3 – Physical Examination

Question 1

Distant exam

Answer 1

• Note mentation, stance, breathing, abdominal contour, gait, head tilt, lameness
• Establish if you need an assistant to move forward

Question 2

Posture and gait

Answer 2

• Able to stand?
• If not is there abnormal posture?
  o Lateral or sternal recumbency
  o Head posture
  o Limb rigidity
  o Tremors
• If can rise, is there generalized weakness, lameness or gait abnormality?

Question 3

Behavioural assessment

Answer 3

• Fearful, social or aggressive?
• Safety during future visits can be addressed
  o Make note in the patient file

Question 4

Vital parameters

Answer 4

1. Temperature
2. HR
3. Respiratory rate
4. BP
5. Pain score

Question 5

Temperature

Answer 5

• There is a range (lower than a human)
• Need to decide when you want to take the temperature
  o If having problems breathing or fractious=maybe wait
• Can use an axillary temperature, but not perfect

Question 6

Heart rate

Answer 6

• Ranges
  o Different for various sizes

Question 7

Respiratory rate

Answer 7

• Can observe or use a stethoscope

Question 8

Mucous membranes

Answer 8

• Normal is pink
  o Pale in cats

Question 9

Capillary refill time

Answer 9

• Less than 2 secs
• If prolonged
  o Shock syndromes
  o Vasoconstriction
  o Cardiac disease
• Anemia makes it hard to assess

Question 10

Dehydration: interstitial fluid space, how do you assess on PE?

Answer 10

• MM
• Skin tent
• Sunken eyes

Question 11

Hypovolemia: intravascular fluid space, how do you assess on PE?

Answer 11

• CRT
• HR: elevated
• BP: low
• Pulses: weak
• Extremities: cool

Question 12

Body weight

Answer 12

• Each visit
  o At least once a day during hospitalization or more

Question 13

Body condition score

Answer 13

• Proportions muscle and fat
• Subjectively by ‘eye’
• Compare using a chart
• *1-9

Question 14

Muscle condition score (MCS)

Answer 14

• Visualize and palpate spine, scapula, skull and wings of ilia
  o If muscle loss, usually in epaxial muscles on either side of spine
• Normal to severe
• *MCS and BCS are INDEPENDENT of each other

Question 15

Eyes

Answer 15

• Size and position
• Corneal capacity
• Anterior chamber clarity
• Conjunctiva and sclera
• Eyelid conformation and masses
• Lens opacity
• Pupil size/symmetry: response to light

Question 16

Ears

Answer 16

• Observe position and carriage of pinnae
• Palpate for thickness
• Look for discharge, redness, pigmentation
• Detect pain
• Do an otoscopic exam

Question 17

Nose

Answer 17

• Symmetry
• Crusting of planum nasale (ex. SCC)
• Nasal discharge
  o Serous
  o Mucopurulent
  o Bloody
  o Seroanguinous (watery and bloody)

Question 18

Oral exam

Answer 18

• Examine lips, mucocutaneous junction, hard and soft palate, tongue, pharynx, tonsils (dogs)
• *look for string foreign body under tongue in all vomiting cats
• Sedation may be required
• Triadan system is most commonly used to document dental findings

Question 19

Head and neck palpation

Answer 19

• Palpate submandibular lymph nodes and mandibular salivary glands
• Facial palpation
  o Symmetry
  o Pain
  o Swellings: carnassial tooth abscess
  o Depression of boy structures
• Palpate and listen over larynx and trachea

Question 20

Thyroid palpation (feline)

Answer 20

• One finger OR two fingers

Question 21

Peripheral lymph nodes

Answer 21

• Palpate submandibular, popliteal and prescapular LNs
  o Inguinal and axillary if indicated
• Should be firm and freely movable
• Note enlargement and asymmetry

Question 22

Performing a thoracic exam

Answer 22

• Palpate for conformation, symmetry and masses
• Auscult
  o Both R and L
  o Dorsal and ventral
  o Move in a ‘checkboard’ manner

Question 23

Respiratory system

Answer 23

• Effort/depth
  o Degree of chest movement
  o Normal, shallow, deep
  o Orthopnea
  o Head extended and/or abdominal component
• Character
  o Normal, adventitial, muffled
  o Inspiratory or expiratory distress/noises

Question 24

Cardiac system: normal heart sounds

Answer 24

• Lub dub
  o S1=closure of AV valves
  o S2=closure of semilunar valves

Question 25

Locations to auscult: cardiac system

Answer 25

- Apex and base L sand R for small patients - Large patients o L 3rd space: pulmonary valve o L 4th space mid thorax=aortic valve o L 5th space=mitral valve o R 4th space = tricuspid

Question 26

What is sinus arrhythmia?

Answer 26

- Regular irregular arrhythmia - HR increases on inspiration and decreases on expiration due to differences in vagal tone during the phases of respiration - *NORMAL IN DOG

Question 27

Performing abdominal palpation

Answer 27

- Observe and palpate for distension, symmetry, pain, organ size and masses - 1 or 2 hands - In deep chested dogs: elevate front end to allow the cranial abdominal contents to ‘fall further back’ - Auscult for presence or absence of peristaltic sound

Question 28

Integument

Answer 28

- Examine hair coat and skin - Assess condition of feet - Look at mucocutaneous junction

Question 29

What is the minimum you should od on a physical exam for musculoskeletal and neurological systems?

Answer 29

- Watch them walk - Palpate each limb - Evaluate pads and nails

Question 30

External genitalia and perineum

Answer 30

- Prepuce and vulva - Penis: extrude the tip - Testicles and mammary chain - Perianal region

Question 31

Rectal exam

Answer 31

- *gloved, digital palpation - Dogs: more amenable - Cats: typically under sedation (not routine in cats) - Palpate anal sacs, rectum narrowing, maybe prostate, urethra and trigone region of urinary bladder