Physical Examination of Dogs & Cats

1. Be consistent & thorough

2. Write it down

3. Back off

4. Use restraint

5. Say Hello

6. Learn from experience

6 Important steps to take note before & during physical examination

F: Always perform a complete exam (topographic region) regardless of the presenting complaint.

T/F: When presented with a chief complaint, it is important to check it right away and focus firstly on it.

light or moderate

best type of restraint to use for the animal to reduce stress

1. sight

2. hearing

3. smelling

4. touch

4 major senses used by the vet during physical examination

Distant examination

This is done by observation prior to handling or restraining the animal, should never be omitted, and may best be undertaken during the period devoted to obtaining the history and taking note of the environment

general or the systematic examination

During this type of examination, the outer surface of the body and external orifices are also examined by inspection.

General expression

This is formed by looking at and listening to the patient from a slight distance

1. Sopor (sleepiness)

2. Stupor (aroused by strong stimuli)

3. Coma (cannot be aroused)

3 levels of consciousness

Pathologic behavior

This form of behavior can occur in such forms as self mutilation, compulsive actions (head-pressing, walking in a circle), convulsions, or aggression

1. Malaise (discomfort)

2. Lying (on its side or sternum)

3. Standing (with one leg, led extended or over-extended)

4. Position of the spinal column (arched, sagging, or stiffly extended neck)

Areas to look when examining for Posture

1. Level of consciousness

2. Behavior

3. Posture

4. Locomotion

5. Body shape

6. Nutritional condition

7. Coat

8. Abnormal sounds

9. Abnormalities that stand out

9 Areas to check during general impression

body weight

To evaluate the course of some illnesses or kinds of therapy, it is also desirable to measure ____ accurately

trunk; lumbar

Fat accumulates chiefly on the ____ and sometimes there is an extra accumulation bilaterally in the____ area.

retrobulbar fat

The eyes can be sunken because of the loss of____ and as a result the nictitating membrane can protrude.

1. Cachectic (Vey Thin)

2. Skinny/ Slim (Underweight)

3. Optimal

4. Overweight

5. Obese

Nutritional condition ordinal scale 1-6

1: Very Thin

BCS: Ribs are easily felt w/ no fat cover

2: Underweight

BCS: Bones are raised w/ minimal tissue between skin & bone

3: Ideal

BCS: Ribs are visible and easily felt

4: Overweight

BCS: Ribs are difficult to see or feel through moderate fat cover

5: Obese

Ribs are not visible and are difficult to feel through thick fat cover. In cats, fat hangs from the abdomen

2.9

Compared with cats of optimal weight, overweight cats are ___ times as likely to be taken to veterinarians because of lameness.

3.9

Obese cats are __ times more likely to develop diabetes mellitus than are cats of optimal weight.

T

T/F. At the usual distances in the examination room, no sounds are heard from an animal at rest.

1. Eructation

2. Flatulence

3. Respiratory sounds

4. Intestinal sounds

5. Joint disorders

Abnormal sounds include these 5

1. Thickened pinna

2. Swelling of one leg

3. Pumping or respiration

3 abnormalities that stand out

1. TPR - outside range

2. Age - older than 6yrs or younger than 12 mos

3. Weight - less than 2kgs or more than 34 kgs

4. Diarrhea or vomiting, trauma history

5. Abnormalities on physical exam

Findings that require a designated supervisor's evaluation include 5 factors like:

1. General Physical Examination

   • General impression (Distant examination)

   • Close Physical Examination

In Physical Examination of Dogs & Cat, 3 general processes are done

Inspection/observation

the use of the sense of sight, by which shape, color, and movement can be observed

Palpation

the use of touch, can obtain information about the shape, consistency, and temperature of the object being examined

Auscultation

the sense of hearing is used primarily to observe sounds occurring in the thoracic cavity; can be accomplished by pressing one's ear against the animal's body, but it is almost always done by use of an instrument that transmits the sound to the ear of the examiner

General inspection

type of inspection that is is a visual evaluation of the entire animal or of large parts of it

Local inspection

type of inspection where it is necessary to use a focal light source, usually a small penlight. Some cavities or passages are inspected with the aid of an instrument specially designed for the purpose, such as an otoscope or vaginoscope

Palpation

It involves utilizing the sense of touch as well as possible

1. Location

2. Size

3. Shape

4. Consistency

5. Painfulness

6. Movability

7. Borders and surfaces

8. Color and temperature

9. Related masses

Aspects important for characterization of a mass during palpation

bone, nerves

Tumors that grow in these areas causes too much pain

malignant

An indistinctly circumscribed mass could be an infiltrating _______tumor

melanin

Depositions of _____ can be the cause of a brown-black color.

regional lymph nodes

presence of multiple masses indicates involvement of ________

chest and back

Percussion is most commonly used on the ___ & ____ for examination of the heart and lungs.

F. It will change since heart is not resonant and the adjacent lungs

T/F: Dring percussion, when the examiner's fingers strike the chest over the heart the sound waves will not change in pitch

1. haircoat

2. reluctance

3. anatomy

The value of percussion in animals is limited by these 3 factors

F. pressure increases

T/F: There is a pressure wave corresponding to the changes in density, because where the medium becomes more dense, the pressure decreases

plessimeter/ pleximeter

In 1827, Piorry tapped on an ivory plate which he called ______

finger­ finger percussion

What do you call to this procedure?

7cm

Acoustic percussion does not penetrate beyond _____ cm into the thorax, and hence deeper lesions will not be revealed by this method.

5cm

In addition, consolidated lesions (tumor or fluid) must be at least ___ cm in diameter in order to produce damping that can be detected.

1. Sonorous percussion tone

2. Damped percussion tone

3. Tympanic percussion tone

In percussion of the trunk (thorax and abdomen), three main percussion sounds can be distinguished:

Sonorous percussion tone

This is the fairly low, strongly resonant tone that is heard by percussion of gas-containing lung tissue

Damped percussion tone

This can be heard over any part of the body that does not contain gas, such as muscles or liver. It is a short (cut­off) sound of low intensity.

Tympanic percussion tone

This tone contains more sound and is a little higher than the sonorous percussion tone. A good example of this tone is that from the gas-filled stomach. It occurs in smaller cavities (stomach, intestines), higher in pitch.

Flatness

This is checked in areas like bones such as the clavicle, ribs, sternum

Dullness

This is checked inn areas with dense organs such as the liver, spleen, heart

Resonance & Hyperresonance

This is observed in adult lung & child lung (respectively)

Tympany

This is checked in abdominal area such as intestines and stomach

• placing the finger of one hand (pleximeter) flat in the intercostal space over the lung field

• briskly tapping it with the middle finger of the opposite hand (plexor)

In small animals, thoracic percussion is usually performed by

• placing a pleximeter (i.e., wood alock, metal block, or spoon) in the intercostal space and;

• hitting it with a rubber reflex hammer (plexor).

In large animal species, the percussion procedure is usually paerformed by

Wood blocks

____ tend to create better resonance and are preferred as pleximeters

7cm; 5cm

Acoustic percussion can assess tissues to a depth of approximately cm and detect lesions as small as __ cm diameter

cranial ventral

Note that the cardiac silhouette lies in the ________ portion of the lung field and manifests as an area of dullness

T

T/F: Enlargement of the cardiac silhouette, or variation in the tympany over the lung field may indicate thoracic disease.

…

Take note!!!

gas pressure or by tissue vibrations

Sounds can be generated in the body by rapid fluctuations in ____ or ____

Laennec

He first described indirect auscultation in 1819. He called his instrument, which consisted of a simple wooden tube, the stethoscope

Auscultation

a method of diagnosis by which the condition of some of the internal organs is determined by listening to the sounds they produce.

“Stethos” = chest

“phonein” = sound

Greek word where stethoscope is derived from

excessive dryness, excessive oiliness, evidence of dandruff, excessive shedding, or abnormal hair loss

Abnormal findings observed in haircoat

scabbing, rashes, lumps or bumps, areas of abnormal thickening, etc.

Abnormal findings observed in skin

redness, discharge, evidence of excessive tearing, cloudiness, etc.

Abnormal findings observed in eyes

discharge, thickening, hair loss

Abnormal findings observed in ears

symmetry, how well the pet breathes, whether there are any problems related to skin folds, etc.

Abnormal findings observed in nose & face

tartar build-up, periodontal disease, retained baby teeth, broken teeth, ulcers in or around the mouth, etc.

Abnormal findings observed in mouth & teeth

1. Pulse

2. PLNDS - swelling or pain

3. Legs - lameness, nerve probs

4. Abdomen - normal/ abnormal, discomfort

4 Areas palpated by vet

heart & lungs

2 areas auscultated by the vet

1. Signalment / History

2. General Appearance / Initial Observations

3. Vital Signs

4. Physical Exam (Systems Approach or Head to Toe)

5. Surgical / Anesthetic Risk Assessment

5 Processes of Physical Exam

1. BCS

2. Mentation

3. Posture & gait

4. Hydration status

General appearance components during examination

Loss of the elasticity of the skin (skin turgor)

_________ is first sign of dehydration. Check the skin of the upper eyelid and the neck for tenting

Vital signs

Evaluated in relation to presenting complaint, history and current health status

1. respiratory movements

2. pulse

3. body temperature

4. coat and skin

5. mucous membranes

6. peripheral lymph nodes

7. other notable abnormalities

The concept of 'general examination' includes these 7 components