Day 1- Clinical Exam: Farm, SA and Equine

Question 1

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

Answer 1

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

Question 2

How should a horses environment be assessed?

Answer 2

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

Question 3

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

Answer 3

What is the horse used for?

How old is it?

How is it kept?

Question 4

Why is what the horse used for an important question?

Answer 4

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

Question 5

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

Answer 5

Type of problem- certain conditions age related

Owners expectations- ‘he’s only two’

Type of treatment- ‘too old for colic surgery’

Question 6

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

Answer 6

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

Question 7

How is a specific history generally taken for horses?

Answer 7

Obviously relates to the problem but includes

When did it start

Has it progressed

Has it had it before

Have you given any treatment

Question 8

How can you do a general examination of a horse?

Answer 8

• 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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

Assess level of pain

Is it safe to examine?

Get a HR

Take blood?

Sedate to allow rectal exam

Surgical?

Question 11

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

Answer 11

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

Question 12

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

Answer 12

History

Can it walk, trot?

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

Question 13

Describe the process of a bovine clinical exam

Answer 13

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

Question 14

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

Answer 14

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

Question 15

What is the cut off temperature of cattle?

Answer 15

39.5 degrees C

Question 16

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

Answer 16

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

Question 17

How is a farm animal auscultated?

Answer 17

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

Question 18

What is the normal HR of a farm animal?

Answer 18

60-80bpm

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

Grunt before contraction- but is very subtle

Question 24

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

Answer 24

1:1 or 1:2

Question 25

How can a displaced abomasum be diagnosed?

Answer 25

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

Question 26

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

Answer 26

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

Question 27

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

Answer 27

Observe shape and distension

Listen to heart and lungs and abdomen

Ping for right deplacment and torision of abomasum

Question 28

What can be assesed from an udder?

Answer 28

Palpate

Take milk sample

Check for clots and look at colour

CMT (milk test)

Question 29

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

Answer 29

Rectal- faecal consistency, rectal tone, rumen, uterus and ovaries, L kidney, distended abomasum/caecum, some guts

Vaginal- discharge, vaginal wall, cervix

Question 30

What does SOAP stand for in a SA clinical exam?

Answer 30

Subjective examination

Objective examination

Assess findings

Plan- diagnostic/therapeutic

Question 31

What is included in the subjective examination?

Answer 31

Body condition

Demeanor

Gait

Behvaiour

DUDE- defacation, urination, drinking, eating

Question 32

What do the following acronyms mean?:

BRPM, BPM, WNL, NPO, TPR

Answer 32

BRPM- breaths per minute

BPM- beats per minute

WNL- within normal limits

NPO- nil per os

TPR- temperature, pulse, respiration rate

Question 33

What happens during a objective examination SA?

Answer 33

Work through in a logical and systematic way

e.g- Start at one end and work to another, examine body systems or combo

Question 34

What should be examined at a SA head?

Answer 34

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?

Question 35

What can be palpated near the head of SA?

Answer 35

Palpate larynx

Palpate trachea

Palpate thyroid glands

Jugular veins

Question 36

What lymph nodes can be found and palpated in SA?

Answer 36

Submandibular

Prescapular

Axillary

Inguinal

Popliteal

Question 37

What is the purpose of abdominal palpation in SA?

Answer 37

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)

Question 38

Describe an objective examination of a SA abdomen

Answer 38

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

Question 40

Describe the objective examination of SA skin?

Answer 40

Look for masses

External parasites

Alopecia- symmetric, erythema

Lesions- pustules, nodules, vesicles, scales, crusts, hyperkeratosis

Question 41

What is the normal RR ins dogs and Cats?

What is the normal HR in dogs and cats?

Answer 41

RR- dogs- 10-20, Cats- 20-40

HR- dogs- 70-140, Cats- 145- 200

Question 42

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

Answer 42

Chest-

Abnormal sounds- crackles, wheezes, referred noise

Trachea-

Harshness, upper airway noise

Question 43

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

Answer 43

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

Question 44

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

Answer 44

Usually taken at femoral artery

Quality, symmetry, Synchronous, Femoral and peripheral

Question 45

What is the normal temperature of cats and dogs?

Answer 45

Cats 38-39.5

Dogs- 37.5-39.5

Question 46

Describe the objective examination of the repro systems

Answer 46

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

Question 47

How should you assess findings?

Answer 47

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

Question 48

What is included on a problem list?

Answer 48

Proven diagnosis

Physical abnormality

Physical examination finding

Owner complaint

Clinical sign

Social problem

Question 49

What is the acronym for the differential diagnosis list?

Answer 49

DAMNIT V

Degenerative, developmental

Autoimmune, anatomic, anomalies

Metabolic, mechanical

Nutritional, neoplastic

Inflammatory, infectious

Toxic, traumatic

Vascular