3.9 Assisting with Specialty Examinations
Key Takeaways
- Eye examinations use the Snellen chart (distance visual acuity) and Jaeger card (near visual acuity); the Ishihara test screens for color blindness
- Ear examinations include audiometry (hearing acuity), tympanometry (middle ear function), and ear irrigation for cerumen (earwax) removal
- Respiratory testing includes peak flow measurement (asthma monitoring), pulse oximetry, and nebulizer treatments administered by the MA
- Gynecological exams require lithotomy position, proper draping for privacy, and preparation of Pap smear supplies and specimen containers
- Pediatric examinations include growth measurements (height, weight, head circumference), developmental milestone screening, and age-appropriate communication
- Orthopedic examinations may require X-ray preparation, splint/cast care education, range of motion assessment assistance, and crutch-fitting instructions
Last updated: March 2026
Assisting with Specialty Examinations
Medical assistants assist with a variety of specialty examinations across different clinical settings. Understanding the equipment, patient preparation, and procedure for each type of examination is essential.
Eye Examinations
| Test | Purpose | Procedure |
|---|---|---|
| Snellen chart | Distance visual acuity (20/20 system) | Patient stands 20 feet from chart; reads smallest line possible; test each eye separately |
| Jaeger card | Near visual acuity | Patient holds card 14-16 inches from eyes; reads smallest print |
| Ishihara test | Color vision (color blindness screening) | Patient identifies numbers within colored dot patterns |
| Pupil assessment | Pupil reaction to light | PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation |
Snellen Results:
- 20/20 = Normal vision (can read at 20 feet what should be read at 20 feet)
- 20/40 = Can read at 20 feet what normal vision reads at 40 feet (worse than normal)
- 20/200 = Legal blindness (with best correction)
Hearing Assessments
| Test | Purpose | Method |
|---|---|---|
| Audiometry | Measures hearing acuity at various frequencies | Patient wears headphones in a sound booth; signals when they hear tones |
| Tympanometry | Assesses middle ear function (tympanic membrane compliance) | Probe inserted into ear canal; measures pressure changes |
| Ear irrigation | Removes impacted cerumen (earwax) | Warm water (body temperature, ~98.6°F) gently flushed into ear canal |
| Weber test | Tuning fork test for hearing lateralization | Fork placed on top of head; sound should be equal in both ears |
| Rinne test | Compares air conduction to bone conduction | Fork placed on mastoid process, then held near ear; air conduction should be longer |
Ear Irrigation Contraindications:
- Perforated tympanic membrane (eardrum)
- Ear tubes (tympanostomy tubes)
- Recent ear surgery
- Active ear infection (otitis media/externa)
Pediatric Examinations
Growth Measurements:
- Height/length — Length board for infants; stadiometer for children who can stand
- Weight — Infant scale (lying) or standing scale (toddlers and up)
- Head circumference — Measured until age 36 months; tape around largest circumference
- Plot all measurements on growth charts (WHO for <2 years; CDC for 2-20 years)
Developmental Milestones (General):
| Age | Milestones |
|---|---|
| 2 months | Social smile, follows objects with eyes, holds head up briefly |
| 6 months | Sits with support, reaches for objects, babbles |
| 12 months | Stands/walks with assistance, says 1-2 words, pincer grasp |
| 18 months | Walks independently, says 10-20 words, stacks 2-3 blocks |
| 2 years | Runs, 2-word phrases, kicks a ball |
| 3 years | Rides tricycle, speaks in sentences, dresses self with help |
Pediatric Communication Tips:
- Use age-appropriate language
- Allow the child to sit on parent's lap during exam
- Let the child handle equipment when safe (stethoscope)
- Explain procedures in simple terms before performing them
- Offer choices when possible ("Would you like me to listen to your heart or look in your ears first?")
Test Your Knowledge
A patient's Snellen visual acuity is recorded as 20/40 in the right eye. This means the patient:
A
B
C
D
Test Your Knowledge
Ear irrigation to remove cerumen (earwax) is CONTRAINDICATED when the patient has:
A
B
C
D
Test Your Knowledge
Until what age should head circumference be measured during pediatric well-child visits?
A
B
C
D