Chapter 40
The Physical Exam,
Specialty Exams,
and Procedures
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Physical Examination
• Determines the general state of health and
well-being of the patient
• Covers all major body systems
• Performed by the provider
– Provider will judge a patient’s speech by asking
questions
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Physical Examination
• MA Role
– Prepare the room, equipment, and patient
– MA may scribe
– MA should have basic knowledge of all H&P
procedures
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Exam Techniques
• Inspection- evaluation by sight
• Palpation- touching
• Percussion- producing sounds by tapping on body
parts
• Auscultation- listening to sounds made by body
• Mensuration
• Manipulation- passive movement of a joint to
determine range of extension and flexion
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Physical Exam Format
General appearance >> Inspection
Skin >> Inspection, palpation
Neck >> Inspection, palpation,
manipulation
HEENT >> Inspection, palpation
Chest >> Inspection, palpation
Heart >> Auscultation
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Physical Exam Format
Lungs >> Auscultation, percussion
Breasts >> Inspection, palpation
Abdomen >> Auscultation done before
inspection, palpation,
percussion
Back >> Inspection, palpation,
manipulation
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Physical Exam Format
Genitourinary >> Inspection, palpation
and rectal (male and Men should begin routine
female) testicular exams at age 15
(monthly)
Extremities >> Mensuration,manipulation
Muscle strength >> Movement with resistance
Reflexes >> Percussion (physician
doesn’t check glabellar
reflex commonly)
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Physical Exam Format
• Other evaluations
– Romberg balance test- to performed to detect any
muscle abnormality
– Coordination tests
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Assisting Provider with Exams
• MA role may include:
– Hand instruments to provider in order of use
– Clean and maintain instruments and supplies
– Provide patient education and reassurance
– Record procedure performed and results on
patient’s chart
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Provider Assessment and Plan
• Documentation of exam
• Provider decisions based on:
– Health history
– Exam findings
– Other procedures and lab tests
• Provider plan may include diet, exercise,
physical therapy, medication, surgery
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Provider Assessment and Plan
• MA role to check patient’s chart for:
– Orders to perform any additional procedures
– Orders for appointments with specialists
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Ear Exams
• Ear irrigation (lavage) may be required prior to
performing procedures
– Due to cerumen (earwax) in the ear
• Audiometry- audiometer is the instrument used to
measure one’s hearing. (tones of frequencies)
• Otoscope-Instrument used when examining the ears
• Tympanometry- Procedure used to determine the
ability of the middle ear to transmit sound waves probe ear canal to measure ear pressure
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Ear Exam
• Tuning fork exams
– Rinne Test- using a tuning fork and holding the
shank against a patient’s mastoid bone until the
patient no longer hears the sound
– Weber Test- vibrating tuning fork is held against
the vertex or the midline of the skull or forehead
An indication of hearing loss is when a patient
doesn’t respond when spoken to by someone who is
out of sight
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Eye Exams
• Provider uses an ophthalmoscope to examine the
internal structures of the eye
• Eye exams check vision acuity or color vision
• Eye irrigation procedures
– Soothes tissue
– Relieves inflammation
– Aids eye in draining
– Patient lies on affected side and head is turned
that way
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Eye Exams
• Visual acuity
– Perform in well-lighted room
– Test patient with and without corrective lenses
– Patient is considered legally blind if acuity is 20/200 or
less
– Occluder is used to cover one of the patient’s eyes
during a vision test
• Snellen chart for distance acuity- most common screening
for distance vision
• Jaeger system for near-vision acuity- most common method
of screening for near vision acuity
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Eye Exams
• Color vision acuity with Ishihara plates
• Patients with thyroid conditions should be screened
routinely for color vision acuity
• Contrast sensitivity screening CSV-1000
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Color Blindness
• Rarest form of color blindness is tritanopia
which means the patient can’t distinguish the
color blue.
• Achromatic vision is total color blindness
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Respiratory Exams
• Vital capacity tests
– Tests the greatest volume of air that can be
expelled upon expiration after a maximum
inspiration
– Spirometry- used to measure capacity
– Peak flow testing-measures patients ability to
exhale
– Pulse oximetry- measures O2 Saturation (SAT) and
pulse rate
– Advise patients to refrain from routine treatments
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Proctological Exams
• Purpose is to examine the anus and interior of rectum
with a proctoscope.
• Used when hemorrhoids, fissure, and ulcerations are
suspected
• Prepare patients with instructions
• Sigmoidoscopy- examination of interior of sigmoid colon to
daignose polyps, ulcerations, tumors, bleeding, cancer, and
lower intestinal disorders
• Annual fecal occult blood tests typically begin around age
50, patients over the age of 40 should test their stool for
blood every 2 years
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Other Important Info
• Biopsy forceps are used to remove a tissue
sample for examination
• Pulmonary function test is only performed on
high-risk patients
• Pap test and pelvic exams should begin by age
21
• Obturator is a tool with a solid, rounded end.
What is this used for?
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