nevus) Brown, black, or tan spot on the skin; raised or unraised; even coloring, round or oval shape and clear borders

Warts Benign skin tumors from a viral skin infection; common, plantar, and venereal

Impetigo Highly contagious bacterial skin infection

Herpes zoster Acute viral infection of nerves under the skin; painful skin eruptions; shingles

Scabies Contagious skin disease caused by a mite; intense itching


40-24

Conditions and Disorders (cont.)

• Skin cancer– Basal cell

• Small waxy craters with rolled borders

– Squamous cell • Lesions appear

ulcerated or have a crust

• More likely to spread to other areas of the body than basal cell carcinomas

– Malignant melanoma• Originates in cells that

produce melanin• Spreads through

bloodstream or lymphatic system


40-25


Malignant Melanoma

Basal Cell Carcinoma

Name the three types of skin cancers pictured here. Which is the most serious type?

Bravo!

Squamous Cell

ANSWER:


40-26

Endocrinology

• Endocrinologists – Treat diseases and disorders of the

endocrine system– Hormonal imbalances can affect growth,

metabolism, and reproduction• Medical assistant

– Assists with examinations – Collects specimens for analysis


40-27

Endocrine Examinations

• Thorough medical history• Assessment

– Skin condition– Weight and cardiac functioning

• Diagnostic urine and blood tests

• Ultrasound, X-rays, and iodine scans


40-28

Endocrine Diseases and Disorders• Diabetes

– Type I• Autoimmune disease• Deficiency of insulin

– Type II• Resistance to insulin• Most common in adults

– Gestational – only occurs during pregnancy

• Thyroid gland disorders– Hypothyroidism

• Underproduction of thyroxine

• Children – cretinism• Adults – myxedema

– Hyperthyroidism• Overproduction of

thyroxine• Graves’ disease

– Goiter – enlarged thyroid


40-29


Type I: An autoimmune disease of the

pancreas Diagnosed most often in

childhood Body does not produce

adequate insulin Treatment includes insulin

injections

Type II: Most common form Generally diagnosed in adults Childhood diagnosis is

increasing Risk factors: obesity, inactivity,

family history Treatment may include oral

medications or insulin

What is the difference between Type I and Type II diabetes?

ANSWER:

Excellent!


40-30

Gastroenterology• Gastroenterologists – diagnose and treat

disorders of the gastrointestinal (GI) tract• Medical assistant

– Understands the basic elements of GI exam and procedures

– Patient education – prepares for the exams– Answers patient questions


40-31

Gastroenterology Examinations• May be invasive based on patient

symptoms

• Provide reassurance and ensure comfort

• Patient instructions– Bring someone to drive home– What cautions to take if patient had local

anesthetic of the throat


40-32

Gastroenterology Examinations (cont.)

• Endoscopy – Direct visualization of a

body cavity– Means for obtaining tissue

biopsies or removing polyps

• Peroral endoscopy – examination of the esophagus, stomach, and duodenum

• Colonoscopy – examination of the large intestine

• Proctoscopy – examination of the lower rectum and anal canal

• Sigmoidoscopy – examination of the sigmoid area of the large intestine


40-33

Diagnostic Testing (cont.)

• Lab tests– Analysis of

stomach contents

– Urine

– Occult blood

• Radiologic exams– Cholecystography

• Gallbladder function test

• Differentiate between bile duct obstruction and gallstones

– Ultrasound


40-34

Diagnostic Testing• Radiologic exams

(cont.)– Barium swallow

• Detect abnormalities in the esophagus, stomach, and small intestine

– Barium enema • Detect abnormalities of

the large intestine

– Radionuclide imaging


40-35

Diseases and Disorders• Level of discomfort may be

misleading in relation to severity

• Document patient’s symptoms accurately and completely – Level of pain– Medications taken, including OTCs

• Refer to Table 40-3 for disorders and descriptions


40-36

Apply Your KnowledgeIdentify the following:

_____________ Any procedure using a scope to visualize a cavity of the body

_____________ Provides direct visualization of the large intestine

_____________ Visualizes only the S-shaped segment of the large intestine

_____________ Used to visualize the upper GI tract

_____________ Examination of the lower rectum and colon

endoscopy

colonoscopy

sigmoidoscopy

peroral endoscopy

proctoscopy

ANSWER:

Scoptacular!


40-37

Neurology• Neurologists

– Diagnose and treat diseases and disorders of the central nervous system

• Medical assistant– Assists with examination – Readies equipment for use– Positions the patient – Hands the doctor equipment– Educates patients


40-38

Neurology Examination

• The neurologist evaluates – Cognitive function

– Cranial nerves

– Motor system

– Reflexes

– Sensory system


40-39

Diagnostic Tests• Electroencephalography – records the

electrical activity of the brain• Imaging procedures

– Skull x-rays– Angiograms– Brain scans

• Other tests– Electromyography – Lumbar puncture

– Computed tomography

– Magnetic resonance imaging

– Positron emission tomography

– Myelography


40-40

Diseases and Disorders• Trauma

– Loss of sensation and voluntary motion

– Paralysis

• AIDS-related neurologic symptoms– Meningitis– Encephalopathy– Peripheral neuropathies


40-41

Diseases and Disorders (cont.)

• Encephalopathy– Alters brain function or structure– Causes– Most prevalent sign is altered

mental status

• Other common diseases – Table 40-4


40-42


A patient has a seizure disorder and will be having an EEG. He asks, “What is an EEG? What should I expect?” How should you answer this patient?

ANSWER: An EEG records the electrical activity of your brain. They will place electrodes on your scalp and have you rest quietly or engage in other activities.


40-43

Oncology• Oncologist – specializes in detection and

treatment of tumors and cancerous growths

• Tumor – Lump of abnormal cells– Benign or malignant– Metastasis – Carcinogenesis

• Medical assistant– Be aware of types,

symptoms, and treatments of cancers

– Patient education – side effects of treatment

– Family education and support


40-44

Oncology Diagnostic Testing• Blood specimens – tumor markers

• X-rays

• CT and MRI scans

• Ultrasound

• Biopsy


40-45

Cancer Treatment• Surgery

– Removal of all or part of the tumor

• Radiation therapy – Radiation to kill or stop

the growth of tumor cells

• Chemotherapy – Anticancer drugs to kill

malignant cells


40-46


What are the three types of treatments for cancer?

ANSWER: Cancers are treated by surgical removal of the tumors, radiation therapy to kill or stop the growth of tumor cells, and chemotherapy, which uses anticancer drugs to kill malignant cells.


40-47

Ophthalmology

• Ophthalmologists – Treat the eyes and related tissues

• Medical assistant– Performs some procedures

• Visual acuity• Color vision• Intraocular pressure


40-48

Ophthalmology Examinations• The interior of the

patient’s eyes using the ophthalmoscope

– Retina– Optic nerve– Blood vessels– Visual fields

• Glaucoma – increased intraocular pressure

• Refraction exam – verify need for corrective lenses

• Slitlamp – used to examine the anterior structures of the eye


40-49

Diseases and Disorders• External eye

– Blepharitis – Ptosis– Sty

• Front of eye– Conjunctivitis – Corneal ulcers and

abrasions

• Internal eye – Cataracts– Glaucoma – Iritis

• Retinal disorders– Retinal detachment– Diabetic retinopathy– Macular degeneration


40-50

Diseases and Disorders (cont.)

• Eye movement – Strabismus

• Children – misaligned or unbalanced muscles

• Adults – nerves and/or muscles

– Amblyopia

• Refractive disorders– Myopia – Hyperopia– Presbyopia– Astigmatism


40-51


Match:

___ Drooping eyelid A. Glaucoma

___ Pinkeye B. Blepharitis

___ Cloudy lens C. Macular degeneration

___ Increased intraocular pressure D. Iritis

___ Loss of central vision E. Conjunctivitis

___ Red, swollen, scaly eyelids F. Sty

___ Infection of eyelash follicle G. Cataract

___ Uveitis H. Ptosis

F

G

E

D

C

B

A

H

ANSWER: IMPRESSIVE!


40-52

Orthopedics• Orthopedics

– Focuses on disorders, injuries, and diseases of the muscular and skeletal systems

• Medical assistant – assists with– General examinations– X-rays– Casting– Hot/cold treatment– Patient education


40-53

Examinations and Procedures • Assessment by

– Inspection

– Palpation

– Diagnostic tests


40-54

Examinations and Procedures (cont.)

• Radiographic exams– X-ray

– CT and MRI scans

– Angiography

– Discography

– Arthrography

– Bone scans

• Arthroscopy – view the inside of a joint

• Bone and muscle biopsies

• Electromyography

• Urine and blood tests


40-55

Diseases and Disorders• Back pain

– Muscle strain– Osteoarthritis– Tumors

• Fractures

• Common diseases and disorders – Table 40-7


40-56


What treatments are commonly used for orthopedic disorders?

ANSWER: Treatments for orthopedic disorders include application of heat, analgesic or muscle relaxants, exercise therapy, braces, and traction.

Nice Job!


40-57

Otology• Otologist – treats diseases and disorders

of the ears

• Otorhinolaryngologist – specializes in nose and throat disorders

• Medical assistant– Auditory screening– Assists with diagnostic tests


40-58

Diseases and Disorders• Outer ear

– Cerumen impaction– Otitis externa – Pruritus

• Middle ear – Otitis media– Mastoiditis– Otosclerosis – Ruptured eardrum

• Inner ear– Labyrinthitis– Ménière’s disease– Presbycusis– Tinnitus


40-59

Apply Your KnowledgeArrange disorders properly:

Inner Ear Middle Ear Outer Ear

7. Cerumen impaction

4. Ruptured eardrum

6. Mastoiditis

10. Pruritus

2. Otitis externa 3. Otitis media1. Ménière’s Disease

5. Tinnitus

11. Presbycusis 8. Otosclerosis

9. Labyrinthitis

Nice Job!


40-60

Surgery• Surgeons

– Repair wounds and broken bones

– Repair or remove diseased or injured organs, limbs, or tissues

– Usually specialize in one field

• Medical assistant– Presurgical

• Patient education• OR preparation• Skin preparation

– Surgical assisting

– Postsurgical• Decontamination of OR

and equipment• Dressing wounds


40-61

Surgery (cont.)

• Biopsy – Simple surgical procedure

– Types• Open• Needle

– Sterile technique required


40-62

Urology• Urologist

– Diagnoses and treats urological disorders and diseases

• Male and female urinary system

• Male reproductive system

• Medical assistant– Assists with general

exams– Collects and

processes urine and blood

– Patient education


40-63

Urology Examinations• Thorough history

– Frequency or urgency of urination

– Difficulty or pain – Incontinence

• Palpation – kidneys and bladder

• Inspection – external genitalia

• Male reproductive system– Inspection – Palpation – Testicular self-exam


40-64

Diagnostic Testing

• Urine and blood tests

• Semen analysis and smears

• Cystometry

• Cystoscopy

• Testicular biopsy


40-65

Diseases and Disorders • Cystitis

• Epididymitis

• Hydrocele

• Impotence

• Kidney stone

• Prostatic hypertrophy

• Prostatitis

• Prostate cancer

• STDs

• Urethritis


40-66

Apply Your Knowledge1. What are the types of biopsies you might assist with

when working for a surgeon?

ANSWER: You might assist with open biopsies and needle biopsies.

2. What examination should be done by a 27-year-old male patient to detect cancer?

ANSWER: He should do a monthly testicular self-examination.

Fantastic!


40-67

In Summary 40.1 The medical specialties discussed in this chapter

include allergy, which is diagnosing and treating allergies, cardiology, dermatology ,endocrinology, gastroenterology, neurology, oncology, ophthalmology, orthopedics, otology, surgery, and urology.

40.2 Exams and diagnostic tests performed in these specialties are numerous. During most of these exams and tests your role may include patient safety and comfort, educating the patient about the necessary preparation and the procedure, and assisting the physician.


40-68

In Summary (cont.)

40.3 Many common diseases and disorders are identified in the specialty practices. You should have an understanding of the implications of these diseases on the patient and the necessary treatments.

40.4 A scratch test is performed to determine if a patient has an allergic reaction to substances. It involves scratching the skin with these substances and then observing the skin for any reaction.


40-69

In Summary (cont.)

40.5 A sigmoidoscopy is done to examine the rectum, anus, and sigmoid colon. The patient is placed in knee-chest or Sims’ position and should be kept safe and comfortable during the procedure.

40.6 The ophthalmoscope is used to examine the eye. It is prepared by checking the charge and turning on the light, replacing the bulb if necessary and attaching the lens if needed.


40-70

In Summary (cont.)40. 7 During a needle biopsy, a piece of tissue is removed

and tested for abnormalities such as cancer. The medical assistant may position and drape the patient, clean and dress the site, and assist the physician as required.


40-71

End of Chapter 40

Diagnosis is not the end, but the beginning of practice.

~Martin H. Fischer

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Assisting with Highly Specialized Examinations