Clinical exam Flashcards
What does SOAP stand for?
Subjective
Objective
Assessment
Plan
What do you look for in the subjective part of the exam?
Signalment
History
Observe demeanour, gait
What do you do in the objective part of the clinical exam?
Physical exam
Measurable parts - HR, RR, capillary refill etc
What is the aim of the plan in SOAP?
Create list of differential diagnosis
Stabilise patient
Communicate with client
Consider further investigation and diagnostic tests
What should you palpate on the head?
Muscles - check for symmetry
Submandibular lymph node
What should you do when examining dog mouth?
Open to look at throat and back of mouth
Check teeth
Assess capillary refill time on gums (<2 seconds)
What should you do when examining the dog neck/throat?
Tracheal pinch test - positive = abnormal
Palpate retropharyngal and prescapular lymph nodes
Examine jugular
Check neck motion
Auscultate neck
What should you do when examining the dog thorax
Examine skin, muscles,s sternum, ribs and hydration Check for symmetry Auscultate heart and lungs Take HR an pulse (should be identical) Percuss lungs
Where is the heart located? How do you find this?
Between ribs 3 and 6
Count from ribs backwards or at olecranon
When auscultating the heart make sure the FL is pulled forward. Where is the olecranon located on the thorax?
5th costochondral junction
What valves are found on either side of the ribs? Where do you auscultate them?
Left = 345 PAM Right = tricuspid valve at 4th - 5th intercostal space
Percussion of the heart should sound dull as it is fluid filled. What is this called?
Cardiac dullness
What should you be checking for when auscultating the heart?
Check HR and pulse
Check for arrhythmias, tachycardia and bradycardia
What are the heart sounds and what causes them?
S1 = blood rebounding on AV valves S2 = deceleration of blood in great vessels after aorta
What do S1 and S2 mark?
Start and end of systole
What are S3 and S4 called?
Are they normal? What do they suggest?
Gallops
Normal in horses
Show decreased compliance and ventricular stiffening in small animals
When listening to murmurs, what should you ask yourself?
Systolic (between S1 and S2) or diastolic?
What is the most intense point?
Pitch?
What is a machinery murumur? Is it systolic or diastolic?
Patent ductus arteriosis
Both systolic and diastolic
How should the lungs sound when percussed?
Tympanic (hollow)
What should you hear when auscultating the lungs?
Barely anything in healthy animal
Especially cat
What borders the lung feeds?
Vertebral column
Sternum
Forelimb
Diaphragm
What is wheezing?
Where is it found?
Is it inspiratory or expiratory?
Dry sound
Lower respiratory tract
Usually expiratory
What is crackling?
Where is it found?
Is it inspiratory or expiratory?
Moist sound
Lower respiratory tract
Either
What are reduced lung sounds a sign of? Give 2 examples of what this could be?
Filling of pleural space
E.g. pleural effusion (fluid between pleura)
E.g. pneumothorax (lung tear –> air in thoracic cavity)
What 3 systems are found in the abdomen?
Urinary
Repro
GI
What should you do when examining the abdomen?
Examine skin and muscle
Auscultate and percuss abdomen
Palpate palpable organs with flat hands
What organs are palpable in the abdomen?
Caudal liver Spleen Kidneys (right more cranial) Intestinal loop Bladder Mammary glands
What should you do when examining the groin and perineum?
Examine skin and external genitalia and anus
Palpate inguinal lymph nodes
Record femoral pulse
Take rectal temperature
What should you do to examine the limbs?
Check nails, nail beds and in between each digit
Check for dewclaws
Check footpads
Check range of movement
Palpate bones of FL/HL
Check femoral/metacarpal pulse
Check lymph nodes- axillary (FL), popliteal (HL)
What lymph nodes are palpable in the dog?
Submandibular Retropharyngeal Prescapular Axillary Inguinal Popliteal
What is the heart rate of a dog?
70-160
What is the RR of a dog?
10-30
What is the HR of a cat?
120-220
What is the RR of a cat?
20-30
