Day 1- Clinical Exam: Farm, SA and Equine Flashcards by Patrick Enion

What can be assesed as soon as you see the horse?

Demeanour

Behaviour- should be responsive, usually eating, interesed in other horses movements

Stance- recumbent, unwilling to rise/move, weight shifting, resting one leg

Signs of previous treatment

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How should a horses environment be assessed?

Signs of colic

Presence/absence of faeces/scour

Uneaten Food

Type of bedding- dusty, edible, disturbed

Mucus on doors and floor

Nearby horses- coughing, stamping, colicking

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What are the most relevant general history questions for a horse?

What is the horse used for?

How old is it?

How is it kept?

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Why is what the horse used for an important question?

Influences things such as:

Potential problem- excercise related fractures might be common, laminitis is not in race horses
Future expectations- does it need to return to athletic function
Timescale- needs to be sound for time
Drugs treatment- may need to be out of the system for race eg

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Why is it important to know the age of the horse?

Type of problem- certain conditions age related

Owners expectations- ‘he’s only two’

Type of treatment- ‘too old for colic surgery’

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Why is it important to know how a horse is kept?

Many proplems associates with specific managment systems

Horses at pasture are much more likely to suffer trauma

Problems often associated with a change in routine

Might influence treatment- only have field cannot box rest

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How is a specific history generally taken for horses?

Obviously relates to the problem but includes

When did it start

Has it progressed

Has it had it before

Have you given any treatment

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How can you do a general examination of a horse?

Need to decide whats relevant- can’t always do a head to toe
Over all frame work- general inspection, vital signs, specific exam

General inspection- get general idea of horses health, no concurrent problems, make sure the horse can move and eat. Food test- if they don’t eat they are ill

Vital sonuds- HR, RR, TPR, not always essential, HR good reflection of stress

Pyrexia (temperature) not always consistent sign but suggests systemic inflammation- on colicking horse could reveal periotnitis or impending collitis

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What are the two types of clinical reasoning that can be used for clinical exam?

Pattern recongition- inductive fast thinking

Based on previous experience and probability, fast and efficient, may jump to false conclusions, suitable for emergencies, no use for unseen condition

Systematic exam- deductive reasoning slow thinking

Methodical, gahters large amount of data about the patient, unlikely to miss problems or jump to conclusions, useful for unseen condition, slow, inefficient, inflexible

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How should you assess a call out to a violent colic?

Assess level of pain

Is it safe to examine?

Get a HR

Take blood?

Sedate to allow rectal exam

Surgical?

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How could you approach a call out to a coughing horse?

Get history/age

Observe at rest- tachypnoea?

Examine nostrils- discharge?

Painful lymphnodes?- suggests infection

Ascultate chest- lower respiratory tract involved if heard

Is it infectious

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How would you approach a call out to a lame horse?

History

Can it walk, trot?

Which leg- examine carefully- static flexion, digital pulses, decide on treatment

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Describe the process of a bovine clinical exam

History- age, production stage, clinical status, herd history
Background- farm, client
On farm- clinical exam, sampling, environment

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What is done and assessed during a clinical exam of a cow (overview)?

Restrain cow safely
Examine from distance
Demeanour
Mobility
Tail End, L side, R side, Head, Udder Vagina

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What is the cut off temperature of cattle?

39.5 degrees C

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What is assessed at the tail end of a farm animal?

Vaginal discharge (endometritis)
Urinary tract
Faecal sampling/consistency- presence of undigested food/blood

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How is a farm animal auscultated?

Heart- under elbow (rib space 3-5)
Lungs- small field use RR

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What is the normal HR of a farm animal?

60-80bpm

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What can be identified from auscultating the cow’s heart?

Murmurs
Endocarditis
Quiet/splashing/absence- traumatic pericarditis (wire puncturing heart)

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What can be assessed about the left abdomen of a cow?

Rumen:
Fill score- 1-5
Observe/palpate- gas/bloat
Consistency of contents
Movements- rumen rate, 3 turnovers in 2 mins

What does the Eric Williams test distinguish between and what can it diagnose?

Distinguishes between primary and secondary contractions
Diagnosis or wire, vagus indigestion

How can primary and secondary cycles of an Eric Williams test be distinguished?

Primary- no sound but the feel rumen contract
Secondary- feel rumen contract then hear eructation

How can you tell if a wire had been ingested with an Eric Williams test?

Grunt before contraction- but is very subtle

What should the ratio of secondary to primary cycles be in a Eric Williams test?

1:1 or 1:2

How can a displaced abomasum be diagnosed?

Starting at elbow and working way up towards hip flicking ans listening the side of the cow Ping indicated gas fluid interphase, map out area of pings Harder in fat cows and a dead/rotten calf gives lots of pings

What should be observed for at the head of a cow?

Eye and nose conjunctiva colour (pink, red=toxic, white= anaemia) Discharges Lesions Lymph nodes Look in mouth- pull tongue to side to look for lesions, ulcers/vesicles

What should be observed on the right side of the cow?

Observe shape and distension Listen to heart and lungs and abdomen Ping for right deplacment and torision of abomasum

What can be assesed from an udder?

Palpate Take milk sample Check for clots and look at colour CMT (milk test)

What can be identified in rectal and vaginal exam of a cow?

Rectal- faecal consistency, rectal tone, rumen, uterus and ovaries, L kidney, distended abomasum/caecum, some guts Vaginal- discharge, vaginal wall, cervix

What does SOAP stand for in a SA clinical exam?

Subjective examination Objective examination Assess findings Plan- diagnostic/therapeutic

What is included in the subjective examination?

Body condition Demeanor Gait Behvaiour DUDE- defacation, urination, drinking, eating

What do the following acronyms mean?: BRPM, BPM, WNL, NPO, TPR

BRPM- breaths per minute BPM- beats per minute WNL- within normal limits NPO- nil per os TPR- temperature, pulse, respiration rate

What happens during a objective examination SA?

Work through in a logical and systematic way e.g- Start at one end and work to another, examine body systems or combo

What should be examined at a SA head?

Head- posture of the head and neck, symmetry, discharge, cranial nerves Eyes- abnormality, uni/bilateral, size/symemetry, position, ocular discharge Nose- nasal discharge (unilateral, bilateral, blood, serous, mucopurulent), airflow, swelling, asymmetry, pain Mouth- lip symmetry, mucous membrane, CRT Teeth- tartar, peridontal disease, fracture Tongue- paralysis, ulceration Pharyngeal Ears- pinna- haematoma, hyperplastic change, neoplasia. Discharge?

What can be palpated near the head of SA?

Palpate larynx Palpate trachea Palpate thyroid glands Jugular veins

What lymph nodes can be found and palpated in SA?

Submandibular Prescapular Axillary Inguinal Popliteal

What is the purpose of abdominal palpation in SA?

Gives and idea of any pain or organomegaly Sometimes can't feel much- overweight Can feel most of cats organs usually Can feel for Ascities or Distension (pyo, pregnancy)

Describe an objective examination of a SA abdomen

Liver- under costal arch unless enlarged Stomach and spleen- left cranial Kidneys- mid abdomen, left more caudally positioned, size, shape, pain SI- gas/fluid filled Colon- usually contains faeces, descending- left caudal Bladder- size, shape, turgidity

Describe the objective examination of SA skin?

Look for masses External parasites Alopecia- symmetric, erythema Lesions- pustules, nodules, vesicles, scales, crusts, hyperkeratosis

What is the normal RR ins dogs and Cats? What is the normal HR in dogs and cats?

RR- dogs- 10-20, Cats- 20-40 HR- dogs- 70-140, Cats- 145- 200

What should you be listening for on chest auscultation and treachea auscultation of SA?

Chest- Abnormal sounds- crackles, wheezes, referred noise Trachea- Harshness, upper airway noise

What should be listened to with a SA objectivr examination of the heart?

Point of maximal intensity (mitral valve, most murmurs here) Identify the first/second sound Listen for abnormalities- muffled sound, rythm, murmurs, extra heart beat PAM on left- ICS 3-pulmonic, 4- aortic , 5- mitral Right ICS 4- tricupsid Heat sounds- S1 closure of mitral and tricupsid valves, S2- closure of pulmonic and aortic valves, S3 rapid ventrical filling, diastolic overload, PDA, S4 ventricular hypertrophy

Where can SA pulses be taken and what is a normal pulse?

Usually taken at femoral artery Quality, symmetry, Synchronous, Femoral and peripheral

What is the normal temperature of cats and dogs?

Cats 38-39.5 Dogs- 37.5-39.5

Describe the objective examination of the repro systems

Penis- trauma, masses, petechia (small red spot from broken capillaries) Prepuce- discharge, phimosis Testis- symmetry, firmness, irregularity Mammary glands- swelling, heat, discharge Vulva- swelling, colour, discharge Vagina- masses Rectal- use index or middle finger, lube, palpate- pelvic canal, prostate, sublumbar inn, masses, perineal region, anal sacs

How should you assess findings?

Look at all clinical findings, try and explain and decide what is significant

What is included on a problem list?

Proven diagnosis Physical abnormality Physical examination finding Owner complaint Clinical sign Social problem

What is the acronym for the differential diagnosis list?

DAMNIT V Degenerative, developmental Autoimmune, anatomic, anomalies Metabolic, mechanical Nutritional, neoplastic Inflammatory, infectious Toxic, traumatic Vascular