CMA Chapter 5: Physical Exam

• In some cases, symptoms are vague and could be caused by one of several diseases, leading to a differential diagnosis
• Routine examinations are performed thereafter at regular intervals to help maintain the patient's health and prevent disease
• Making a diagnosis


  Relies on medical history, physical examination, and any laboratory and diagnostic tests
• New patients usually receive a complete physical examination, which gives the physician baseline information about the patient
• You may collect specimens for diagnostic testing as a medical assistant
• Instruments used during the physical examination enable the examiner to see, hear, or feel areas of the body being assessed
• When a patient comes into the office, the physician can make a clinical diagnosis based only on the patient's symptoms
• This baseline information is valuable for future comparison and can aid the physician in diagnosing and identifying a disease or condition
• Components relied on for making a diagnosis

  • Medical history
  • Physical examination
  • Laboratory and diagnostic tests
• The purpose of the complete physical examination is to assess the patient's general state of health and detect signs and symptoms of disease
• As a medical assistant, you are responsible for assisting with taking the medical history, preparing the patient for the examination, and assisting the physician during the examination
• The exact equipment used varies among medical offices according to physicians' preferences and the specific needs
• During the examination, you must anticipate the needs of the physician and patient and be prepared to assist as necessary
• Nasal specula are also available in a disposable form
• Supplies that should be available in the examination room

  • Tape measure
  • Gloves
  • Tongue depressors
  • Cotton-tipped applicators
• Reason for variation in the types of instruments and supplies used in each medical office
• Some hammers have a brush and needle in the handle specifically used to test sensory perception
• Examiner places the tip of the audioscope in the patient's ear and asks the patient to respond to each tone produced
• Physician may order additional auditory tests based on the results of the hearing test using a tuning fork
• Otoscope has a stainless steel handle, light, magnifying lens, and cone-shaped hollow speculum
• Portable units may have a common base handle with various otoscope or ophthalmoscope tips for different examinations
• Tuning Fork


  • Used to test hearing
  • Stainless steel instrument with a handle at one end and two prongs at the other end
  • Examiner strikes the prongs against his or her hand to produce a humming sound
• Percussion Hammer

  • Used to test neurologic reflexes
  • Also called a reflex hammer
  • Has a stainless steel handle and a hard rubber head
• Otoscope and Audioscope

  • Otoscope permits visualization of the ear canal and tympanic membrane
  • Audioscope is used to screen patients for hearing loss
• Nasal Speculum

  • Inserted into the nostril to assist in the visual inspection of the lining of the nose, nasal membranes, and septum
  • Tip of the instrument is inserted into the nose and the handles are squeezed to allow for visualization
• Audioscope's handle has a variety of indicators and selection buttons to adjust its tones
• Ophthalmoscope


  • Used to examine the structures of the eyes
  • Has a stainless steel handle containing batteries or may be mounted on the wall
  • Head of the ophthalmoscope has a light source, magnifying lens, and opening to view the eye
• Examination Light and Gooseneck Lamp


  Some offices are equipped with an adjustable overhead examination light for better visualization during the examination. The gooseneck lamp is a floor lamp with a movable stand that bends at the neck for use when the overhead lighting is not adequate. It is the responsibility to make sure all examination lights are in proper working order and to direct the light toward the area of the body as indicated by the physician
• Structure of the eyes

  Like the otoscope, it may have mounted on the wall. The head of the ophthalmoscope also has a light source, magnifying lens, and an opening through which to view the eye. Portable units may have a common base handle with various otoscope or ophthalmoscope tips that can be attached for different examinations
• Stethoscope


  • It is used to listen to the sounds of the heart, lungs, and intestines. It is also used for taking blood pressure
• The laryngoscope handle is similar to the battery handle of a portable otoscope or ophthalmoscope, but the head allows attachment of curved or straight laryngoscope stainless steel blades and a small light source. The examiner places the blade in the patient's throat to visualize the larynx or vocal cords, which cannot be seen by simply looking down the patient's throat
• An ear, nose, and throat specialist may wear a headlight or head mirror during the examination of these structures. This instrument consists of a light or mirror attached to a headband that fits over the examiner's head. A headlight provides direct light on the area being examined; the mirror reflects light from the examination light into the area
• Examination tools

  • Stethoscope
  • Penlight or Flashlight
  • Headlight or Mirror
  • Laryngeal Mirror and Laryngoscope
  • Vaginal Speculum
• The laryngeal mirror is a stainless steel instrument with a long, slender handle and a small, round mirror. It is used to examine areas of the patient's throat and larynx that may not be directly visible
• The stethoscope is used for listening to body sounds
• The general physical examination of female patients may include a pelvic examination and Papanicolaou (Pap) smear. This is a simple test in which cells obtained from the cervix or vagina are examined microscopically for abnormalities including cancer. To obtain the cells for a Pap smear, or to visually examine internal female reproductive structures, the vaginal speculum is inserted into the vagina to expand the opening. This instrument is made of stainless steel or disposable plastic
• A penlight or flashlight provides additional light to a specific area during the examination. The penlight is the shape and size of a ballpoint pen and is easily carried in the examiner's pocket. A common flashlight may be used if a penlight is not available. The penlight is often used to examine the eyes, nose, and throat
• A sigmoidoscope is a longer instrument used to visualize the rectum and the sigmoid colon, with an obturator, fiberoptic light handle, and magnifying lens
• Lubricant


  • Water-soluble gel used to reduce friction and provide easy insertion of an instrument in the physical examination
  • May be used for a bimanual examination and rectal examinations
• Pap smear

  1. Vaginal speculum is inserted into the vagina to expand the opening

  2. Ayre spatula or cervical scraper is used to obtain vaginal or cervical cells

  3. Histobrush may also be used to obtain cells for a Pap smear

  4. Collected cells are transferred to either a glass slide or a liquid preservative and sent to a laboratory for analysis