Day 1 (to and with radiography) Flashcards
Ancillary Dx methods
- Tubing
- Ultrasonography
- Endoscopy
- Radiography
Physical exaams
Inspection Palpation Auscultation Percussion Olfaction Measurement
Permanent vs non-permanent data
examples
White marks on the head (7)
Stripes
Star
Blaze
White face
Snip
Flesh marks
White muzzle
Distant examinations
Size
Conformation
Body condition (1 - 9)
Posture
Gait
Behaviour and demeanour
- Excitation states
- Depression states
Obvious pathological changes
Rectal temp
Adult horse: 37.0 – 38.0 C
Foal: 37.5 – 38.5 C
Pulse and HR
Adult: 28 – 42 beats per minute (BPM)
Foal At birth: 60 – 80 BPM
0 – 2 hours: 120 – 150 BPM
12 hours: 80 – 120 BPM
24 hours: 80 – 100 BPM
1 – 7 days: 60 – 100 BPM
1 w- 6 month: 40 – 60 BPM
Palpation of pulse
Facial artery
Transverse facial artery
Medial and lateral digital artery
RR
10 – 18 breaths/minute
Sequence of physical examination
Skin
Lymphnodes
Mucous membranes
Respiratory system
Cardiovascular system
Gastrointestinal system
Urinary system
Genital system
Haematopoietic system
Endocrine system
Locomotory system
Nervous system
Primary skin lesions (8)
Macule
Papule/plaque
Vesicule
Pustule
Urtiaria
Nodule
Tumor
Cyst
Secondary skin lesions (10)
Alopecia
Scaling
Crusting
Scar
Erosion
Ulcer
Lichenification
Fissure
Hypo-/hyperpigmentation
Necrosis
Types of skin biopsies
Shave b
Punch b
Wedge b
Excisional b
Palpable Ln in normal horse
Mandibular lnn (Y-shaped, lobulated) and Superficial inguinal lnn
Palpable ln when enlarged
Laterar retropharyngeal ln and Superf. cervical ln
Ln by rectal palpation
Ileosacral ln and mesenteric ln
Abnormal mm (4)
Dark pink - SI strangulation
Red - Grass sickness
Red + toxic rim - Colitis
Yellow - icterus
Resp exam: steps
Nose and paranasal sinuses
Guttural pouches
Gough
Larynx
Trachea
Thorax
Diseases of the maxillary sinus
Most frequent, often upper teeth disease
Guttoral pouch - communication and exam
no coms, inspection, palpation, percussion (resonant)
Induction of cough
- Press the arytenoid cartilage of larynx
- Press the first tracheal rings
Exam of larynx and trachea
Inspection, palpation, auscultation
Mild stridor on ausc is normal on larynx
Laryngeal noise is audible in a weaker form on auscultation of trachea
Normal lung border
o Deltoids tuberosity: 7th ICS
o Point of shoulder: 10th ICS
o Ischiadic tuber: 14th ICS
o Tuber coxae: 16th ICS
Location of the heart
2nd to 6th intercostal space
Location of heart beat
Left side: 3rd – 5th ICS
Right side: 3rd to 4th ICS
Heart sound - S1
Beginning of systole
Caused by the initial movement of the ventricle, the abrupt arrest of blood flow as AV valves tense, and the early part of ejection
Heart sound - S2
End of systole
Caused by the change in direction of blood flow, closing the semilunar valves
Heart sounds - S3
Termination of rapid ventricular filling
Commonly heard at or caudal and dorsal to the apex beat
Heart sounds - S4
Atrial contraction and sudden arrest of the distended ventricle
Systolic murmur
Caused by blood flow in aorta and pulmonary artery in early systole
Left side of thorax
PMI over aortic or pulmonary valves
Grade 1-3/6
Early to midsystolic
Intensity may change with exercise
Diastolic murmur
Caused by ventricular filling
Common in young horses and thoroughbreds
Left side of thorax
PMI over mitral area
Grade 1.3/6
Early diastolic (S2-S3) or late diastolic (S4-S1)
Quality is often musical/squeaking
Point of maximum intensities
Pulmonary – left 3rd ICS below point of shoulder
Aortic – left 4th ICS below point of shoulder
Mitral – left 5th ICS halfway between shoulder and sternum
Tricuspid – right 4th ICS
Cardiac blood tests
AST, CK (MM) and LDH (LDH1) levels, and isoenzymes
Tests for cardiac troponin I and T are available in horses
Exam of abdomen - Ausc (normal)
Left side
- Dorsal third: dulled tympanic
- Medium third: dulled tympanic
- Ventral third: dulled
Right side
- Dorsal third: tympanic
- Medium third: dulled tympanic
- Ventral third: dulled
Exam of liver
- Serum levels of hepatic enzymes
- Bile salts
- Ammonia
- Glucose
- Bilirubin
- Clotting factors
- Plasma proteins
Physical exam is impossible, use US or x-ray
Exam pancreas
Use parameters
- Serum amylase and lipase activity
- Peritoneal fluid amylase activity (not specific)
Where to perform US of stomach
Left side 10th-15th ICS
Indications of abdominal US (9)
Colic
Weight loss, anorexia
Pyrexia → fever
Leukocytosis, leucopenia
Elevated plasma fibrinogen
Abnormal X-ray findings
Elevated liver enzymes
Elevated kidney values
Abnormal peritoneal fluid
Methods of physical exam - neurological diseases (7)
Inspection
Palpation
Postural reactions
Vertebral reflexes
Cranial nerves
Sensitivity
Pain perception
Ancillary methods - neuro
Neuroradiography
- Plain
- Myelography
- Angiography (cerebral and vertebral)
Nuclear scintigraphy → x - ray Computed tomography
Magnetic resonance image
Electroencephalography (electromyelography)
Laboratory tests – blood, urine, CSF
Head posture and coordination
Vestibular lesion: head tilt
Cerebral lesion: deviation of head and neck toward the side of the lesion
Cerebellar lesion: jerky movements during voluntary motion and fine tremor when at rest (intention tremor)
Olfactory nerve
Evaluation of smell
Optic nerve
Menace reflex, test for vision
Trigeminal nerve
evaluation of facial cutaneous sensation palpebral reflex
Corneal reflex
ability to chew, movements of the jaw
Facial nerve
evaluation of facial symmetry and movement palpebral and corneal reflex
Vestibulocochlear nerve
evaluation of hearing
evaluation of balance
Hypoglossal nerve
evaluation of tongue function
Menance reflex
one of three forms of blink reflex – reflex blinking that occurs in response to the rapid approach of an object
Horner’s syndrome
upper palpebral ptosis, hyperthermia and unilateral sudoresis of the face and variable regions of the neck and trunk also enopthalamos, third eyelid protrusion and miosis
Glossopharyngeal, vagus and accessory nerves
- swallowing reflex
o feeding and watering test
o nasogastric tubing
o endoscopy - slap test
Oculomotor nerve
pupillary light reflexes
Reflexes to check on recumbent horse (5)
forelimb flexor reflex
biceps reflex
triceps reflex
hind limb flexor reflex
- tibial (plantar aspect of the metatarsus)
- peroneal (dorsal part of the tarsus and metatarsus)
- femoral (medial thigh region)
patellar reflex
interpretation of a horse’s ability to move its head, neck and limbs when recumbent
- if the horse can lift only its head, the lesion is in the cranial cervical region
- if the horse can raise its head and neck, the lesion is in the caudal cervical region
- if the horse cannot rise into a sitting position (dog-sitting position) the lesion is in the cervical cord
- If the thoracic limbs are functional, the lesion is caudal to T2
- If the deficit is in the trunk or hind limbs, the lesion is located between T2 and S2
- Localized sweating indicates a lesion in the descending sympathetic tracts
Urine analysis
Physical exam (color, odor, clarity, viscosity, specific gravity)
Reagent strip analysis (urine dipstick test)
Sediment examination
Enzymuria –> GGT, ALP, LDH
Fractional clearance of electrolytes (w/serum)
Bacterial culture
Clarity: usually turbid (CaCO3 and mucus) – if it is clear this can be a sign of polyuria
Specific gravity – measured with hand held refractometry
- <1008 g/L (hyposthenuria)
- 1008-1014 g/L (isosthenuria)
- >1014 g/L (hypersthenuria)
- Normal urine: >1020-1025 g/L
