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Flashcards in Examination methods Deck (14)
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1

PURPOSES of a diagnosis

The purpose a clinical examination is to detect the clinically significant abnormalities of function and determine the body system involved
• being able to recommend specific treatment
• to provide an accurate prognosis
• to make recommendations for cost effective control
• prevention of new cases when groups of animals are at risk

2

METHODS OF EXAMINATION

PHYSICAL EXAMINATION
• Inspection (inspectio)
• Palpation (palpatio)
• Auscultation (auscultatio)
• Percussion (percussio)
• Smelling (olfactus)
• Measuring (mensuratio)
ADDITIONAL CLINICAL EXAMINATION
• non instrumental (aspiration, biopsy, centesis, excision, extirpation, tubing, catheter, diagn. lapar)
• instrumental (X-ray, ECG, US, endoscopy, CT, MR)
CLINICAL LABORATORY EXAMINATION
• blood, urine, rumen-content, faeces, liquor, milk

3

SIGN and SYMPTOM

• Symptom: changes which are observed by the owner
• Sign: the abnormal findings of the vet during physical examination
-specific (pathognomic) v nonspecific
-permanent v temporary
-main v accessory
• Syndrome: special group of symptoms, together are highly specific for disease
DIAGNOSIS (the name of a disease)

4

INSPECTION - parameters

• general (skin, posture, behaviour, gait, condition) body regions
• with the unaided eye with the aid of instruments ophthalmoscope, otoscope, vaginoscope, penlight, radiography, ultrasonography, endoscope
-give time and attention!
-good illumination

5

PALPATION- parameters

• direct vs indirect
• outside vs inside
• superficial vs deep
• alteration in: location, shape, size, borders, surface, consistency, structure, painfulness, movability, surroundings, covered skin, temperature
• Ballotation (ballotation+auscultation)-LA
• Undulation (tactile percussion)-SA

6

TERMS of consistency

DOUGHY: pressure causes pitting which persist for a variable time as in edema
FIRM: resistance to pressure is similar to that of normal liver/ muscle-like
HARD: the structure has a bone/cartilage-like consistency
FLUCTUATING: wave-like movement is produced in a structure by the alternating application of pressure
EMPHYSEMATOUS: the structure is enlarged and puffy and yields on pressure, it produces a crepitating or crackling sound due to the presence of air or gas in the tissue
GLANDULAR

7

AUSCULTATION

auscultation of spontaneous or artificially induced sounds
• indirect (mediate) vs direct (immediate)
• general rules:
–the animal should stand still
–a certain examination order should be followed (min 2 full breathing cycles in min 5-6 sites on each side)
–silent circumstances
• sound: combination of vibrations with different frequencies
• noise: no special underlying relation among frequencies, no periodic character

8

PERCUSSION

short weak=>dull resonant=>resonant=>tympanic (based on air quantity)
-Acoustic percussion: obtain information about the condition of the surrounding tissues (create sound waves, resonancy) thorax, paranasal sinuses, abdominal cavity, sc emphysema
• border estimation (lung border)
• assessment of a tissue density to a depth of 7 cm
• detect a lesions at least 5 cm in diameter
-percussion to localize pain (pain percussion) percussion blow: 5 reticular pain tests
-weak, superficial (define the borderline)
-strong, deep
• methods:
–direct (finger to finger)
–indirect (pleximeter and percussion hammer)

9

Components of percussion sound (Marek)

1. Crackling sound of tapping the hammer and the pleximeter/finger-finger
2. Sound of the thoracic wall or the wall of any organ
3. Resonant sound of gas-containing tissue (lung) or other organ filled
• Main characteristics of percussion sound
-volume/loudness vibrations amplitude (air dependent):
strong/sharp <=> weak/dull
-pitch/frequency number of vibration/min (size dependent):
high<=>low
-tone/resonance homogenous/non-homogenous sonorous/resonant(normal lung)<=>damped/dull/non-resonant
-duration
short <=>long

10

Main percussion sounds

• sonorous/resonant: fairly low, strongly resonant (air containing organ, i.e. normal lung)
• damped/dull: short sound of low intensity (any part does not contain gas, liver, heart, muscle)
• tympanic (stronger, longer, higher than sonorous, w/ higher pitch) i.e. striking a hallow organ containing gas under pressure, gastric volvulus
• Special sounds:
-steel-like (pathognomic for torsion)/ -cracked /-drum-like

11

SMELLING

-expired air
-oral cavity (foetor ex ore)
=>bad smell can be putrid/ acetone/ NH3(= kidney failure)/ faeces smell
-skin
-excreta (urine, faces, other)

12

MEASURING

Instruments:
-thermometer, measuring tape, vernier caliper, string of calibrated ovoids

13

Developing diagnosis

Developing a correct diagnosis:
- Deductive diagnosis (dg. per deductionem) w/ pathognomic symptoms
- Excluding diagnosis (dg. per exclusionem or dg. differencialis)
- Diagnosis obtaining from the therapeutic results (dg. ex juvantibus)
TYPES
• causal, ethiological diagnosis (e.g. parvovirus enteritis)
• topographical diagnosis (concerning an organ e.g. hepatitis)
• symptomatic diagnosis (e.g. jaundice, fever)
• functional diagnosis (e.g. lameness of the urinary bladder)
• tentative diagnosis (e.g. sarcoptes)
• main and additional dg (e.g. enteritis and flea allergy)

14

Types of diagnosis

Comparing with the reality:
• exact- diagnosis vera, certus
• objective- diagnosis objective
• presumtive- diagnosis verosimilis
• undetermined- diagnosis incerta
• false- diagnosis falsa
Possible causes of a false diagnosis
- diagnosing without examination
- examination is not accurate
- misunderstanding one or more symptoms
- prestige-based diagnosis
- neglecting of repeated examinations
- insufficient diagnostic equipment
- inappropriate interpretation of the laboratory data