Lecture Clinical procedures for medical assisting (4/e): Chapter 9 – Booth, Whicker, Wyman

CHAPTER

9

Assisting with
Highly Specialized
Examinations
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9­2

Learning Outcomes
9.1

Discuss the medical specialties of allergy, cardiology,
dermatology, endocrinology, gastroenterology,
neurology, oncology, ophthalmology, orthopedics,
otology, surgery, and urology.

9.2

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.

9.3

Identify the most common diseases and disorders
seen in these medical specialties and typical

treatments for them.
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9­3

Learning Outcomes (cont.)
9.4

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

9.5

Carry out the procedure for assisting with a
sigmoidoscopy.

9.6

Prepare the ophthalmoscope for use.

9.7

Carry out the procedure for assisting with a needle
biopsy.

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9­4

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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The Medical Assistant’s Role in Specialized
Examinations

9­5

• 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
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9­6

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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9­7

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

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9­8

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

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9­9

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:

ANSWER:

C May be localized or systemic response A.
___

Allergen

A Substances causing an allergic reaction B.
___

Anaphylaxis

___
D Inappropriate immune responses

C.

Allergic reaction

E Diagnoses and treats allergies
___

D.

Allergies

___
B Life-threatening reaction

E.

Allergist

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9­10

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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9­11

Cardiology Examination
•

Auscultation
– Blood
pressure
– Overall cardiac
health

•

•

Electrocardiogram
(EKG or ECG)
– Measures the
electrical activity
of the heart

Palpation
– Chest wall
– Vessels in
extremities
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9­12

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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9­13

Radiography and Imaging Techniques
• Chest x-ray
• Radionuclide
studies
– Contrast medium

ingested or injected
– Angiography

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Radiography and Imaging Techniques

9­14

(cont.)

• Ultrasound
• Echocardiography
– Tests structures and function of heart

• Heart MRI
– Provides detailed pictures of heart and
vessels

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Radiography and Imaging Techniques

9­15

(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

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9­16

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

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9­17

Apply Your Knowledge
True or False:

ANSWER:

___

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

echocardiogram

T Angiography is an x-ray of a blood vessel after injection of a
___
contrast medium.

T Managing heart conditions often involves lifestyle changes.
___
F A Holter monitor is only done in an inpatient setting.
___

most often done on an
outpatient basis.

T A stress test measures the patient’s response to an increasing workload.
___
T An endocardiography is a form of ultrasound.
___

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9­18

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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9­19

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

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9­20

Skin Lesions

Macule

Nodule

Papule

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9­21

Skin Lesions (cont.)

Pustule

Bulla

Ulcer

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9­22

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

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9­23

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

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9­24

Conditions and Disorders (cont.)
• Skin cancer
– Basal cell
• Small waxy craters
with rolled borders

– Squamous cell

– Malignant melanoma
• Originates in cells that
produce melanin
• Spreads through
bloodstream
or lymphatic system

• Lesions appear
ulcerated or have a
crust
• More likely to spread
to other areas of the
body than basal cell
carcinomas

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9­25

Apply Your Knowledge
Name the three types of skin cancers pictured
here. Which is the most serious type?
ANSWER:

Squamous Cell

Bravo!

Malignant
Melanoma

Basal Cell
Carcinoma
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