Assisting with Highly Specialized Examinations

1. 40 Assisting with Highly Specialized Examinations

2. Learning Outcomes 40.1 Discuss the medical specialties of allergy, cardiology, dermatology, endocrinology, gastroenterology, neurology, oncology, ophthalmology, orthopedics, otology, surgery, and urology. 40.2 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. 40.3 Identify the most common diseases and disorders seen in these medical specialties and typical treatments for them.

3. Learning Outcomes (cont.) 40.4 Carry out the procedure for assisting the physician in performing a scratch test. 40.5 Carry out the procedure for assisting with a sigmoidoscopy. 40.6 Prepare the ophthalmoscope for use. 40.7 Carry out the procedure for assisting with a needle biopsy.

4. 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

5. The Medical Assistant’s Role in Specialized Examinations • 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 examinationsand procedures • Communicate with and educate patients

6. 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

7. 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

8. 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 Allergy Testing

9. Apply Your Knowledge • 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. • Match the following: • ___ May be localized or systemic response A. Allergen • ___ Substances causing an allergic reaction B. Anaphylaxis • ___ Inappropriate immune responses C. Allergic reaction • ___ Diagnoses and treats allergies D. Allergies • ___ Life-threatening reaction E. Allergist ANSWER: C A D E B 2 for 2!

10. 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

11. Auscultation Blood pressure Overall cardiac health Palpation Chest wall Vessels in extremities Electrocardiogram (EKG or ECG) Measures the electrical activity of the heart Cardiology Examination

12. 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

13. Radiography and Imaging Techniques • Chest x-ray • Radionuclide studies • Contrast medium ingested or injected • Angiography

14. Radiography and Imaging Techniques (cont.) • Ultrasound • Echocardiography • Tests structures and function of heart • Heart MRI • Provides detailed pictures of heart and vessels

15. Radiography and Imaging Techniques (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

16. Diseases and Disorders

17. ANSWER: F Apply Your Knowledge Very Good! True or False: ___ An ECG tests the function of the heart through sound waves. ___ Angiography is an x-ray of a blood vessel after injection of a contrast medium. ___ Managing heart conditions often involves lifestyle changes. ___ A Holter monitor is only done in an inpatient setting. ___ A stress test measures the patient’s response to an increasing workload. ___ An endocardiography is a form of ultrasound. echocardiogram T T most often done on an outpatient basis. F T T

18. 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 Dermatology

19. 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 Dermatology Examinations

20. Skin Lesions Macule Nodule Papule

21. Skin Lesions (cont.) Pustule Ulcer Bulla

22. Conditions and Disorders

23. Conditions and Disorders (cont.)

24. Skin cancer Basal cell Small waxy craters with rolled borders Squamous cell Lesions appear ulcerated or have a crust More likely to spread to other areas of the body than basal cell carcinomas Malignant melanoma Originates in cells that produce melanin Spreads through bloodstream or lymphatic system Conditions and Disorders (cont.)

25. Apply Your Knowledge Name the three types of skin cancers pictured here. Which is the most serious type? Bravo! ANSWER: Malignant Melanoma Basal Cell Carcinoma Squamous Cell

26. Endocrinology • Endocrinologists • Treat diseases and disorders of the endocrine system • Hormonal imbalances can affect growth, metabolism, and reproduction • Medical assistant • Assists with examinations • Collects specimens for analysis

27. EndocrineExaminations • Thorough medical history • Assessment • Skin condition • Weight and cardiac functioning • Diagnostic urine and blood tests • Ultrasound, X-rays, and iodine scans

28. Diabetes Type I Autoimmune disease Deficiency of insulin Type II Resistance to insulin Most common in adults Gestational – only occurs during pregnancy Thyroid gland disorders Hypothyroidism Underproduction of thyroxine Children – cretinism Adults – myxedema Hyperthyroidism Overproduction of thyroxine Graves’ disease Goiter – enlarged thyroid Endocrine Diseases and Disorders

29. Type I: An autoimmune disease of the pancreas Diagnosed most often in childhood Body does not produce adequate insulin Treatment includes insulin injections Type II: Most common form Generally diagnosed in adults Childhood diagnosis is increasing Risk factors: obesity, inactivity, family history Treatment may include oral medications or insulin Excellent! Apply Your Knowledge What is the difference between Type I and Type II diabetes? ANSWER:

30. Gastroenterology • Gastroenterologists – diagnose and treat disorders of the gastrointestinal (GI) tract • Medical assistant • Understands the basic elements of GI exam and procedures • Patient education – prepares for the exams • Answers patient questions

31. Gastroenterology Examinations • May be invasive based on patient symptoms • Provide reassurance and ensure comfort • Patient instructions • Bring someone to drive home • What cautions to take if patient had local anesthetic of the throat

32. Endoscopy Direct visualization of a body cavity Means for obtaining tissue biopsies or removing polyps Peroral endoscopy – examination of the esophagus, stomach, and duodenum Colonoscopy– examination of the large intestine Proctoscopy – examination of the lower rectum and anal canal Sigmoidoscopy – examination of the sigmoid area of the large intestine Gastroenterology Examinations (cont.)

33. Lab tests Analysis of stomach contents Urine Occult blood Radiologic exams Cholecystography Gallbladder function test Differentiate between bile duct obstruction and gallstones Ultrasound Diagnostic Testing (cont.)

34. Diagnostic Testing • Radiologic exams (cont.) • Barium swallow • Detect abnormalities in the esophagus, stomach, and small intestine • Barium enema • Detect abnormalities of the large intestine • Radionuclide imaging

35. Diseases and Disorders • Level of discomfort may be misleading in relation to severity • Document patient’s symptoms accurately and completely • Level of pain • Medications taken, including OTCs • Refer to Table 40-3 for disorders and descriptions

36. Apply Your Knowledge ANSWER: Identify the following: _____________ Any procedure using a scope to visualize a cavity of the body _____________ Provides direct visualization of the large intestine _____________ Visualizes only the S-shaped segment of the large intestine _____________ Used to visualize the upper GI tract _____________ Examination of the lower rectum and colon endoscopy colonoscopy sigmoidoscopy peroral endoscopy proctoscopy Scoptacular!

37. Neurology • Neurologists • Diagnose and treat diseases and disorders of the central nervous system • Medical assistant • Assists with examination • Readies equipment for use • Positions the patient • Hands the doctor equipment • Educates patients

38. Motor system Reflexes Sensory system Neurology Examination • The neurologist evaluates • Cognitive function • Cranial nerves

39. Computed tomography Magnetic resonance imaging Positron emission tomography Myelography Diagnostic Tests • Electroencephalography –records the electrical activity of the brain • Imaging procedures • Skull x-rays • Angiograms • Brain scans • Other tests • Electromyography • Lumbar puncture

40. Diseases and Disorders • Trauma • Loss of sensation and voluntary motion • Paralysis • AIDS-related neurologic symptoms • Meningitis • Encephalopathy • Peripheral neuropathies

41. Diseases and Disorders (cont.) • Encephalopathy • Alters brain function or structure • Causes • Most prevalent sign is altered mental status • Other common diseases – Table 40-4

42. Apply Your Knowledge A patient has a seizure disorder and will be having an EEG. He asks, “What is an EEG? What should I expect?” How should you answer this patient? ANSWER: An EEG records the electrical activity of your brain. They will place electrodes on your scalp and have you rest quietly or engage in other activities. CORRECT!

43. Medical assistant Be aware of types, symptoms, and treatments of cancers Patient education – side effects of treatment Family education and support Oncology • Oncologist – specializes in detection and treatment of tumors and cancerous growths • Tumor • Lump of abnormal cells • Benign or malignant • Metastasis • Carcinogenesis

44. Oncology Diagnostic Testing • Blood specimens – tumor markers • X-rays • CT and MRI scans • Ultrasound • Biopsy

45. Cancer Treatment • Surgery • Removal of all or part of the tumor • Radiation therapy • Radiation to kill or stop the growth of tumor cells • Chemotherapy • Anticancer drugs to kill malignant cells

46. Apply Your Knowledge What are the three types of treatments for cancer? ANSWER: Cancers are treated by surgical removal of the tumors, radiation therapy to kill or stop the growth of tumor cells, and chemotherapy, which uses anticancer drugs to kill malignant cells. Right!

47. Ophthalmology • Ophthalmologists • Treat the eyes and related tissues • Medical assistant • Performs some procedures • Visual acuity • Color vision • Intraocular pressure

48. The interior of the patient’s eyes using the ophthalmoscope Retina Optic nerve Blood vessels Visual fields Glaucoma – increased intraocular pressure Refraction exam– verify need for corrective lenses Slitlamp– used to examine the anterior structures of the eye Ophthalmology Examinations

49. External eye Blepharitis Ptosis Sty Front of eye Conjunctivitis Corneal ulcers and abrasions Internal eye Cataracts Glaucoma Iritis Retinal disorders Retinal detachment Diabetic retinopathy Macular degeneration Diseases and Disorders

50. Eye movement Strabismus Children – misaligned or unbalanced muscles Adults – nerves and/or muscles Amblyopia Refractive disorders Myopia Hyperopia Presbyopia Astigmatism Diseases and Disorders (cont.)