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Chapter 17 Assisting with the Physical Examination 341
The medical assistant may be required to be present in
the patient examination room during the physical exam.
The American Medical Association (AMA) recommends
that a third party—someone other than the physician and
patient—be present during a physical examination. Your
presence provides a witness for the physician if there are
any misunderstandings or accusations by the patient.
The medical assistant hears and observes all the activity
that occurs in the patient room during the physical exam.
A patient may request that the medical assistant remain
in the room if the physician does not require it.
C
O
G
PHYSICAL EXAMINATION
EQUIPMENT
Various instruments are used during the physical exam
to help the examiner see, hear, or evaluate the areas of
the patient’s body that are being assessed. In most cases,
the physician is the one who uses the instruments. The
medical assistant needs to be familiar with the instruments and supplies, so you are prepared to assist the
physician. Basic exam supplies are shown in Figure 17-1.
Instruments should be kept in a designated storage
cabinet, drawer, or location in each examination room.
The instruments and supplies used depend on the physician’s preference. Some basic exam room supplies are
always available during the physical examination and
may include those listed in Table 17-1.
C
O
G
PHYSICAL EXAMINATION
INSTRUMENTS
Percussion Hammer (Reex Hammer)
It is used to test neurological reexes, the nervous system’s response to specic stimuli.
Figure 17-1 Common supplies used in adult physical
examination: tape measure, gloves, tongue depressor,
and cotton-tipped applicator. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins'
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
The percussion hammer has a stainless steel handle
and a hard rubber head (Fig. 17-2). The physician tests
the patient’s reexes by striking the hammer over the
tendons, the tough cords of tissue connecting muscle to
bone.
The tip of the handle also may be used on the sole of
the foot to assess the Babinski reex—an abnormal reex
where stroking the sole of the foot causes the big toe to
move upward. The Babinski reex is a sign of brain or spinal cord injury (except in children under two where it is
the normal response). Stroking the sole of the foot should
result in the toes curling downward in the plantar reex.
Table 17-1
Tape measure Nondisposable Take measurements of parts of the patient’s body,
Gloves Disposable Latex and latex-free gloves are used whenever
Tongue
depressors
Cotton-tipped
applicators
Patient gown
and drape
Basic Exam Room Supplies
chest, or head of an infant and measure size of a
skin lesion. Units on the tape may be in inches or
centimeters.
there may be contact with body uids or broken
skin.
Disposable Wooden device used to press down the tongue
during examination of the mouth and throat.
Disposable Also called swabs. May be used to test sensory
reactions and collect samples for laboratory
testing.
Disposable Complete physical examination requires patient
to disrobe and put on the gown. The drape is
used to cover the patient’s lap and legs.
342 Section IV Clinical Medical Assistant Skills
Figure 17-2 A reex hammer. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Tuning Fork
A tuning fork is used to test hearing (Fig. 17-3).
It’s a stainless steel instrument with two prongs at
one end and a handle at the other. The examiner strikes
the instrument against her hand, causing the prongs to
vibrate. The vibrating prongs produce a humming sound.
While it’s vibrating, the examiner places its handle
against a bony area of the patient’s skull, near one of the
ears. The patient is asked to describe what, if anything,
he is hearing in that ear. The results of this test may lead
the physician to order additional auditory tests.
Nasal Speculum
The nasal speculum is a stainless steel instrument, which
is inserted into the nostril to help the examiner see inside
(Fig. 17-4).
It also may be available in a disposable form. A speculum
is a tool designed to allow examiners to investigate body
cavities. Using the nasal speculum, the physician inspects:
The lining of the nose
r
The nasal membranes
r
The septum, a thin wall between the nostrils that
r
divides the two nasal cavities
Figure 17-4 A nasal speculum. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Speculum
A speculum is a medical tool that enlarges and separates
the opening of a body cavity so the examiner can see the
interior structures and mucosa. A nasal speculum and
vaginal speculum are routinely used during a complete
physical examination.
Otoscope
The otoscope allows the examiner to see inside the ear
canal and inspect the tympanic membrane (Fig. 17-5).
Also known as the ear drum, the tympanic membrane
is a thin, oval membrane between the outer ear and middle ear. It transmits sound vibrations to the inner ear. The
otoscope has a stainless steel handle at one end. At the
other end is a head that consists of three parts, the light,
magnifying lens, and cone-shaped hollow speculum.
A portable otoscope requires batteries to power the
light source. An otoscope may be part of a unit attached
to a wall. The unit is plugged into an electrical outlet to
provide power. The speculum is covered with a disposable cover before it is placed in the ear canal.
Figure 17-6 shows an exam room wall unit otoscope
with disposable ear pieces, an ophthalmoscope, and a
blood pressure unit.
Figure 17-3 A tuning fork. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Figure 17-5 A portable otoscope. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Chapter 17 Assisting with the Physical Examination 343
Figure 17-6 Wall-mounted examination instruments.
From left: sphygmomanometer with cuff, otoscope,
ophthalmoscope, and dispenser for disposable otoscope
speculum covers. (Image from Shutterstock.com.)
Ophthalmoscope
An ophthalmoscope is a medical tool used to inspect
the interior structures of the eyes. The ophthalmoscope
allows the examiner to inspect the interior structures of
the eyes. Like the otoscope, the ophthalmoscope has a
handle at one end and a head with several parts including
the light, magnifying lens, and an opening to view the eye.
A portable ophthalmoscope, shown in Figure 17-7,
requires batteries to power the light source.
The portable unit also may have a common handle
with interchangeable otoscope or ophthalmoscope head
pieces that can be attached for examination of the eye
and ear. The physician may use the otoscope light source
to examine the nose and mouth.
Stethoscope
You are probably familiar with the stethoscope, an
instrument used for listening to body sounds. It has a
bell with a diaphragm at one end (Fig. 17-8).
Figure 17-8 A stethoscope. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Flexible rubber tubing connects the bell to two earpieces. The earpieces have plastic or rubber tips that
must be adjusted and directed inward before they are
placed in the examiner’s ears.
The diaphragm is placed on the patient’s body, and
the examiner listens to sounds through the earpieces.
The stethoscope is typically used to listen to sounds of
the heart, lungs, intestines, and carotid arteries.
C
O
G
PHYSICAL EXAMINATION
LIGHTING
Special lights help the physician see more clearly during
physical exams. It’s your responsibility to make sure all
these lights are in working order. Turn the light(s) on
and off prior to the examination. If a light is battery
operated, have additional batteries on hand. It is important to maintain a supply of replacement bulbs for all
light sources.
Overhead examination light—Some ofces have an
r
adjustable overhead examination light.
Gooseneck lamp—This is a oor lamp with a mov-
r
able stand that bends at the neck (Fig. 17-9). Some
examination tables are equipped with a light source
similar to the gooseneck light. The physician may use
this lamp when overhead lighting is not good enough.
Penlight—This small light is the size and shape of
r
a ballpoint pen. It can be carried conveniently in a
pocket. If no penlight is available, a small ashlight
is a good substitute. These small lights provide extra
light to a specic area, such as the eye, nose, or throat.
Figure 17-7 A portable ophthalmoscope. (Reprinted
from Kronenberger J, Ledbetter J. Lippincott Williams
& Wilkins’ Comprehensive Medical Assisting. 5th ed.
Philadelphia, PA: Wolters Kluwer; 2016.)
While assisting the physician, you may be asked to
direct the examination light or the gooseneck lamp
toward a specic area of the body. The physician usually
holds the penlight.
344 Section IV Clinical Medical Assistant Skills
Figure 17-9 A gooseneck examination light. (Reprinted
from Kronenberger J, Ledbetter J. Lippincott Williams
& Wilkins’ Comprehensive Medical Assisting. 5th ed.
Philadelphia, PA: Wolters Kluwer; 2016.)
C
O
G
SPECIALIZED MEDICAL
EXAMINATIONS
Ear, Nose, and Throat Examinations
An otorhinolaryngologist is a physician who specializes in treating disorders and diseases of the ears, nose,
and throat. During examinations, the physician may
wear a headband that has a light or mirror attached.
A head light provides direct light to the area being
examined.
A mirror reects light from the examination light into
the area being examined (Fig. 17-10).
Other special instruments used by the physician to
visualize the throat and the larynx—the part of the throat
that contains the vocal cords include the following:
The laryngeal mirror is a stainless steel instrument
r
with a long slender handle and a small round mirror.
It’s used to examine areas of the patient’s throat and
larynx that may not be directly visible.
The laryngoscope consists of a handle and a head
r
(Fig. 17-11).
The handle is similar to the battery handle of an oto-
r
scope or ophthalmoscope. The head has a small light.
Different blades can be attached to the head to help
the examiner see the larynx or vocal cords. The blades
may be curved or straight.
Study Skill
To assist in learning the equipment necessary for
basic and specialty exams, draw a picture of a clinic
that has many exam rooms. Assign each exam room
a type of exam and write the type of physician that
performs that type of exam and the equipment necessary for that type of exam. This activity will help
you visualize an actual exam room and what you
will need to set up the patient for the exam.
Special Roles for Clinical Medical
Assistants
Figure 17-10 A head light. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Clinical medical assistants who work in specialized medical ofces may need to be familiar with other supplies
and instruments. Some examples of specialized medical
assistants include the following:
Ophthalmic medical assistants help with eye care and
r
assist ophthalmologists. Some duties may include
testing eye muscle function or teaching patients how
to use and care for contact lenses. They also maintain
optical instruments related to eye examinations and
eye care.
Podiatric medical assistants assist podiatrists—physi-
r
cians who care for and treat foot diseases and injuries. These medical assistants may need to make foot
impressions and assist with foot surgery. The podiatrist may ask the medical assistant to take x-rays.
It is the responsibility of the medical assistant to
ensure that the state in which they work allows this
task within the scope of practice for a medical assistant. Further education, training, and licensure are
required.
Chapter 17 Assisting with the Physical Examination 345
The speculum is inserted into the vagina and is used
to expand the vaginal opening. The physician can then
examine vaginal canal and cervix. Cells from these
structures can be obtained to submit to the laboratory
to perform the Pap smear. Other equipment used during
a gynecological examination may include the following.
Cotton-Tipped Applicator
A disposable applicator is larger than the small cotton-tipped swabs with which you may be familiar.
Figure 17-13 shows a large swab, cervical scraper, and
histobrush.
Often, it is used to remove excess vaginal secretions or to apply medications during gynecological
Figure 17-11 Laryngoscope handle and blades (straight
and curved). (Reprinted from Kronenberger J, Ledbetter
J. Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
Gynecological Examinations
A gynecological examination pertains to the examination of the female reproductive system. A complete physical examination of a female patient may include a pelvic
examinations.
Lubricant
This is a water-soluble gel used to reduce friction. It is
used to allow easier insertion of the vaginal speculum
during examination of the vagina and as a lubricant on
a gloved nger for manual examination of the vagina. It
is also used for rectal examinations of female patients
and to examine the rectum and prostate in male patients.
examination and a Papanicolaou (PAP) smear. A Pap
smear is performed by scraping cells of the wall of the
vagina and cervix—the part of the uterus that protrudes
into the vagina. The smear is examined with a microscope to detect any abnormal cells, including cancer cells.
Ayre Spatula or Cervical Scraper
This disposable scraper is about 6 inches long and is
made of plastic or wood. One end of the scraper has a
tip with an irregular shape (Fig. 17-13). It is placed in
the cervical opening and rotated to collect a specimen.
Gynecological Equipment
Vaginal Speculum
The vaginal speculum is an instrument that is either non-
The other end of the scraper has a rounded tip. This
end may be used to collect a specimen from the vaginal
wall.
disposable stainless steel, which needs to be cleaned and
sterilized, or it is made of disposable plastic. Figure 17-12
shows a disposable and a nondisposable speculum.
Figure 17-12 Vaginal specula. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Figure 17-13 Cotton-tipped applicator (left), Ayre
spatula (center), and histobrush (right). Cotton-tipped
applicators of this size are frequently used to remove
excess vaginal secretions or to apply medications
during the gynecologic examination. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
346 Section IV Clinical Medical Assistant Skills
Histobrush
This disposable brush is made of nylon or plastic with
soft bristles at one end. It may be used to obtain cells for
a Pap smear (Fig. 17-13).
The conventional Pap smear was performed by
transferring the collected cells to a glass slide, which
is sprayed with a xative and then sent to the laboratory for analysis. The more widely used, comprehensive,
and more accurate method is called the ThinPrep Pap
Test. The specimen for the ThinPrep method is collected
using the brush or plastic spatula and the substance collected is rinsed into a vial of liquid. The vial is sent to the
laboratory where the liquid is examined for any disease
including cancer cells.
After the specimen is obtained for the Pap smear, a
bimanual examination is performed. To perform this
examination, two gloved, lubricated ngers from one
hand are inserted into the vagina, while the other hand
is placed on the abdomen. This allows the physician or
practitioner to palpate internal structures in the pelvic
cavity.
Case Questions
A
F
F
should the medical assistant relay to the physi-
cian prior to seeing the patient?
C
O
G
What should the medical assistant tell
Rebecca Martin to reassure her about
the physical examination process? What
EXAMINATION
TECHNIQUES
physician reviews the patient’s general appearance,
including:
Movements
r
Color of skin and membranes
r
Contours or shapes
r
Symmetry, equality of size and shape, or asymmetry,
r
inequality of size and shape
Odors
r
Palpation
Palpation performed with both hands is called bimanual
palpation. Palpation performed with the ngers only is
a digital exam. The physician palpates areas of the body
for several reasons:
To determine pulse characteristics
r
To detect the presence of growths, swelling, tender-
r
ness, or pain
To assess the size, shape, and location of organs
r
To assess skin temperature, moisture, texture, and
r
elasticity
Manipulation
The physician moves the arms and legs at the joints to
determine the patient’s ability for extension and exion. Extension is a movement of the joint that increases
the angle between the bones at the joint. Flexion refers
to bending a limb at the joint to decrease the angle
between the bones. Extending and exing the joints
help the examiner determine the range of motion
(ROM)—the ability of the joint to go through normal
motions.
During the examination of a patient, the physician may
use different techniques that will help the physician
gather information about the patient’s health. There are
six basic examination techniques:
Inspection—looking at areas of the body to observe
r
physical features
Palpation—touching or moving body areas with the
r
ngers or hands
Manipulation—moving a body part or joint
r
Percussion—tapping or striking parts of the body
r
with the hand or an instrument to produce sounds
Auscultation—listening to body sounds
r
Mensuration—the process of measuring
r
Inspection
The physician inspects the patient both with the naked
eye and with instruments. Inspection may be done
using room lighting or using a special light source. The
Percussion
Percussion allows the physician to determine the position, size, and density of the air or uid that is inside
a body organ or cavity. When performing percussion,
the physician listens for sounds and feels the vibrations. Two types of percussion are performed with the
hand:
Direct percussion refers to striking the body with a
r
nger.
Indirect percussion is placing a nger on an area of
r
the body and then striking the nger with a nger of
the other hand.
Auscultation
The physician places a stethoscope or ear directly on
areas of the patient’s body including the heart, fetal heart
tones, lungs, abdomen, intestines, and blood vessels.
Chapter 17 Assisting with the Physical Examination 347
Mensuration
The process of measuring body parts including the measurement of:
The patient’s height and weight
r
The pressure of the patient’s grip
r
The exion and extension in an extremity
r
The size and depth of a wound
r
The circumference of the head, chest, or waist
r
The length and circumference of a limb
r
The expansion of the uterus
r
C
O
G
Medical assistants are usually asked to prepare examination rooms. The room should be clean, well lighted,
well ventilated, odor free, and at a comfortable temperature for the patient. Equipment and supplies should be
prepared including the:
r
r
r
PREPARING THE
EXAMINATION ROOM
Examination table—The table should be cleaned
between patients with an approved disinfectant. You
must remove used table paper and replace it with
clean paper.
Equipment—Ensure that the equipment is in working
order at the beginning of each day. It should be clean
and ready to use.
Supplies—Make sure the room has a supply of gloves,
cotton-tipped applicators, and other supplies needed
during an examination.
different from yours? These are some tips to help
you assist these patients and their families:
Provide patients with detailed explanations
r
about treatments. Details that are obvious to you
may not be clear to the patient.
Respect cultural practices and values that are
r
different from yours.
Listen carefully to the patient’s concerns. If you
r
do not understand what is being said, ask the
patient to repeat it.
Be aware that in some cultures, the husband
r
speaks for his wife and she will not speak or
answer directly to you.
Individuals from certain cultures do not make
r
direct eye contact.
Touching or getting too close to the patient, or
r
pointing with your nger, may be considered
rude or disrespectful in specic cultures.
Some patients may appear uncomfortable when
r
asked to disrobe for an examination. Explain
that the physician needs to visually examine the
body and only that area will be uncovered.
In some cultures, female patient’s clothing may
r
not be removed unless a female family member
is present.
Talk to the physician if the patient does not want
r
to follow the instructions. The physician and the
patient may be able to reach a compromise that
will allow the examination to be performed.
C
O
G
After the room is ready, the medical assistant can escort
the patient to the treatment area. Call the patient from
the waiting area by name and conrm that it is the right
patient. It is important to use good interpersonal skills
when interacting with each patient. The goal is to put
the patient at ease and ensure that the patient has condence in you and the physician. Treat each patient as an
individual. Speak clearly with a condent tone of voice
as you ask questions and explain any procedures.
PREPARING THE PATIENT
Cultural Connection
Patients from various cultural backgrounds may
seek medical treatment in your medical facility.
They may have very different expectations and
reactions to treatment that come from their own
cultural experiences. How can you make a good
connection with patients from a culture that is
C
O
G
Before the physician sees the patient, you may be
responsible for recording the patient’s past history
(PH), chief complaint (CC), present illness (PI), and
vital signs. A urine specimen may be indicated prior
to a complete physical examination. Ask the patient
to collect a specimen prior to the examination. When
the patient’s bladder is empty, it is easier for the physician to examine the abdomen. Escort the patient to
the restroom and provide instructions for collecting the
specimen.
tions for disrobing. You’ll need to explain which clothes
to remove and how to put on an examination gown.
Depending on the type of exam to be performed, patients
may wear the gown with the opening in the front or the
back. For example, a patient who needs a breast exam
will wear the gown open in the front. To protect the
patient’s privacy, the medical assistant will leave the
GETTING READY FOR THE
EXAMINATION
In the examination room, give the patient instruc-
348 Section IV Clinical Medical Assistant Skills
room while the patient undresses. Some patients may
have special needs requiring your assistance, including:
Elderly patients or patients with physical disabilities
r
may use wheelchairs, walkers, or canes to move from
place to place. In the examination room, they may
need your help to disrobe, to move onto the examination table, and/or to move into different positions
during the examination.
Pregnant patients may require assistance to move
r
onto the examination table or to assume different
positions during the examination. Some examination
positions may not be suitable for women in the later
stages of pregnancy.
When the patient has put on the examination gown,
you may have the patient sit on the examination table
until the physician is ready to see the patient. If the
patient is feeble or unsteady, the patient may not be safe
sitting on the exam table unattended. You may have the
patient sit in a chair in the exam room until the physician is ready to see the patient. Then you would assist
the patient onto the exam table.
When a patient is sitting on the exam table in a gown,
place a drape on the patient’s lap to cover the legs. The
patient is now ready to see the physician.
At all times, you want to respect and protect the
patient’s privacy. Here are some tips:
Make sure the door is closed or that the patient is in
r
a screened area when changing.
Do not ask a patient who is wearing a gown to walk
r
through public areas, such as the waiting room, to get
to other rooms.
Expose only the body parts that are needed for the
r
examination. Use drapes to cover exposed body areas.
C
O
G
As a medical assistant, your responsibilities involve
assisting the physician as well as the patient.
r
r
ASSISTING THE PHYSICIAN
Helping the physician—You may need to hand the
physician instruments or supplies or direct an examination light. For legal reasons, you also may be
required to remain in the room when a male physician examines a female patient or when a female
physician examines a male patient. You will also be
expected to help the patient into different examination positions.
Move the body slowly.
Watch for signs that the patient may be
uncomfortable.
Provide a small pillow to help the patient feel more
at ease.
Helping the patient—You may need to assist the
patient to move into the proper position for an
examination. You will assist the physician to adjust
the drape to expose only the parts of the body being
examined.
C
O
G
Various patient examination positions may be required
in order for the physician to appropriately examine the
patient (Fig. 17-14). Table 17-2 is a list of exam positions: the body part examined using the position and
the equipment, instruments, and supplies used for the
examination.
drapes to protect patient privacy. Patient examination
positions include the following:
r
r
r
r
r
r
r
PATIENT EXAMINATION
POSITIONS
As the patient changes positions, be sure to adjust the
Erect, standing, or anatomical position—Also known
as anatomical position, the patient stands erect and
faces forward with the arms at the sides.
Sitting position—The patient sits erect at the end of
the examination table. The feet are supported on a
footrest or stool. Because the back is not supported,
this position may be difcult for weak or elderly
patients.
Supine position—The patient lies on the back with
arms at the sides. A pillow may be placed under the
head for comfort. Most patients are comfortable in
this position.
Dorsal recumbent position—The patient is supine
with the legs slightly separated, the knees bent, and
the feet at on the table. When the knees are bent,
there is less stress on the back. Some elderly patients
or patients with back pain may nd this position
more comfortable than the supine position.
Lithotomy position—This position is similar to the
dorsal recumbent position. The patient’s legs are well
separated and the patient’s feet are supported in stirrups instead of at on the table. The stirrups should
be level with each other, about 12 inches out from the
edge of the table. You may help patients move their
feet in and out of the stirrups. Moving both feet at
the same time prevents back strain. For patients who
have difculty getting into this position, the dorsal
recumbent position may be used.
Sims’ position—The patient lies on the left side
with the left arm and left shoulder behind the
body. The right leg and arm are sharply exed on
the table. The left knee is slightly exed. Patients
who are uncomfortable lying on their sides, such as
those with hip joint problems, may nd this position difcult.
Prone position—The patient lies on the abdomen with
the head supported and turned to one side. The arms
may be under the head or by the sides, depending on
Chapter 17 Assisting with the Physical Examination 349
K
Figure 17-14 Patient exam positions. A. Erect or standing. B. Sitting. C. Supine. D. Dorsal recumbent.
E. Lithotomy. F. Sims. G. Prone. H. Knee-chest. I. Fowler. J. Semi-Fowler. K. Trendelenburg. (Reprinted from Kronenberger
J, Ledbetter J. Lippincott Williams & Wilkins’ Comprehensive Medical Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer;
2016.)
which is more comfortable for the patient. This position is not used for an obese patient or a patient in the
late stages of pregnancy. It may also be too uncomfortable for elderly patients or patients with breathing
difculties to be in this position.
Knee-chest position—The patient kneels on the table
r
with the arms and chest on the table. The patient’s
hips are elevated and back straight. The patient’s head
is turned to one side. You may need to help guide the
patient into the correct position. Elderly patients,
pregnant patients, or obese patients may nd this
position difcult.
Fowler position—The head of the examination table
r
is elevated 80 to 90 degrees. The patient is sitting with
the torso upright and the legs extended on the examination table.
Semi-Fowler position—The examination table head
r
is elevated 30 to 45 degrees. The patient is in a halfsitting position with the knees slightly bent.
Trendelenburg position—The patient lies supine on
r
the table. The lower end of the table is raised about
30 degrees so the head is lower than the feet and legs.
This position is not used commonly in a medical
Reverse Trendelenburg position—The patient lies
r
supine on the table with the head higher than the feet
and legs. The head of the table is elevated about 30
degrees to reach this position.
350 Section IV Clinical Medical Assistant Skills
Table 17-2
Position Body Parts Examined Equipment, Instruments, and Supplies Used
Sitting General appearance
Supine Chest Stethoscope
Lithotomy
Dorsal recumbent
Sims
Examination Positions and Their Uses
Head, neck Stethoscope
Eyes Ophthalmoscope, penlight
Ears Otoscope, tuning fork
Nose Nasal speculum, penlight, substances to smell
Sinuses Penlight
Mouth Gloves, tongue blade, penlight
Throat Gloves, tongue blade, penlight, laryngeal mirror,
Axilla, arms
Chest Stethoscope
Breasts
Upper back Stethoscope
Reexes Percussion hammer
Abdomen Stethoscope
Breasts
Female genitalia and internal
organs
Female rectum Gloves, lubricant, fecal occult blood test
laryngoscope
Gloves, vaginal speculum, Ayre spatula, histobrush, lubricant, microscopic slide or liquid
preparation
Standing Male genitalia and hernia Gloves
Spine, posture, gait, coordination,
balance, strength, exibility
Dorsal recumbent
Sims
Prone Back, spine, legs
Knee-chest Rectum Gloves, lubricant, anoscope, proctoscope, or
Fowler’s Head, neck, chest Stethoscope
Trendelenburg Chest, abdomen, pelvis, legs, feet Stethoscope
Reverse Trendelenburg Head, chest, abdomen, legs, feet Stethoscope
C
O
G
POSTEXAMINATION
PROCEDURES
Male rectum Gloves, lubricant, fecal occult blood test
Prostate Gloves, lubricant
sigmoidoscope; fecal occult blood test
Female genitalia Glove, lubricant, vaginal speculum, Ayre
spatula, histobrush
Prostate Gloves, lubricant
Offering to help the patient return to a sitting
r
position.
Directing the patient to dress, assisting the patient as
r
needed.
After the physician has completed the patient examination, the medical assistant has many responsibilities that
include the following:
Providing the patient with follow-up instructions.
r
Escorting the patient to the front ofce to:
r
Check out and discuss any billing issues.