Physical Exam

What is often the first and most important diagnostic test performed on a patient?

A thorough physical examination.

What is the key to performing a good physical examination?

Carefully and completely performing all parts of the examination every time.

What does TPR stand for?

Temperature, pulse, and respiration.

What is the normal resting heart rate for a dog?

60-120 beats per minute (BPM).

What is the normal resting heart rate for a small dog?

80-120 BPM.

What is the normal resting heart rate for a large dog?

60-80 BPM.

What is the normal resting heart rate for a puppy?

110-180 BPM.

What is the normal resting heart rate for a cat?

120-140 BPM.

What is the normal resting heart rate for a kitten?

140-220 BPM.

How do you calculate heart rate using a 15-second count?

Count the beats for 15 seconds and multiply by 4.

What is the normal resting respiratory rate for a dog?

10-34 respirations per minute (RPM).

What is the normal resting respiratory rate for a cat?

16-40 RPM.

How do you calculate respiratory rate using a 15-second count?

Count respirations for 15 seconds and multiply by 4.

When should respiratory rate ideally be measured?

Before touching the animal because handling and stress can elevate the rate.

What is the normal temperature range for dogs and cats?

100-102.5°F.

At what temperature is a fever a concern?

Above 103.5°F, although 103°F may be concerning in an animal that is not struggling or resisting.

What is meant by an animal spiking a temperature on the table?

An animal's temperature temporarily rises because of stress or struggling during the examination.

What should you do if a stressed animal has an elevated temperature?

Allow the animal to settle down and then take the temperature again.

What should always be done before using a thermometer?

Lubricate it.

What type of thermometer is recommended?

An 8-second digital thermometer.

Why can stress affect vital signs?

Stress can elevate the heart rate, respiratory rate, and temperature.

What does pink, moist mucous membrane (MM) indicate?

Normal findings; blood pressure and oxygen levels are within normal range.

What can pale or light pink mucous membranes indicate?

Possible anemia, shock, or blood loss.

What can brick-red mucous membranes indicate?

Vasodilation associated with fever, shock, or sepsis.

What do blue mucous membranes indicate?

Insufficient oxygen levels, possibly due to respiratory distress or hypoxemia.

What is hypoxemia?

A lower-than-normal level of oxygen in the blood.

What are petechiae?

Small spots that may indicate a clotting disorder, disseminated intravascular coagulation (DIC), or a platelet disorder.

What does yellow discoloration of the mucous membranes indicate?

Bilirubin buildup (icterus), possibly due to liver dysfunction.

What is DIC?

A serious disorder in which proteins that control blood clotting become abnormally active.

How can hydration status be evaluated using a skin tent?

Pick up the skin above the eye or in the middle of the back and observe how quickly it returns to its normal position.

What should happen to a skin tent in a properly hydrated dog or cat?

The skin should return without a delay.

What is the normal capillary refill time (CRT)?

Less than 2 seconds.

What are the signs of normal hydration?

0% dehydration and no detectable delay in the skin tent.

What percentage of dehydration is classified as mild?

5-6%.

What are the signs of mild dehydration?

A sluggish skin tent.

What percentage of dehydration is classified as moderate?

7-9%.

What are the signs of moderate dehydration?

Skin tents for several seconds, eyes are slightly sunken, and mucous membranes are tacky.

What percentage of dehydration is classified as severe?

10-12%.

What are the signs of severe dehydration?

Very delayed skin tenting, prolonged CRT, dry mucous membranes, and sunken eyes.

What percentage of dehydration is described as incompatible with life?

13-15%.

What are the signs of dehydration incompatible with life?

Prolonged CRT and unresponsiveness; dehydration greater than 12% usually leads to shock or death.

What are the five body condition categories listed on the exam sheet?

Obese, overweight, normal, thin, and emaciated.

What should you evaluate when examining the head?

Symmetry, bulges, growths, wounds, and tenderness in the facial muscles.

What should normal eyes look like during a physical examination?

Clear and free of debris, without a visible third eyelid or gray/blue haze.

What color should the sclera normally be?

Clear and white.

What is entropion?

An eyelid, usually the lower eyelid, that folds inward.

What is ectropion?

An eyelid, usually the lower eyelid, that turns outward and exposes the inner surface.

What can corneal edema be associated with?

Trauma or swelling.

What abnormal colors should you look for in the eyes?

Redness or yellow discoloration.

What should you check when examining the ears?

Debris, redness, skin thickening, excessive hair blocking the canal entrance, and visibility of the tympanic membrane.

What is the tympanic membrane?

The eardrum.

What may ear mites look like during an ear examination?

Small white wax-like balls that move around.

What type of debris may be seen in an animal with ear mites?

Dark, coffee-ground-like debris in the ear.

What should you evaluate when examining the nose?

Symmetry, swelling, bumps, wounds, and nasal discharge.

What are stenotic nares?

Abnormally narrow nostrils.

Why should you check the nostrils of brachycephalic breeds?

To make sure their nostrils are not too narrow.

What does brachycephalic mean?

Having a short, broad head and face.

What should you look for on the lips?

Ulcers, cuts, and masses.

What should you evaluate on the teeth and gums?

Tartar buildup on the teeth and redness or inflammation of the gums.

What should you check on the tongue?

Swelling, discoloration, and ulceration.

What should you check on the hard and soft palate?

Discoloration, ulceration, and masses.

What structure should you examine near the back of the mouth when possible?

The epiglottis.

Why should you be cautious when examining an animal's mouth?

The animal can easily bite you.

Why is it especially important to check under a cat's tongue?

String and other foreign material may be hidden there.

What should you evaluate when examining the neck?

Symmetry, masses, muscle tenderness, and range of motion.

What neck movements should you assess?

Flexion, extension, and turning from left to right.

How far should a normal animal be able to flex its neck?

The nose should be able to touch the chest.

How far should a normal animal be able to extend its neck?

The nose should point straight toward the ceiling.

How far should a normal animal be able to rotate its neck?

The nose should be able to touch the side of the dog or cat on either side.

How is the chest divided when auscultating the lungs?

Into 9 quadrants: 3 upper, 3 middle, and 3 lower.

What should normal lung sounds be like?

Air moving through the lungs at a minimal intensity with a smooth, steady sound.

What are two common abnormal lung sounds?

Crackles and wheezes.

What can the absence of lung sounds indicate?

Pleural effusion or pneumothorax; masses and lung consolidation can also cause absent sounds.

What do crackles sound like?

Like Rice Krispies cereal.

What can crackles indicate?

Fluid within the alveoli, such as with pulmonary edema.

What are wheezes?

Abnormal breathing sounds that can indicate a narrowed airway.

What condition in cats can be associated with wheezing?

Feline asthma.

What can an absence of lung sounds in the ventral lung field indicate?

Pleural effusion.

What can an absence of lung sounds in the dorsal lung field indicate?

Pneumothorax.

What can auscultation of the heart evaluate?

Heart rate, rhythm, and heart sounds.

Where should you auscultate the heart in a dog?

On each side of the chest around the level of the elbow.

Where is the heart best heard in a cat?

Over the sternal area, moving the stethoscope head from left to right to evaluate both sides.

Which heart valves are auscultated on the left side?

Pulmonic, aortic, and mitral.

Which heart valve is auscultated on the right side?

Tricuspid.

What should you do with the animal's pulse while auscultating the heart?

Feel the pulse and check whether it matches the heartbeat.

What is a grade 1 heart murmur?

Very quiet; only audible after listening for several seconds.

What is a grade 2 heart murmur?

Quiet, but audible immediately.

What is a grade 3 heart murmur?

Moderate intensity and easily audible.

What is a grade 4 heart murmur?

Louder than normal heart sounds.

What is a grade 5 heart murmur?

Loud enough to be detected by feeling the chest wall.

What is a precordial thrill?

A vibration that can be felt over the chest wall, associated with a loud heart murmur.

What is a grade 6 heart murmur?

Very loud and audible without placing the stethoscope on the body wall.

Which animals should have their mammary glands checked?

Both male and female animals.

What abnormalities should you look for when examining the mammary glands?

Discharge, tenderness, redness, swelling, masses, lacerations, ulcerations, and discoloration.

How is the abdomen examined?

By palpation.

Which organs or structures are evaluated during abdominal palpation?

The liver, spleen, kidneys, urinary bladder, and intestines.

On which side of the abdomen is the spleen located?

The left side.

Which organs should normally not be palpable in a dog?

The liver and kidneys.

In which species are the kidneys easy to feel during abdominal palpation?

Cats.

What should you assess when examining the back?

Move down the spine while applying firm, even pressure to check for pain or abnormalities.