exam 1 Flashcards
(57 cards)
Clinical Diagnosis: pattern recognition
-A constant “unconscious” interplay of exam and patterns
-Tends to prioritize the most likely differentials automatically
* Have to have enough of a repertoire to know when pattern doesn’t fit
* Can be efficient but also wrong at times (not enough reflection). Type 1 thinking (fast).
Clinical Diagnosis: Deductive Reasoning
- Also common to experts, need to be expert to know which clues are most important
- Novice can’t see the forest for the trees
- Establish a hypothesis from initial clues
- Use physical exam or other information to
prove or disprove theory - Type 2 thinking (slow)
Clinical Diagnosis: Algorithms
- Often generated by experts
- Have formalized the diagnostic approach
used by that expert or group of experts - Can be very helpful for complicated cases,
common to clinical pathology
types of thinking in critical thinking
- Usually are in Type 1 (95%) intuitive
- Type 2 is work (analytic)\
-two types work together
-why not always type 2? it is not reactive enough, can be draining due to increase brain energy leading to fatigue. can be effected by stress, tired, feelings, ect.
Framing bias
(Huckleberry Finn, lean vs. fat meat)
Availability bias
easiest to recall)
Anchoring bias
reliance on first piece of information given “tunnel vision”
Outcome bias
(FIC cats, metronidazole and diarrhea)
Confirmation bias:
everything supports your theory
Clinical Diagnosis: Problem
Oriented Approach
- What is used at the WCVM
Type 2 thinking (if you give it a chance). - Basis for the Problem Based
Medical Record (POMR) - A well written POMR should
allow any doctor to come in
and understand what has
happened and what is planned for a patient.
Problem Based
Medical Record (POMR)
- Lists all problems identified
- Once all problems listed then can go on to
establish plan and possibly diagnosis - Provides documentation of all the diagnostics,
treatments, and communication, including
plans, established diagnoses, and ongoing patient assessments - Serves as a legal record of diagnoses considered,
treatments provided , communications with clients,
and your reasoning for any action or lack of action
taken.
POMR steps in diagnostics in problem orientated approach
1.) Data base collection (initial problem list)
– History and Physical Exam
2.) Problem Identification
– Integrating the History and Physical Examination
– Propose a relevant list of Differential Diagnoses for each problem
3.) Plan Formulation
– Diagnostic, Treatment, Client- education plan
4.) MR documentation Assessment and Follow-up
Clinical Diagnosis: Problem
Oriented Approach to organize problems
-get POMR interpret
-place problems in groups or categories such as look at later and prioritize problems,
-make differential list
-try to localize system: ex primary GI (parasites), secondary GI (renal disease)
* Can use the DAMNITV
crutch
* Refining problem list, problems change as start treating the patient.
– Inactivate some problems (no longer dehydrated)
– Establish diagnosis in others
– Generate new plan
Problem Oriented Approach three types of diagnostic plans
- There are 3 types of plans that need to be
accounted for in this initial summary and in the subsequent progress report ( or SOAP)
– Diagnostic plan(s),
– Therapeutic plan(s)
– Client education plan(s)
Client Communication Plan
and Documentation
– Update on the animal’s status
– Update on complications that have occurred
– Prognosis update
– Financial update
– Make sure everything is documented in a
timely fashion, especially if things are declined.
parts of physical exam
-distance exam
-posture and gate
-behavioral assessment
-vital peramitors
-body weight (BCS, MCS)
-head and neck
-oral exam
-thoracic exam
-palpate abdomin
-hair and skin
-musculoskeletal
-genitals
posture and gait in physical exam
■ Is the patient able to stand?
– If not, then is there an abnormal posture?
■ In lateral, or sternal recumbency
■ Head posture – opisthotonus, head tilt
■ Limb rigidity – flaccid, rigid in extension
■ Tremors, convulsions
– If able to rise, then is there a generalized weakness, a lameness or a gait abnormality
Normal temperature ranges dog and cat
– 37.5 to 39.2 oC in dogs
→ 38.3 to 39.2 according to the AKC
– 38.1 to 39.2 for cats
Heart rate
■ Normal heart rates (ranges can vary
Canine :
■ Small dogs (< 10 kg): 110-160 bpm
■ Medium dogs (10-25 kg): 80-120 bpm
■ Large dogs (> 25 kg): 60-100 bpm
– Feline :
■ 160-220 bpm
Respiratory Rate
■ Normal
– Canine: 15-30 bpm
– Feline: 12-36 bpm
Capillary refill time (CRT)
■ Normal is < 2 seconds
■ Prolonged CRT is associated with shock syndromes, vasoconstriction (can be secondary to medications or hypothermia), cardiac disease
■ Anemia makes it hard to assess
dehydration versus hypovolemia!
(dehydration)
■ MM
– Tachy or dry
■ Skin tent
– Over thorax/scapulae
– Overweight animals hard to get
a skin tent when dehydrated
– Underweight or older animals
can have a skin tent when not
dehydrated
-sunked eyes
(hypovolemia)
■ CRT
– >2.5 seconds
■ Heart rate
– elevated
■ Blood pressure
– low
■ Pulses
– Weak
■ Extremities
– cool
Muscle condition score (MCS)
■ Visualize and palpate the spine, scapulae, skull, and wings of the 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
■ Muscle condition score is graded as normal, mild loss, moderate loss, or severe loss
Performing thoracic examination
■ Palpate over the thorax for conformation, symmetry and masses
■ Auscult the thorax
– Both right and left
– Dorsal and ventral
– Move the stethoscope in a “checkboard” manner over the lungs and heart
