Day 1- Clinical Exam: Farm, SA and Equine Flashcards
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
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
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?
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
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’
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
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
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
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
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?
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
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
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
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
What is the cut off temperature of cattle?
39.5 degrees C
What is assessed at the tail end of a farm animal?
Vaginal discharge (endometritis)
Urinary tract
Faecal sampling/consistency- presence of undigested food/blood
How is a farm animal auscultated?
Heart- under elbow (rib space 3-5)
Lungs- small field use RR
What is the normal HR of a farm animal?
60-80bpm
What can be identified from auscultating the cow’s heart?
Murmurs
Endocarditis
Quiet/splashing/absence- traumatic pericarditis (wire puncturing heart)
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
