History Taking & Physical Examination Flashcards
How many minutes can you perform a thorough history and physical exam?
10-15 minutes
YES or NO
prefer to take the history prior to the examination
YES
Avoid leading questions (example: “You haven’t observed any change in appetite, have you?”
age, sex, breed
Signalment
Signalment
age, sex, breed
Usually want to address this with owner early so they are aware that you know the reason for the visit.
Chief complain
Body system review
Integument
Eyes and ears
Musculoskeletal
Cardiovascular
Respiratory
GI
Urogenital
Nervous
“any history of skin problems; i.e., fleas, allergies, hair loss …?”
Body system to be review
Integument
“any previous infections, hearing difficulties, sore eyes, head shaking…?”
Body system to be review
Eyes and ears
“any problems walking or climbing stairs?…”
Body system to be review
Musculoskeletal
“any coughing or weakness with exercise…?”
Body system to be review
Cardiovascular
“ever see runny eyes, runny nose, cough, sneeze…?”
Body system to be review
Respiratory
“how’s his/her appetite; any vomiting/diarrhea; foul breath…?”
Body system to be review
GI
“is he/she neutered/spayed; any discharges; how is his/her H20 intake -increased/decreased; how is his/her urination - same as always; intact female?…”
Body system to be review
Urogenital
“any history of seizures; tremors; weakness; collapse?…”
Body system to be review
Nervous
Physical Examination Tools
Stethoscope
otoscope
ophthalmoscope
penlight
pleximeter
hemostat
glove
Inspection from a distance:
Observe gait as animal enters room
Demeanor: shy, assertive, etc.
Mental status
Conformation and symmetry
Nutritional status
Neurological deficits
Visual deficits present Head tilt
Weakness
Close inspection
Socialize first
Proceed slowly, using least restraint necessary
uremic smells
NH3
sweet smells
acetone
-Use application of light finger pressure to the body surface to determine consistency of parts underneath. Trace structures, don’t grab them.
Abdominal Palpation
Techniques for Abdominal Palpation of Cats and smaller dogs
one hand
Techniques for Abdominal Palpation of Larger dogs
both hands
Organs that are not palpable
liver, stomach, right kidney
This organ may be palpable.
Left kidney
Ability to palpate this organ is dependent upon degree of distension
bladder
Primarily used for evaluation of the cardiovascular and respiratory systems. Can also be used in gastro-intestinal system.
Auscultation
Bell for ______ sounds-heart
low-pitched
Diaphragm for _______ sounds-airways
high-pitched
blowing, like air through straw. Created by air moving through larger airways (sinuses, larynx, trachea, major bronchi)
Bronchial (tubular)
Respiratory organs w/ loudest sound when auscult
larynx and trachea
Thought to originate in part from separation and distention of alveoli by in-rushing air.
Increased vesicular sounds occur with intensified respirations (physiologic), increased respiratory excursions (e.g., from fever), emphysema (are harsh), developing bronchitis.
Vesicular sounds
__________ sounds secondary to decreased expansion of a lung, pleuritis, consolidation, neoplasia, pneumothorax
Decreased sounds
Abnormal sounds
adventitial sounds
Abnormal sounds = adventitial sounds
Rales
Moist
Dry
most prominent on inspiration but can be heard in both phases. Produced by exudate within air passages. May vary in intensity, temporarily relieved by coughing.
Rales
fluid of low viscosity. Can be coarse, medium or fine
Moist
vibration of sticky, tenacious mucus within large bronchi; in chronic respiratory conditions. May be hissing, squeaking or whistling
Dry
between parietal and visceral pleura.
Pleural friction rubs
Develop following chronic pleuritis when pleura is thick and dry. Not altered by coughing and best heard at periphery of lung fields.
Pleural friction rubs
Detect presence of murmurs, other abnormal heart sounds, arrhythmias
Cardiac auscultation
AV valve closure - louder, longer, lower pitched- “lub”
1st heart sound
semilunar valve closure - softer, shorter - “dub”
2nd heart sound
Interval between 1st and 2nd and shorter
(systole)
1st heart sound
AV valve closure “lub”
2nd heart sound
semilunar valve closure “dub”
Interval between 1st and 2nd
systole
Interval between 2nd and 1st
diastole
point of maximal intensity (PMI) of valves should ausculted on __________. Auscult thoracic inlet.
left (pulmonic, aortic, LAV) and right (RAV)
Characterize as to location, intensity, systole/diastole. Use bell and diaphragm as murmurs will differ in pitch.
Murmurs
for low-pitched sounds-heart
Bell
for high-pitched sounds-airways
Diaphragm
Associated with hydrothorax, pneumonia, masses, hernia, effusions, cardiac paresis, obesity.
Muffled heart sounds
Interval between 2nd and 1st sound
(diastole)
Interval between 2nd and 1st sound
(diastole)
