Equine clinical exam Flashcards
When does a clinical exam begin?
As soon as you see the horse
What can be assessed from initially seeing the horse?
- Demeanour
- Behaviour
- Stance
- Signs of previous treatment e.g. clipping, bandage
What can be assessed when looking at the horses environment
- signs of colic
- presence or absence of faeces
- signs of eating
- type of bedding
- mucus on doors/floor
- nearby horses: coughing, stamping
What are the 3 most relevant questions when obtaining a general history/
- What is the horse used for?
- How old is it?
- How is it kept?
What is the importance of asking what the horse is used for?
- Potential problem: exercised related fractures might be common in racehorses, but laminitis is not
- Future expectations: return the horse to athletic function or would pasture-sound do
- Timescale for resolving the problem: “he needs to go hunting on the weekend”
- Drugs/treatments that might be used: “whatever you give him, needs to be out of his system by the race on Saturday”
What is the importance of asking the age of the horse?
Type of problem: certain conditions age related.
- Owners expectations: “he’s only two, he got his whole career ahead of him” or “he’s only two and already broken”
- Type of treatment
What is the importance of asking how the horse is kept?
- Many problems associated with specific management systems e.g. Pelvic flexure impactions a disease of stabled horses. Grass sickness a disease of horses at pasture
- Horses at pasture much more likely to suffer trauma than stabled horses
- Problems often associated with changes in routine
- Might influence treatment (“how can I Box-rest him ?– we’ve only got the field!”)
What are some specific questions that need to be asked relating to a problem?
- When did it start?
- How has it progressed?
- Has he had it before?
- Have you given any treatment yourself?
The overall framework of a general exam consist of which 3 steps?
- general inspection
- vital signs
- specific exam
What is the ‘food test’?
- Horses are greedy
- Heathy horses will not refuse food or a treat
- Any horse that refuses is probably ill or colicking
Which vital signs should be assessed?
Heart rate, respiratory rate, temperature (TPR)
Why is pyrexia always significant in a horse?
- When it occurs it suggest systemic inflammation
- Taking the temperature on a colicking horse might reveal a peritonitis or impending colitis
Describe pattern recognition in your clinical reasoning
Clinical diagnosis based on previous experience and probability.
- Inductive reasoning
- Type 1 thinking
- Fast thinking
What are the pros and cons of pattern recognition?
Pros:
- Fast and efficient
- Suitable for emergencies
Cons:
- May jump to conclusions or make assumptions
- Cant use if presented with a new condition
Describe a systematic exam
- Deductive reasoning
- Type 2 thinking
- Slow thinking
- The clinician gathers as much information as possible, to rule out possible causes before choosing treatment
What are the pros and cons of a systematic exam?
Pros:
- Methodical
- Gathers large amount of data about the patient – maybe revealing other problems beside the presenting condition.
- Unlikely to miss problems or jump to conclusions
- Useful if presented with an unfamiliar condition
Cons:
- Slow
- Inefficient
- Can result in unnecessary diagnostic tests being carried out
You are presented with a coughing horse. What steps would you take as part of your routine of assessment, diagnosing and any other steps?
- Gather history
- Observe at rest: tachypnoea, dyspnoea
- Examine nostrils: airflow, wheezing, discharge
- Palpate submandibular LN
- Auscultate chest
Purulent nasal discharge in a coughing horse could be indicative of?
Respiratory tract infection
Mucoid nasal discharge in a coughing horse could be indicative of?
Marked airway inflammation but not necessarily bacterial
Where in the respiratory tract is likely to be affected if abnormal sounds are heard on auscultation?
LRT
If you suspect a coughing horse is infectious what steps must be taken?
ISOLATE!
Nasopharyngeal swab for respiratory pathogens
Antibiotics?
NSAIDS?
You are presented with a lame horse. What steps would you take as part of your routine of assessment, diagnosing and any other steps?
- History
- Observe at rest
- See it move at walk
- See if it can trot
- Try and observe which leg is affected
- Examine the limb carefully
- Draw up a plan
If a horse is not lame at a walk, what should you do next?
See if its lame at a trot, then see if its lame when you lunge it
If following a careful limb examination you can not find the likely problem causing lameness, what are the next steps?
- Either trial rest and NSAIDS for set period (2-4 weeks) and re-exam
OR - Start Nerve blocks
You are presented with an ‘off-colour’ horse. What steps would you take as part of your routine of assessment, diagnosing and any other steps?
- Obtain a history
- See if it passes the food test: if yes its not likely to be colic
- Examine mm and HR
- Rectal temp
You are presented with a wounded horse. What steps would you take as part of your routine of assessment, diagnosing and any other steps?
- Get history
- Assess demeanour
- Alert and responsive?
- Inspect the wound
- See if the horse is lame
- Restrain (sedate) horse and clip and clean wound edges
- See if would can undergo primary closure, if not debride and bandage
Which drugs should be given at the end of treating a wounded horse?
Antibiotics
NSAIDs
Tetanus
You are presented with a horse suffering with weight loss. What steps would you take as part of your routine of assessment, diagnosing and any other steps?
- History, BCS, weight, assess management
- Examine for signs of illness in the horse
- Either way take blood samples and bichem, faecal sample
You are presented with a horse suffering with weight loss.
Following tests the results come back as abnormal, what are the next steps?
Consider Peritonitis, abdominal abscess, hepatitis, neoplasia, CHF
- Abdominal ultrasound
- Rectal exam
- Liver biopsy
You are presented with a horse suffering with weight loss.
Following tests the results come back as normal, what are the next steps?
Could try management changes (feed more!).
If after 6 weeks horse still loosing weight, or owner not happy with this then investigate further.
What is the first vital step that has to be done when treating a colic?
Assess level of pain.
Is it safe to examine?
Yes = non-violent colic
No = violent colic
You are presented with a horse suffering with a violent colic.
What steps would you take as part of your routine of assessment, diagnosing and any other steps?
- Get a HR
- Sedate (xylazine)
- Rectal exam to feel for a surgical lesion
- If present then consider referral
- If no surgical lesion felt then perform a peritoneal tep
You are presented with a horse suffering with a violent colic.
A surgical lesion is felt on rectal exam but the owner will not refer, what are the options?
- Euthanasia
- (Possibly try strong analgesia and hope for the best?)
You are presented with a horse suffering with a violent colic.
No surgical lesion is felt on a rectal exam, what are the next possible options?
- Administer analgesia and refer
- If O not willing to refer can administer analgesia and reassess in 2 hours
You are presented with a horse suffering with a non-violent colic.
What steps would you take as part of your routine of assessment, diagnosing and any other steps?
- Check mm, HR, gut sounds
- Rectal exam (sedate?)
Same as violent colic
