Canine PE Flashcards
List the steps involved for a physical exam.
- read patient and assess FAS
- assess general appearance, behavior, gait, posture, orientation, BCS, and state of consciousness
- properly approach patient and lift if needed
- properly restrain patient
- get vitals within 5 minutes of meeting patient (HR, RR, Temp, MM, CRT)
- examine head
- palpate peripheral LN
- auscultate heart and lungs, feel femoral pulse while auscultating heart, palpate thoracic region
- palpate abdomen
- palpate each limb and take them through ROM
- lift tail and look at perineal area
What does a signalment include?
- name (optional)
- age
- sex and if altered
- color (optional)
- breed
- species
What do you examine for general appearance?
- mentation
- FAS
- BCS
- gait and posture
- behavior
- orientation
- state of consciousness
What is “normal” mentation?
- BAR (bright, alert, responsive)
- QAR (quiet, alert, responsive)
What is considered “abnormal” mentation?
- dull or obtunded (decreased response to environmental stimuli)
- stuporous (responds only to painful stimuli)
- comatose (no response to painful stimuli)
- inappropriate (neuro deficits)
BCS is scored out of how many numbers?
9
Describe BCS of 1.
- all bondy prominences evident from a distance
- no discernible body fat
- obvious loss of muscle mass
Describe BCS of 2.
- ribs, lumbar vertebrae, and pelvic bones easily visible
- no palpable fat
- some evidence of other bony prominences
- minimal loss of muscle mass
Describe BCS of 3.
- ribs easily palpated and may be visible with no palpable fat
- tops of lumbar vertebrae visible
- pelvic bones becoming prominent
- obious waist and abdominal tuck
Describe BCS of 4.
- ribs easily palpable with minimal fat covering
- waist easily noted when viewed from above
- abdominal tuck evident
Describe BCS of 5.
- ribs palpable without excess fat covering
- waist observed behind ribs when viewed from above
- abdomen tucked up when viewed from side
Decribe BCS of 6.
- ribs palpable with slight excess fat covering
- waist is discernible viewed from above but is not prominent
- abdominal tuck apparent
Describe BCS of 7.
- ribs palpate with difficulty; heavy fat cover
- noticeable fat deposits over lumbar area and base of tail
- waist absent or barely visible
- abdominal tuck may be present
Describe BCS of 8.
- ribs not palpable under very heavy fat cover or palpable only with significant pressure
- heavy fat deposits over lumbar area and base of tail
- waist absent
- no abdominal tuck
- obvious abdominal distension may be present
Describe BCS of 9.
- massive fat deposits over thorax, spine, and base of tail
- waist and abdominal tuck absent
- fat deposits on neck and limbs
- obvious abdominal distension
What is a normal BCS?
4-5
Vitals should be taken within how long of meeting patient?
5 minutes
What do healthy mucous membranes look like?
pink and moist
What are abnormal mucous membrane presentations?
- pale and dry
- icterus (yellow)
- cyanotic (blue/purple)
- petechia (bright red spotting)
Describe how to take CRT.
- find unpigmented oral mucous membrane
- blanche (press lightly onto gums)
- remove finger and determine the time of fill
What is a normal CRT?
returns to color in 1-2 seconds
A CRT greater than 2 seconds is called what?
delayed CRT
What is CRT and what is it evaluating?
- capillary refill time
- crude evaluation of circulation and perfusion
Describe how to perform skin tent.
Lift skin on forehead or between shoulder blades and determine the time for skin to return to original location.
What does a skin tent show on a dehydrated patient?
delayed or prolonged return of skin
What are the clinical signs for a patient with less than 5% dehydration?
no clinical signs
What are the clinical signs for a patient with 5-8% dehydration?
- subtle loss of skin elasticity and skin turgor
- tacky or sticky MM
- normal eyes
What are the clinical signs for a patient with 8-10% dehydration?
- skin tenting
- dry MM
- sunken eyes
- dull corneas
- tachycardia
What are the clinical signs for a patient with greater than 10% dehydration?
- considerable loss of skin turgor
- severely sunken eyes
- tachycardia
- weak and thready pulse
- hypotension
- altered level of consciousness
What is a normal temperature in a canine?
100-102.5 F
What is a normal temperature in a feline?
100-102.5 F
What is a normal pulse for a canine?
- Large: 60-120 bpm
- Small: 120-160 bpm
What is a normal respiratory rate for a canine?
10-30 rpm
What is a normal pulse for a feline?
160-180 bpm
What is a normal respiratory rate for a feline?
10-30 bpm
What can influence vital signs?
- age
- breed
- stress
- excitement
How can you determine heart rate and respiratory rate?
- count number of beats or breaths per 15 seconds and multiply by 4
- count number of beats or breaths per 30 seconds and multiply by 2
Is it acceptable to count a heart or respiratory rate for 6 seconds and multiple by 10?
NO
Where can you collect a heart rate?
- auscultate or palpate apex beat (mitral valve) on left hemithorax
- palpate femoral artery pulse
Where can you collect a respiratory rate?
- visualzie thorax and abdomen move with each breath from a distance
- palpate each inhalation on caudal thorax/cranial abdomen
- auscultate with stehoscope on thorax or trachea
If a patient is panting, how do you record respiratory rate?
Can record as “panting” but still count a rate. It will be tachypneic
What do you evaluate for eyes?
- eyelid symmetry and shape
- pupil symmetry
- conjuctiva
- discharge
- globe (position, movement, vision, lens, cornea, sclera, fundus)
- cranial nerve functions associated with eyes
What cranial nerve reflex/response is associated with eyes?
- palpebral reflex
- menace response
- pupillary light reflex (direct and indirect)
- dazzle light reflex
Describe palpebral reflex.
- gently touch medial/lateral canthus
- if CN V (trigeminal) and VII (facial) intact, then it will ilicit a blink
Describe menace repsonse.
- gently advance hand to eye of interest and if that eye blinks ot patient moves away CN II (optic), VI (abducens), and VII (facial) intact.
- cover the opposite eye, do not touch eyelashes, and do not bring in execssive airflow to avoid false response
Describe the pupillary light reflex (direct and indirect).
- direct: pupils constrict when shined in eye
- indirect: contralateral pupil constricts (to less degree) when shines in opposition eye
Describe the dazzle light reflex.
- alternative to pupillary light reflex if the pupils can’t be visualized
What do you evaluate for ears?
- external pinnae (concave and convex)
- grossly examine external ear canal for discharge, stenosis, pruritis, excoriations, and masses/polyps)
- otoscopic exam of horizontal canal and determine if tympanic membrane intact
What do you evaluate for nose?
- shape, symmetry, color, erosions
- nares (patency and discharge)
What do you examine for oral cavity?
- is mouth painful when opened
- are hard and soft palate intact
- are there any masses
- dental occlusion
- teeth and gums
- tongue (including under)
How do you examine the neck?
- palpate trachea from larynx to thoracic inlet
- try to elicit a cough with extra-tracheal palpation
- check the thyroid (generally not palpable)
- attempt to visualize jugular vein or note a jugular pulse (not normal)
- palpalte mandibular LN
- Palate mandibular salivary glands
Describe healthy peripheral lymph nodes.
- symmetric to contralateral LN
- soft
- mobile
- non-painful
- no heat
What are the palpable peripheral lymph nodes?
- mandibular LN
- Popliteal LN
- Prescapular LN
- manidbular salivary gland
What are the non palpable peripheral lymph nodes?
- axillary LN
- iliac LN
- inguinal LN
What do you evaluate for skin?
- run hands over entire surface of skin (including ventral abdomen and paw pads)
- describe coat quality
- describe any masses
- describe any pathology
- ectoparastite presence
What is included in a musculoskeletal evaluation?
- thoracic limbs
- spine - cervial to coccygeal
- pelvic limbs
- evaluate gait if not already done prior
How do you examine thoracic limbs?
- examine from digits to scapula
- palpate muscle development, symmetry between limbs
- systematically flex/extend each joint
- palpate bones for fractures/instability
- edema or joint effusion presence
- presence of pain, heat, masses, foreign bodies
- conscious proprioception
What is the purpose of testing conscious proprioception?
evaluates patient’s awareness of their limbs in space and their ability to correct any abnormal positioning
How do you examine spine?
- palpate along each dorsal spinous process/transverse process from cercival to coccygeal for pain, crepitus, or assymetry
- evalute epaxial muscle development and symmetry
- hyper flex neck and extend dorsally and ventrally
- flex laterally in right and left directions
- lift tail to evaluate for pain
How do you examine pelvic limbs?
- examine from digits to coxofemoral joint
- palpate muscle development, symmetry between limbs
- systematically flex/extend each joint
- palpate bones for fractures/instability
- edema or joint effusion presence
- presence of pain, heat, masses, foreign bodies
- conscious proprioception
How do you examine the thorax?
- palpate both sides of ribs at same time
- look for symmetry of ribs
- masses?
- cardiac and respiratory evaluation
What are the steps of a cardiovascular evaluation?
- collect heart rate if not done prior
- auscultate left and right sides of the heart
- assess femoral pulse
What valves are you listening for on the left side of the thorax and what are their associated intercostal spaces?
- mitral valve: 5th intercostal
- aortic valve: 4th intercostal
- pulmonic valve: 3rd intercostal
What valve are you listening for on the right side of the thorax and its associated intercostal space?
- tricuspid valve: 4th-5th intercostal
Describe a healthy cardiac auscultation.
- strong
- no murmurs
- no arrythmias
What is a heart murmur?
- abnormal movement of blood through heart chambers and valves
- graded 1-6
What is an arrythmia?
- abnormal rhythm
- requires ECG for further evaluation
The femoral pulse should be what in relation to the heart rate?
strong and synchronous
When you auscultate the heart, you also palpate what?
femoral arterial pulse
What are the steps for a respiratory evaluation?
- assess respiratory effort
- auscultate trachea to appreciate referred upper airway sounds
- auscultate three locations on left and right hemithoraxes (cranioventral, central, dorsal) for 1-2 breaths each
Describe the dorsal and ventral lung fields.
- ventral lung field along sternum goes from thoracic inlet to 7th rib
- dorsal lung field along spine ends at 11th rib
Decribe normal trachea sounds.
harsh, tubular sounds
Describe tertor trachea sounds and what they indicate.
- snoring or snorting
- nasal cavity/pharynx abnormality
Describe stridor tracheal sounds and what they indicate.
- wheezes (airflow restriction)
- continues high pitch (larynx abnormality
Lungs elicit bronchovesicular sounds. Describe what each is associated with and their sounds.
- Bronchial: associated with central regions of lungs. tubular sounds, similar to trachea sounds but more quiet
- vesicular: associated with eripheral lung (cranioventral and dorsal). soft sounds.
What are abnormal respiratory sounds?
- decreased sounds
- increased (harsh) sounds
- crackles
- wheezes
How do you perform an abdominal palpation?
- fingertips/palms points dorsally
- begin just caudal to ribs and end at pelvis
- use gentle but firm and directed pressure
- slide hands cranial to caudal and dorsal to ventral
What organs should be palpable on a normal abdominal palpation?
- intestines if feces are present
- bladder if full
- caudal pole of left kidney in dogs
- both kidneys in cats
What organs should not be palpable on a normal abdominal palpation?
- liver
- pancreas
- stomach
- adrenal glands
- spleen
- uterus
How can you describe abdominal palpation findings?
- soft/compliant vs tense/hard
- non painful vs painful
- abdominal masses
- organomegaly
- urinary bladder fullness: turgid/distended, mildly, moderately, non palpable (empty)
What do you evaluate the anus for?
- anal sphincter tone
- anal sac
- temperature
What do you examine the perineum for?
- skin
- edematous
- masses
- fistulas
- hernia
What do you evaluate the vulva for?
- discharge
- erythema
- swelling
What do you examine the mammary glands for?
- supernumerary vs missing
- edematous
- warm
- discharge
- masses
How many mammary glands should there be?
5 bilaterally, 10 total
What do you examine the prepuce for?
- discharge
- erythema
- edematous
What do you examine the penis for?
- discharge
- erythema
- edematous
What do you examine the testicles for?
- symmetry
- bilateral descent
What do you examine the prostate for via rectal examination?
- small in size
- symmetry
- non painful
Small otoscope cones are used for what patients?
cats or dogs under 20 pounds
Medium otoscope cones are used for what patients?
dogs 20-80 pounds
Large otoscope cones are used for what patients?
dogs greater than 80 pounds or dogs under anesthesia
Describe how to use an otoscope.
- gently insert cone into the center of the lumen of the vertical ear canal
- as the canal narrows and bends, the pinna is grasped gently and moved outward and downward to straighten out ear canal
- after making the bend into the horizontal ear canal and advancing the speculum, the eardrum (tympanic membrane) should be visualized
Describe a healthy prostate.
- non painful
- bilobed/symmetrical
- smooth
- no masses
How big is a normal prostate?
- about 3-5 cm wide from left to right
- about 1.5-2.5 cm long from cranial to caudal
Describe the features of indirect opthalmoscopy.
- image is upside down and backwards
- requires dilation
- not as magnified
- farther from patient
- can be more difficult
Describe the features of direct opthalmoscopy.
- upright image
- magnified
- small field of view – 10mm
- close to patient
Explain how to perform indirect opthalmoscopy.
- hold the light source (Finoff transilluminator) next to your eye
- shine light in eye so that you visualize the tapetal reflection (bright green, fluorescent image)
- then move the lens into place so it is in the same axis as the light source (2-8cm from patient’s eye, hold loight source next to your eye and an arm’s length away from patient)
- hold within the same axis (so observer’s head, light source, lens, and patient pupil is all in line)
- the lens should remain parallel with the patient’s pupil and iris
Explain how to perform direct opthalmoscopy.
- eye is held close to the ophthalmoscope
- start with diopter on zero
- note the tapetal reflection through the opthalmascope and move in close to the patient with one hand on muzzle
- move close enough to get the fundus into focus and move diopter until there is a sharp image
Direct opthalmascope is measure in diopters. Explain.
3 diopters = 1mm of movement in globe
- positive numbers are green (movement in globe toward clinician/front of eye)
- negative numbers are red (movement in globe away from clinician/back of eye)
