CH 12 The Physical Exam

The position for examination of the genitals and anal area (e.g., gynecological exams and Pap smears) is the:

Lithotomy postition

The cleaning and disinfecting of the exam table should be completed how often? a. After each invasive procedure b. After every patient c. When visibly soiled with body fluids d. All of the above

All of the above

Light Source To Examine The Ear Canal And Tympanic Membranes Is The

Otoscope

When a provider listens and evaluates sounds by tapping the fingers on the body, he is using which physical examination technique? a. Auscultation b. Percussion c. Palpation d. Inspection

Percussion

A male provider will legally require the assistance of a medical assistant in which type of exam? a. Performing a rectal exam on a male patient b. Performing a throat exam on a female patient c. Performing a Pap smear on a female patient d. Performing an ear exam on a male patient

Performing a Pap smear on a female patient

Basin

Serves several purposes: - Used instruments may be placed in the basin to be either cleaned or discarded - May hold body fluids, such as emesis - May be used to collect fluids during irrigations

When the patient is in the ___________ position, he will be lying flat on his back and the drape should be placed lengthwise over the front of the patient.

Supine

The provider performs abdominal auscultation, percussion, and palpation with the patient in which position? a. Sims' position b. Semi-Fowler's position c. Supine position d. Prone position

Supine position

Vital Signs

Techniques - Auscultation - Mensuration Medical Assistant's Responsibilities - Assist the patient to a sitting position. - Obtain temperature, pulse and respiration, and blood pressure. - Obtain height and weight. Provider's Responsibilities/Description of Exam Section Vitals are obtained by the medical assistant and repeated by the provider if abnormalities are evident.

In addition to maintaining a clean and prepared examination room, room temperature: a. must be set cool for medication preservation. b. must be conducive to examinations. c. should be lowered in the afternoon. d. should be raised in the afternoon.

must be conducive to examinations.

Fecal Occult Blood Test

- A small cardboard testing card along with a bottle of developer solution - Tests for blood in the stool

Percussion Hammer

- A small triangular hammer made of hard rubber - Used to test reflexes during an examination

Various Specimen Collection Kits Or Containers

- Anticipate which specimens may need to be collected and the specimen collection equipment or supplies needed

Exam Room Prep

- Discard all disposable items such as used drapes, gowns, bandaging material, wrappers, & other such items into the proper trash receptacles. - Place nondisposable gowns & drapes in the laundry bin. - Place all reusable items in the proper storage area. - Place the exam table in its proper position & properly arrange all furniture. - Thoroughly disinfect all counter surfaces & the exam table with an approved disinfectant. - If the flooring needs tending, clean according to office policy. - Restock supplies that are running low. - Spray deodorizer if lingering odors are present. Spray disinfecting spray if the previous patient had a communicable disease. - Prepare any items necessary for the next patient (adjustments or supply enhancement may be made following the patient interview).

Tape Measure

- Either in inches or centimeters - Used to measure body circumference and length

Opthalmoscope

- Light source to examine eye interior and optic vessels - Maintain functional operation of equipment within the exam room

Otoscope

- Light source to examine the ear canal and tympanic membranes - Ensure that the disposable speculums that attach to the otoscope are stocked for use

Cotton or Rayon-Tipped Sterile Applicators

- Many specimens will require the use of a sterile applicator, such as wet mount slides and tissue or cell slides

Gowns

- May be paper or fabric - May be different lengths - Depending on the type of exam, may open to the front or back

Drapes

- May be paper or fabric - Used for patient privacy and comfort

Procedures That May Be Necessary Before Dismissing The Patient Include The Following:

- Performing additional lab or diagnostic testing - Administering or dispensing certain medications - Giving any prescriptions or drug samples to the patient and providing instructions on how to take the medication - Setting up an outside test for the patient - Completing a referral and setting up an appointment with a specialist - Providing the patient with home care instructions - Setting up a new appointment for the patient

Tongue Depressors

- Sterile; used to compress the tongue when inspecting the throat - Can also be used during neurological evaluations, such as tracking eye movements

Stethoscope

- Used for blood pressures and auscultation of body sounds including breath, heart, and bowel

Neurological Pinwheel

- Used to check nerve sensitivity as it is rolled across the skin

Tuning Fork

- Used to test for bone and air conduction deafness - Important in neurological examinations

Lubricants

- Usually in a tube; nonsterile - Used to increase comfort when performing a manual rectal examination or to lubricate certain instruments for insertion into different body cavities

Gloves

- Usually non-latex nitrile, though some may be latex - Sterile or nonsterile - Different sizes available - Learn the different providers' sizes in your facility

A patient has the right to privacy and the medical assistant can assist in maintaining the patient's privacy by doing which of the following? a. Asking the patient questions in the hallway b. Asking the patient questions in the exam room c. Asking the patient questions in the reception area d. None of the above

Asking the patient questions in the exam room

To detect organ enlargement, organ displacement, and deep masses, the provider would use which technique? a. Light percussion b. Deep percussion c. Light palpation d. Deep palpation

Deep palpation

Manipulation Technique

Description Applying passive movement to a joint while using force. Examples of What Might be Evaluated - Range of motion of some joints

Inspection Technique

Description Frequently used to observe the patient for any signs of pathology that might indicate a disease or disorder. This includes observation of physical, mental, and emotional signs. Examples of What Might be Evaluated - Skin lesions - Scars - Body colors such as cyanosis - Speech patterns - Gait changes - Posturing - Anxiety

Auscultation Technique

Description Involves listening skills using a stethoscope. Many parts of the body emit sounds that provide clues to assist with diagnosis and treatment. This is done before palpation and percussion for best results. Examples of What Might be Evaluated - Lung sounds - Heart sounds - Bowel sounds

Mensuration Technique

Description Measurements of different areas of the body, using a tape measure and scales. Examples of What Might be Evaluated - Height - Weight - Length or circumference of a limb - Infant chest circumference Infant head circumference

Percussion Technique

Description Sounds are evaluated by tapping the fingers on the body. Various sounds reverberate over structures to allow determination of the type of structure involved, either solid, liquid, or gas (air). Dullness indicates fluid or a solid structure. Tympany (a drum-like sound) indicates air or gas. Examples of What Might be Evaluated - Size and location of organs - Gas fluids in abdomen - Fluids in pleural spaces - Liver enlargement

Palpation Technique

Description Touching the body is one way to evaluate tenderness and pain as well as the location and size of internal organs. Some palpation is light in pressure, whereas some involves deeper pressure. Examples of What Might be Evaluated Light palpation: - Pain and tenderness - Muscle resistance - Superficial masses - For relaxation Deep palpation: - Organ enlargement - Organ displacement - Deep masses

Knee-chest

Description/Draping - From the prone position, separate the knees and bring to the chest, raising the buttocks - Drape should be placed diagonally across the patient When Position Is Used - Examination of the anus and rectum - Proctological procedures

Full-Fowler's

Description/Draping - Head of table is brought up to a 90 degree angle - Draping same as semi-Fowler's When Position Is Used - Used for patients who cannot sit back at all because of head or neck injuries or breathing difficulties

Supine

Description/Draping - Lying flat on the back - Drape should be placed lengthwise over the front of the patient When Position Is Used - Evaluation of the head, neck, shoulders, chest, abdomen, and extremities - Auscultation of abdominal sounds Palpation of thoracic and abdominal regions

Semi-Fowler's

Description/Draping - Lying flat on the back with the head raised to a 45 degree angle - Drape should be placed squarely over the patient When Position Is Used - Examination of the head, neck, and upper body - Used for patients with respiratory difficulties

Dorsal Recumbent

Description/Draping - Lying flat on the back with the knees bent and the soles of the feet flat on the table - Drape should be placed lengthwise or diagonally over the patient When Position Is Used - Examination of vaginal and rectal areas - Insertion of a straight or Foley catheter - Examination of the head, neck, thorax, and abdominal areas

Lithotomy

Description/Draping - Lying flat on the back with the knees flexed and the feet in stirrups - Drape should be placed squarely or diagonally across the patient When Position Is Used - Examination of the genitals and anal area - Gynecological exams and Pap smears

Prone

Description/Draping - Lying flat on the stomach - Drape should be placed lengthwise over the back of the patient When Position Is Used - Examination of the back and vertebrae - Exploration of any skin lesions that are present

Sims'

Description/Draping - Lying on the left side with the left shoulder placed behind the patient while the right leg is flexed and placed in front of the left leg - Drape should be placed lengthwise or diagonally across the patient When Position Is Used - Examination of the rectum and vagina - Rectal temperatures - Enemas - Flexible sigmoidoscopy

Sitting

Description/Draping - Sitting on the side or end of the exam table - Drape should be placed squarely over patient's lap When Position Is Used - Obtaining vital signs - Reviewing medical history - Examining the head and neck - Evaluating reflexes - Listening to cardiac and breath sounds

Trendelenburg Position

Description/Draping - The head of the table should tilt downward toward the floor and the feet should point upward toward the ceiling - Drape should be placed lengthwise over the front of the patient When Position Is Used - Used for patients that feel faint or are at risk for going into shock

Trendelenburg Alternative Postition

Description/Draping - The patient's feet and legs are elevated with several pillows or by elevating the foot portion of the table - Drape should be placed lengthwise over the front of the patient When Position Is Used - Used in place of Trendelenburg when the table is unable to be placed in Trendelenburg position

To detect pain and tenderness, muscle resistance, superficial masses, and for relaxation, the provider would use which technique? a. Deep palpation b. Light palpation c. Light percussion d. Deep percussion

Light palpation

_________________ is the measurements of different areas of the body, using a tape measure and scales.

Mensuration

The lithotomy position is useful in which type of patient exam? a. Neuro exam b. Pap test c. Shoulder exam d. Ear exam

Pap test

Guidelines for preparing the exam room include all of the following, except: a. Thoroughly disinfect all counter surfaces and the exam table with an approved disinfectant. b. Prepare any items necessary for the next patient (adjustments or supply enhancement may be made following the patient interview). c. Place nondisposable gowns and drapes in the biohazard container. d. Discard all disposable items such as used drapes, gowns, bandaging material, wrappers, and other such items into the proper trash receptacles.

Place nondisposable gowns and drapes in the biohazard container

Choose the primary rationale behind draping the patient. a. Privacy and dignity b. Accessibility c. Visualization d. None of the above

Privacy and dignity

A patient that requires examination of the back and vertebrae should be placed in which position? a. Sims' b. Supine c. Prone d. Sitting

Prone

A patient being seen for a flexible sigmoidoscopy should be placed in the _________________ position for the procedure.

Sims'

What instrument is used to test for bone and air conduction deafness? a. Otoscope b. Percussion hammer c. Tuning fork d. Ophthalmoscope

Tuning fork

Cardiovascular System

Techniques - Auscultation - Inspection - Palpation - Auscultation Medical Assistant's Responsibilities - Assist the patient in transition to the semi-Fowler's position. - Lower the patient gown, and provide a drape for comfort and privacy. - Provide a stethoscope with a bell attachment and diaphragm. - Assist the patient to sitting. As the patient leans forward, provide support and security. Provider's Responsibilities/Description of Exam Section Jugular and carotid pulsations are inspected and palpated. Using the stethoscope, the carotids are evaluated for bruits. While the patient exhales, the provider will listen for murmurs and other abnormalities.

Breasts

Techniques - Inspection - Palpation Medical Assistant's Responsibilities - Address comfort levels and privacy. - The patient's gown may be opened to expose the upper chest area. - Replace the gown when completed. Provider's Responsibilities/Description of Exam Section Inspection of the breasts (both genders) occurs, followed by palpation of the breast tissue, axillary nodes, and epitrochlear nodes.

Prostate And Rectal Exam For Men

Techniques - Inspection - Palpation Medical Assistant's Responsibilities - Assist the patient into the Sims' position. - Provide draping for privacy. - Provide an occult blood card if ordered. - Have gloves and lubricant available. - Assist the patient from the exam table and assist with dressing if needed. Provider's Responsibilities/Description of Exam Section The anal region will be inspected along with the genitalia, if this is not done while the patient is standing. The rectum and prostate are then palpated.

Skin

Techniques - Inspection - Palpation Medical Assistant's Responsibilities - Assist the patient with the gown. - Provide adequate lighting in the room. Provider's Responsibilities/Description of Exam Section The skin on the face and upper body is observed. Any discolorations are noted, including patterns, locations, and colors. The hair, hands, and nails are inspected and palpated.

HEENT (head, eyes, ears, nose, throat)

Techniques - Inspection - Palpation Medical Assistant's Responsibilities - Darken the room for the eye exam. - Provide working equipment, including ophthalmoscope, batteries for ophthalmoscope, otoscope, tongue depressors, and speculum for nasal evaluation. Provider's Responsibilities/Description of Exam Section This section includes examination of the head, eyes, ears, nose, and throat. Head: scalp, hair, skull, face exam Eyes: The provider assesses the physical parts of the eye. Ears: Inspects auricles, canals, and ear drums; performs gross hearing screening exam Nose: Inspects internal and external nasal cavities; palpates sinuses Throat: Inspects mouth, lips, gums, teeth, tongue, tonsils, and palate

Gynecological Exam For Women

Techniques - Inspection - Palpation Medical Assistant's Responsibilities - Prepare tools for examination. - Assist the patient into the supine position, then place feet in the stirrups. - Provide draping for privacy. - Put a light in place for the exam. - Assist the patient in relaxing for the exam. - Assist the patient from the exam table and assist with dressing if needed. Provider's Responsibilities/Description of Exam Section The provider will inspect the external genitalia, vagina, and cervix. A Pap smear will be completed at this time. The uterus and ovaries will be palpated. A rectal exam can be completed at this time.

Breasts/Axillae

Techniques - Inspection - Palpation Medical Assistant's Responsibilities Assist the patient in removing the gown from the breast area. Provide coverage when the exam is complete. Provider's Responsibilities/Description of Exam Section The provider will complete the breast exam in the supine position, to include inspection for dimpling and palpation for masses. The axillary nodes are palpated.

Musculoskeletal (upper body)

Techniques - Inspection - Palpation Medical Assistant's Responsibilities Assist the provider as requested. Provider's Responsibilities/Description of Exam Section Range of motion can be evaluated. The hands, shoulders, arms, neck, back, and joints are inspected and palpated.

Back

Techniques - Inspection - Palpation Medical Assistant's Responsibilities Open the back of the gown to expose the spine and muscles of the back. Provider's Responsibilities/Description of Exam Section The provider will look at and feel the muscles and vertebra of the back. Alignment will be evaluated. Often, the sacral region will be evaluated as well as the range of motion of the lower extremities.

Neck

Techniques - Inspection - Palpation Medical Assistant's Responsibilities Remove the gown from the neck region. Provider's Responsibilities/Description of Exam Section This evaluation includes palpating and inspecting the cervical lymph nodes. Masses and pulses are felt. The thyroid gland is palpated at this time.

Lower Extremities

Techniques - Inspection - Palpation - Inspection Medical Assistant's Responsibilities - Provide tools for a neurological exam of the lower extremities. - Provide a reflex hammer. - Allow the patient to sit briefly prior to standing. - Assist the patient to a standing position. - Provide support with gait if necessary. Provider's Responsibilities/Description of Exam Section The lower extremity pulses are palpated. Area is inspected for edema, ulcerations, and discolorations. Pitting edema is evaluated. Muscle tone and joint deformities are assessed. Sensations and reflexes are tested. The legs are inspected for varicose veins. Muscle tone and alignment is evaluated. The gait may be reexamined at this time.

Abdomen

Techniques - Inspection - Palpation - Auscultation - Percussion Medical Assistant's Responsibilities - Assist the patient into the supine position. - Remove the gown from the abdominal region and drape the area. Provider's Responsibilities/Description of Exam Section The abdomen will be palpated lightly, then more deeply, while being inspected. Bowel sounds will be auscultated. The liver and spleen will be assessed by percussion. The aorta will be palpated, with the pulsations evaluated.

Posterior Thorax And Lungs

Techniques - Inspection - Palpation - Percussion - Auscultation Medical Assistant's Responsibilities Provide a stethoscope to the provider. Provider's Responsibilities/Description of Exam Section The spine and muscles of the upper back are palpated and inspected. The provider will percuss each side for dullness. Using the stethoscope, breath sounds will be evaluated.

Anterior Thorax And Lungs

Techniques - Inspection - Palpation - Percussion - Auscultation Medical Assistant's Responsibilities Provide a stethoscope. Provider's Responsibilities/Description of Exam Section The chest region and breath sounds are evaluated. Voice sounds are also assessed. This is similar to the posterior thorax and lung examination.

Nervous System

Techniques Inspection Medical Assistant's Responsibilities Assist the patient to a sitting or supine position, as requested by the provider. Provider's Responsibilities/Description of Exam Section This section of the examination may be done at various times. It is composed of five components: - Mental status - Cranial nerves - Motor system - Sensory system - Reflexes

General Survey

Techniques Inspection Medical Assistant's Responsibilities Share with the provider any observations (the process of watching or visualizing) noted when assisting the patient to the exam room (the provider doesn't always see the patient walk or the difficulty the patient experienced in removing clothing). Provider's Responsibilities/Description of Exam Section This portion of the exam continues throughout the entire physical. It involves observing the general state of health, to include posture (position of the body), gait (the way the patient walks), grooming, odors, facial expressions, speech, and level of awareness.

Procedures that may be necessary before dismissing the patient include all of the following, except: a. Providing the patient with home care instructions. b. Performing additional lab or diagnostic testing. c. Giving any prescriptions or drug samples to the patient and providing instructions on how to take the medication. d. Telling the patient you will review the chart and call if there are to be any outside tests.

Telling the patient you will review the chart and call if there are to be any outside tests.

What is the independent organization that certifies health organizations, states that health organizations need to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs?

The Joint Commission

The patient should be instructed to move in which direction when moving from the supine position to the prone position? a. Toward the medical assistant to prevent falling off the table b. Away from the medical assistant to prevent the drape from falling off c. Toward the end of the exam table to prevent falling off the table d. None of the above

Toward the medical assistant to prevent falling off the table

Manipulation

applying passive movement to a joint while using force

The part of the physical examination that involves listening skills using a stethoscope is:

auscultation

After performing any necessary procedures, share the results of the procedure with the provider ________________.

before dismissing the patient

If the patient is being seen for transitional care following a hospital visit, make certain that the ________________ from the hospital visit are available.

discharge notes

Vertigo

disturbance in the equilibrium of the body and balance that causes the patient to be dizzy

Tympany

drum-like sound upon percussion that indicates air or gas within the related region

Palpation

examination by application of the hands and fingers to the body to evaluate size and function of the body and to determine abnormality in size or texture

All of the following are examination techniques except: a. inspection. b. interpretation. c. auscultation. d. palpation.

interpretation

A good medical assistant is able to anticipate the provider's needs prior to the provider's order. In most cases, the medical assistant should: a. perform additional lab or diagnostic testing prior to the exam. b. perform any test or procedure that he thinks the provider may order. c. never perform any test or procedure without a direct order from the provider. d. never bill for tests or procedures completed by the medical assistant.

never perform any test or procedure without a direct order from the provider

Prior to the exam, the medical assistant should screen the patient, ________________ , allow the patient to empty the bladder, and position and drape the patient.

obtain the vital signs

A patient that is being seen for an abscess on the lower back would be instructed to put the gown on: a. open in the front. b. open in the back. c. Both a and b d. None of the above

open in the back.

The equipment used to view the structures of the eye interior and vessels is the: a. otoscope. b. stethoscope. c. ophthalmoscope. d. autoscope.

ophthalmoscope

The light source used to examine the eye interior and optic vessels is the: a. percussion hammer. b. tuning fork. c. ophthalmoscope. d. otoscope.

ophthalmoscope

When preparing the patient for the physical examination or any other procedure, _________________ will increase access to the patient's body to facilitate the examination process.

proper positioning and draping

Before cleaning the exam room, the medical assistant should: a. check outstanding electronic tasks. b. put on the appropriate personal protective equipment (PPE). c. look for any personal belongings that may have been left behind. d. check with the front desk to see if another patient has checked in.

put on the appropriate personal protective equipment (PPE)

The Sims' position is used for all of the following except a: a. rectal exam. b. colonoscopy. c. pelvic exam. d. reflex evaluation

reflex evaluation

Stage 2, Meaningful Use, Core Objective #12

states that providers should use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.

Auscultation

the act of listening to body sounds with the aid of a stethoscope

Mensuration

the act of measuring, including height and weight measurements

Posture

the position of the body whether standing, sitting, or lying down

Examination

the process of inspecting the body and its systems to determine the presence or absence of disease

Observation

the process of watching or visualizing

Percussion

to use the fingertips to tap the body slightly but sharply to determine position, size, and consistency of an underlying structure or cavity

Patients should be allowed to rest a moment before being escorted off of the table because some patients suffer from ______________ and can become very dizzy with swift position changes.

vertigo

Inspection

visual examination of the surface of the body as well as the body's posture and movement to detect disease and other conditions