Physical Exams Flashcards
How to perform a physical exam
Tools required
Stethoscope thermometer percussion hammer penlight otoscope glove ophthalmoscope
Skull types
Brachycephalic
Mesaticephalic
Dolichocephalic
Observation
Demeanor body condition posture mental status facial expressions nutritional status neurological deficits head tilt weakness
Palpation
Using the hands and the sense of touch to detect tenderness, altered temperature, texture, vibration, pulsation, masses or swelling and other changes in body integrity
Light palpation
Performed on the abdomen to detect areas of tenderness
Deep palpation
Assess the underlying organs
What can’t you feel when palpating
Liver stomach right kidney in the dog both kidneys in cats bladder depending on degree of dissension is felt caudoventral region
What can you feel when palpating
Left kidney
Intestines
Terms to use when palpating
Doughy soft firm normal hard bone-like fluctuance soft elastic emphysematous air/gas in tissue
Percussion
tapping of the body surface to produce vibration and sound
Percussion sounds
Flatness: dull dense tissue (muscle/bone)
Dullness: thud like encapsulated tissue (liver and spleen)
Resonance: hollow sound (air filled lungs)
Hypersonance: booming sound (gas filled area)
Tympany: drum like sound (air filled organ)
Ausculation
Listening to sounds produced by the body maybe direct with the ear and no instrument or indirect using a stethoscope
Diaphragm of stethoscope
High-pitch sounds produced by vowels lungs and heart
Bell of a stethoscope
Lower frequency sounds that may not easily be detected by diaphragm
Insuring a thorough exam
Try to always use the same order of examination as to not forget a component of the exam
Two aspects of a physical exam
General observation and systematic approach(visual auditory olfactory and tactile senses)
Systematic approach
Slide 28
General appearance / initial observation
Slide 30
General appearance
Body and coat condition
Terms for coat
Dull scaly dry/dandruff oily/seborrheic shedding matted parasites alopecia pruritic comdomes
Symmetry
Note asymmetry observe closely for complementary or non complementary confirmation of the thorax or abdomen
note any differences in size or shape of the extremities
Pain scale
Slide 38
Mentation
Patients attentiveness/reaction to environment provides basis to evaluate the degree of Consciousness Depression Excitement Overreaction to stimuli Vision/balance
Normal temp in dogs
100 to 102.2 degrees F
Normal temp in cats
100 to 102.2 degrees F
Celcius to Fahrenheit
F= (1.8)C + 32
Fahrenheit to celcius
C= (F - 32) ÷ 1.8
1 to 2 degrees above normal usually means:
Excitement
4 degrees and higher temp can mean:
Infection
Inflammatory(autoimmune)
Neoplastic (cancer)
The body maintains its normal temperature by balancing heat production with heat lost through a thermostatic feedback mechanism in which organ?
Eek
Complete cardiovascular system check (heart physical)
Includes: heart rate, cardiac auscultation(sound, pulse quality(rhythm)
Normal heart rate in dogs
60 to 160
Normal heart rate in cats
140 to 220
When getting a heart rate
Should listen to both left and right sides
Place stethoscope between 4th and 6th intercostal spaces
Left side of heart (which is point of maximal intensity?)
3 valves
- mitral
- aortic
- pulmonic
Right side of heart
1 valve
-tricuspid
What is a lub-dub?
S1(lub):loud low pitch
S2(dub):closure of semilunar valves
Abnormal heart sounds
Murmur(swishing)
Muffled (fluid in chest)
Normal sinus
Regular heart beat with normal rate
Sinus arrhythmia
Normal to slow hr and increases during inspiration and decreases on expiration
Normal in dog and cat
Other arrhythmias
Increase or decrease not associated with inspiration/expiration (skips a beat, pauses too long)
Pulse deficit
Listen to heart at same time as palpatine femoral pulse
Bounding pulses
Fever
Hyperthyroidism
Early shock
Pluses is weak
Late shock
Hypotension
Pluse areas
Over the dorsum of metatarsal area
Middle of thigh near where leg joins body
Difficult to hear in cats
MM(mucous membrane)
Indication of the blood flow to peripheral tissue
CRT(capillary refill time)
Reflects perfusion of peripheral tissue Time required for blood to refill capillaries after displacement by finger Normal 1 to 2 seconds Longer than -poor peripheral perfusion -shock vasodilation vasoconstriction heart failure Less than -anxiety, compensatory shock, fever pain
Pulse strength and quality
Indicates strength of heart to move blood through system
Body temp
Indicates if blood is moving slow or fast through system
Places to view mm
Gingivae over k9
Conjunctiva of the eye
Inside vulva membranes
Penis membrane
Jugular
Shouldn’t see jugular pluse normally
Look for pulse and distention
Pink mm
Normal
Adequate perfusion/oxygenation of peripheral tissue
Pale/white mm
Anemia poor perfusion vasoconstriction
Blood loss, shock, decrease peripheal blood flow
Blue cyanotic
Inadequate oxygenation
Hypoxemia
Brick red mm
Increase perfusion vasodilation
Early shock, sepsis, fever, systemic inflammatory response syndrome
Yellow icteric mm
Bilirubin accumulation
Hepatic or biliary disorder and or hemolysis
Brown mm
Methemoglobinemia
Acetaminophen toxicity in cats, intravascular hemolysis
Petechiae (red splotchy) mm
Coagulation disorder
Platelet disorder, DIC, coagulation factor deficiencies
7 questions to ask during history information
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