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CHAPTER
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40Assisting with Highly
Specialized Examinations
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-2
Learning Outcomes
40.1 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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-9
Apply Your Knowledge
1. 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
E
D
B
A
C
ANSWER:
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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
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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
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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
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40-13
Radiography and Imaging Techniques
• Chest x-ray
• Radionuclide studies – Contrast medium
ingested or injected– Angiography
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40-14
Radiography and Imaging Techniques (cont.)
• Ultrasound
• Echocardiography– Tests structures and function of heart
• Heart MRI– Provides detailed pictures of heart and
vessels
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-16
Diseases and Disorders
Category 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 tissue
Valvular diseases Heart valves do not open or close fully
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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:
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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
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-21
Skin Lesions (cont.)
Bulla
Pustule
Ulcer
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40-22
Conditions and Disorders
Condition/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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-25
Apply Your Knowledge
Malignant Melanoma
Basal Cell Carcinoma
Name the three types of skin cancers pictured here. Which is the most serious type?
Bravo!
Squamous Cell
ANSWER:
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
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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
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-29
Apply Your Knowledge
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
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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
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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
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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
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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
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-36
Apply Your Knowledge
Identify 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!
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-38
Neurology Examination
• The neurologist evaluates – Cognitive function
– Cranial nerves
– Motor system
– Reflexes
– Sensory system
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-40
Diseases and Disorders
• Trauma– Loss of sensation and voluntary
motion– Paralysis
• AIDS-related neurologic symptoms– Meningitis– Encephalopathy– Peripheral neuropathies
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-42
Apply Your Knowledge
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-44
Oncology Diagnostic Testing
• Blood specimens – tumor markers
• X-rays
• CT and MRI scans
• Ultrasound
• Biopsy
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-46
Apply Your Knowledge
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-47
Ophthalmology
• Ophthalmologists – Treat the eyes and related tissues
• Medical assistant– Performs some procedures
• Visual acuity• Color vision• Intraocular pressure
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-51
Apply Your Knowledge
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
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40-53
Examinations and Procedures
• Assessment by– Inspection
– Palpation
– Diagnostic tests
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-55
Diseases and Disorders
• Back pain– Muscle strain– Osteoarthritis– Tumors
• Fractures
• Common diseases and disorders – Table 40-7
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-56
Apply Your Knowledge
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-59
Apply Your Knowledge
Arrange 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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
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40-61
Surgery (cont.)
• Biopsy – Simple surgical procedure
– Types• Open• Needle
– Sterile technique required
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-64
Diagnostic Testing
• Urine and blood tests
• Semen analysis and
smears
• Cystometry
• Cystoscopy
• Testicular biopsy
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40-65
Diseases and Disorders
• Cystitis
• Epididymitis
• Hydrocele
• Impotence
• Kidney stone
• Prostatic hypertrophy
• Prostatitis
• Prostate cancer
• STDs
• Urethritis
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
40-66
Apply Your Knowledge
1. 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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.