Physical Exam Flashcards
Distant Examination
-observe patient while taking history or clarifying the complaint
-introduce yourself to patient
-establish whether you will need an assistant or not
Specifics to see in distant exam
mentation, stance, breathing rate and effort, abdominal contour, gait, head tilt, visual or auditory deficits, asymmetry
Observing posture and gait
-Is animal able to stand?
-No, then are they in lateral or sternal recumbency, head posture, limb rigidity, tremors, convulsions. Or are they weak, lame or have a gait abnormality
Behavioural Assessment
-Determine whether animal is fearful, social or aggressive
-Assess safety of hospital staff during future visits (muzzle, directly into exam room)
Check vital parameters
1 .Temperature
2. HR
3. RR
4. BP
5. Pain score
6. Mucous membranes
7.Capillary Refill time
Temperature
-some patients are best to do later if having significant trouble breathing or are fractious
-in excited dog, if initially elevated then can recheck 30mins later
Capillary refill time
-normal under 2 secs
-prolonged associated with shock, vasoconstriction, cardiac disease
-anemia makes it hard to assess
Assessing dehydration
**interstitial fluid space
-check mucous membranes, skin tent, sunken eyes
Assessing hypovolemia
*intravascular fluid space
-CRT over 2.5s
-elevated HR
-low blood pressure
-weak pulses
-cool extremities
Body weight
-weigh patients each visit
*at least once a day during hospitalization if not more depending on their disease
Body condition score
Takes into account muscle and fat
-subjective by eye
-scale to 5 or scale to 9
Muscle condition score
Visualize and palpate the spine, scapulae, skull, wings of ilia
*muscle loss usually occurs in the epaxial muscles on each side of the spine while muscle loss at other sites can be more variable
How do you grade muscle condition
-graded as normal, mild loss, moderate loss, severe loss
Checking eyes
-size and position
-corneal opacity
-anterior chamber clarity
-conjunctiva and sclera
-eyelid confirmation and masses
-lens opacity
-pupil size/symmetry (response to light)
Checking ears
-observe position, and carriage of pinnae
-palpate thickness of pinnae
-look for discharge, redness, pigment
-detect pain
-do otoscope when needed (some patients cooperate better than others)
Check nose
-symmetry
-crusting of planum nasale
-discharge (describe serous, mucopurulent, bloody, serosanguinous)
Oral exam
-check lips, mucocutaneous junctions, teeth, hard and soft palate, tongue, pharynx, tonsils, check foreign bodies under tongue
*may need sedation or GA
*use Triadan system to document dental
Head and neck palpation
-palpate submandibular lymph nodes and mandibular salivary glands
-facial palpation (symmetry, pain, swellings/tooth abscesses, depressions of bony structures like fontanelle)
-palpate larynx and trachea (especially upper resp disease; and can elicit cough with dogs with tracheal disease)
Thyroid palpation
Rare in dogs, unless its a tumour
Cats more common
*one finger or two finger method
Peripheral lymph nodes
-palpate submandibular, popliteal, prescapular lymph nodes
*look for enlargement or asymmetry
-can check for inguinal and axillary lymph nodes if needed (disease state)
Thoracic exam
-palpate over thorax for confirmation, symmetry, masses
-ascultation
*both right and left
*dorsal and ventral
*move the stethoscope in a “checkboard” manner over the lungs and heart
Effort and depth of the respiratory system
-degree of chest movement
-normal, shallow, deep?
-orthopnea (elbows turn out when breathing)
-head extended and/or abdominal component
Assessing the character of the respiratory system
-normal, adventitial (crackles or wheezes) or muffled/absent lung sounds
-inspiratory or expiratory distress/noises
Assess Cardiac system
Check for normal heart sounds
-LUB DUB
-S1- closure of AV valves
-S2- closure of semilunar valves
Locations to auscultate heart
- Apex and base L and R for small patients (parasternal in cat)
- Left 5th intercostal space sternally= mitral valvue
- Left 3rd intercostal space sternally= pulmonary valve
- Left 4th space mid thorax= aortic valve
- Right 4th space mid thorax= tricuspid valve
SInus arrhythmia
Heart rate increases on inspiration and decreases on expiration due to differences in vagal tone during the phases of respiration
*normal in dog
Abdominal palpation
-Place hands and apply firm pressure allowing everything to slip through fingers
-intestines, lymph nodes, kidneys, spleen, etc.
-check for enlargement, masses, abnormalities
-ascultation for peristaltic sounds
Checking integument
-examine hair coat and skin
-assess condition of feet (paws, pads, nails)
-look at mucocutaneous junctions
Musculoskeletal and neuro basic exams
-watch patient walk
-palpate each limb (feel for heat, swelling, masses, pain, joint swelling)
-depending on presenting complaint, can check limb range of motion, or more specific neurological exams
Examining the prepuce and vulva
-matter hair, clipper/grooming damage
-foreign body
-discharge
-masses
-enlarged/swollen vulva
Examining the penis
-extrude the tip to loop for signs of trauma, foreign body, grooming injuries, masses
Assessing testicles and mammary chain
-asymmetry, swelling, masses, heat, pain
Assessing perianal region
-masses
-ulcers/fistulas
-matted hair
-ruptured anal sac
-fecal staining (diarrhea? mucous? blood? )
Assessing anus and rectum
Gloved, digital palpation
-easier in dogs; cats often under sedation
-palpate anal sacs and rectum for narrowing, check for prostate, sublumbar lymph nodes, urethra, trigone region of bladder
