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
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?")
A patient's Snellen visual acuity is recorded as 20/40 in the right eye. This means the patient:
Has normal 20/20 vision in the right eye
Can read at 20 feet what a person with normal vision reads at 40 feet
Can read at 40 feet what a person with normal vision reads at 20 feet
Is legally blind in the right eye
Ear irrigation to remove cerumen (earwax) is CONTRAINDICATED when the patient has:
A buildup of hard cerumen
A perforated tympanic membrane
A history of hearing loss
An allergy to latex
Until what age should head circumference be measured during pediatric well-child visits?
6 months
12 months
24 months
36 months
Sections you finish are checked off in the contents.