Examination methods Flashcards
Diagnosis making process
History, physical exam and additional techniques are all processed to eventually come to a diagnosis, then we can determine prognosis and treatment
Purpose of clinical exam
To detect the clinically significant abnormalities of function and determine the body system involved
Purposes of a diagnosis
Recommend specific treatment
Accurate prognosis
Recommendations of cost effective control
Prevention of new cases when groups of animals are at risk
Methods of exam
Physical
Additional
Clinical lab
Physical exam
Inspection Palpation Auscultation Percussion Olfaction Measuring
Additional exams can be …
Instrumental or non-instrumental
Non-instrumental additional exams
Aspiration Biopsy Centesis Excision Extirpation Tubing Catheter Laparotomy
Instrumental additional exams
X-ray ECG US Endoscopy CT MRI
Clinical lab exams
Urine Blood Faeces Rumen content Liquor Milk
What is a symptom?
Changes which are observed by the owner
What is a sign?
Abnormal findings of the vet during the physical exam
Can be:
Specific= pathognomic
Permanent
Main=chief
Non-specific/ temporary e.g anorexia, lethargy, vomitting
Accessory (so not the chief?)
What is a syndrome?
Special group of symptoms that are characteristic/ highly specific for a disease
Diagnosis
The name of the disease
Inspection, 2 areas
General and by body regions
Inspection: general
Skin Posture Behaviour Gait Condition
Inspection: body regions
With the unaided eye
With aid of instruments e.g opthalmascope, otoscope, vaginoscope, penlight, radiography, US, endoscope
Give enough time and attention
Good lighting
Palpation
Direct vs indirect
Outside vs inside
Superficial vs deep
What are you looking for alterations in when you palpate?
Location Shape Size Consistency Structure Painfulness Movability Surroundings Symmetry Surrounding skin: integrity, temp, lifting up to a skinfold
Palpation: ballotation
Ballotation and auscultaion
“Floating” organs, push sharply with a finger and detect it by the returning impact
Undulation
Tactile percussion
Detects fluid, like a ballon filled with water
Pneumoundulation can be seen with fat
Terms of consistency
Doughy Soft,Hard Rubber, Firm Hard Fluctuating Emphysematous
Doughy
Pressure causes pitting which can last for variable periods of time
Often seem in edema
Soft-hard, rubber, firm
Resistance to pressure is similar to that of a normal liver
Hard
Bone like consistency
Fluctuating
Indicates fluids?
Wave-like movement produced by the structure by the alternating application of pressure
Emphysematous
Indicates air or gas in the tissue
Structure is enlarged or puffy
Yields on pressure
Crepitating or crackling sound
Auscultation
Use a stethoscope
Want to detect spontaneous or artificially induced sounds
Indirect- mediate
Direct- immediate
General rules of auscultation
Animal is standing still
Follow a certain exam order
Silence
*Lift left leg
Move 5-6 ICS 1 or 2 full inspiration and expiration cycles
Auscultation: sound
Combination of vibrations with different frequencies
Auscultation: noise
No special underlying relation among frequencies
No periodic character
Acoustic percussion
Conducted to obtain info about the surrounding tissues It creates sound waves/ resonance Lung border estimation Tissue depth estimation up to 7cm Lesions at least 5cm in diameter
Acoustic percussion: areas
Thorax
Paranasal sinuses
Abd cavity
Subcut emphysema
Pain percussion
Percussion blow, first do it weak and superficial- to define the borderline, then do it stronger and deeper
To localize pain
Methods of percussion
Direct: finger on finger
Indirect: plessimeter and percussion hammer
Components of percussion sound
Crackling sound of hammer and plessimeter
Sound of thoracic wall or wall of any organ
Resonant sound of gas/fluid filled organ
The main percussion sounds
Sonorous/resonant: air containing organ e.g lung
Damped/dull: not containing gas! e.g muscle
Tympanic: higher in pitch due to large amount of air in the organ e.g in gastric volvulus
The normal percussion sound of small animals
Volume: Sharp
Pitch/frequency: high or low
Tone: sonorous/ resonant
Duration: long
Special sounds heard during percussion
Metallic/ steel-like
Cracked
Hollow/drum like
Metallic/ steel like abnormal percussion sound
High pitch
Sharp
Musical
Often heard with abomasal displacement
Cracked abnormal percussion sound
Rasping, whizzing sound with additional noises
Hollow/ drum like abnormal percussion sound
Strong, high, long
Can be tympanic or non-tympanic
Smelling
Expired air
Oral cavity
Skin
Excreta e.g urine and faeces
- EPI faeces contain undigested fat, smells like melted butter
Gastroenteritic- smells putrid
Measuring
Thermometer
Measuring tape
Vernier caliper- thickness of skin
String of calibrated ovoids
Deductive diagnosis
Based on pathognomic symptoms e.g tetanus
Excluding diagnosis
I.e Differential diagnosis
Diagnosis ex juvantibus
From obtaining the therapeutic results
E.g babesiosis
Types of diagnosis
Casual, aetiological e.g parvoenteritis
Topographical- concerning an organ e.g hepatitis
Symptomatic e.g jaundice, fever
Functional e.g lameness of the urinary bladder
Tentative- suspect before the final diagnosis e.g scabies
Main and additional e.g enteritis and flea allergy
Diagnosis: comparing with reality
Exact Objective Presumptive Undetermined False
Possible causes of a false diagnosis
Diagnosing without examination Exam is not accurate enough Misunderstanding symptoms Prestige-based diagnosis Not doing repeat exams Insufficient diagnostic equipment Incorrect interpretation of lab data
