Vet Exam Past Paper PDF

# Chapter 7 - Assisting With Examinations & Treatments ## Lesson 1 - Physical Examinations ### Introduction - A physical examination of the animal is the veterinarian's key tool in diagnosing problems and/or disease. - A complete physical exam includes a thorough history of all past medical probl...

# Chapter 7 - Assisting With Examinations & Treatments ## Lesson 1 - Physical Examinations ### Introduction - A physical examination of the animal is the veterinarian's key tool in diagnosing problems and/or disease. - A complete physical exam includes a thorough history of all past medical problems, observation of the animal prior to restraint, and a thorough physical evaluation of all the body systems. ### History & Medical Record - Before the veterinarian examines the animal, the animal's records should be reviewed. - If this is the first visit, a new patient file should be created. - Be sure the file includes: - The owner's current name, address, and phone number. - Ask the owner to describe any problems or concerns regarding their animal. This includes the chief complaint, the duration of the problem, and its progression. - Record the animal's vaccination and deworming history, past traumatic incidents or illnesses, surgical procedures, and medications being given to the animal. - If the animal is a dog, it is important to record if it is on heartworm medication, and if so, what type and when it was last administered. - The animal's diet is also important to note in case hospitalization is necessary. - Determine if the animal lives indoors, outdoors, or both. - Once the animal's history is complete, the veterinarian can review it with the owner and then proceed with the physical exam. ### Observations of Attitude & Behavior - The physical exam should begin with observation of the animal prior to handling and restraint. - By watching the animal, the veterinarian can learn several important things, such as: - Its attitude or mental state. - Its character. - Its general appearance. - Its respiratory rate. - Any lameness. - By observing the animal's behavior, the veterinary assistant can determine the type and amount of restraint necessary to control the animal. - A thorough physical exam requires an accurate weight. - The assistant should measure and record the animal's weight before the veterinarian begins the actual physical exam. - Weight is important in assessing the body condition of the animal. - It is also required to determine the proper dose of any prescribed medications. - After weighing the animal, the assistant should measure and record its temperature, pulse, and respiration rate before the animal becomes anxious. ### Restraint for the Physical Examination - The veterinary assistant should transport a small animal into the examination room and a large animal to an area of restraint where the physical exam is to be performed. - When the veterinarian is performing a physical exam on an animal, the assistant should restrain the patient so that it is reasonably comfortable, but unable to injure the restrainer, the veterinarian, or itself. - An effective physical exam requires proper restraint of the animal. - The animal's disposition should determine the amount and type of restraint. - Often, applying gentle pressure while holding the head and neck is sufficient to restrain a small calm animal, but sometimes an anxious animal may require tranquilization. - Proper restraint of large animals may require head gates, squeeze chutes, or stocks. ### Physical Examination of Small Animals - Once the animal is restrained, the veterinarian will evaluate the integument for any abnormalities such as dry scaly skin, scabs, lesions, or parasites. - The veterinary assistant can perform a preliminary evaluation of the skin when handling the animal before the veterinarian begins the physical exam. - Bring any abnormalities to the attention of the veterinarian for further evaluation. - The veterinarian will examine the patient's ears, eyes, nose, oral cavity, and head. - An otoscope is useful for evaluating the condition of the ear canal and tympanic membrane (ear drum). This instrument allows clear observation of wax, mites, ticks, or foreign objects. - The eyes will be examined with the use of an ophthalmoscope. This instrument is necessary for viewing the internal structures of the eye, such as the iris, lens, and optic disc. - Next, the veterinarian will examine the oral cavity to determine the condition of the teeth. - The gums will be checked for color (they should be pink), the presence of lesions, or gingivitis. - The veterinarian will then examine the head for any bumps, swellings, lesions, or other abnormalities. - The veterinarian will use a stethoscope to evaluate the cardiovascular and respiratory systems. - First, the pulse and respiratory rate and character are monitored. - Careful evaluation of the heart can lead to early detection of a heart murmur, if present. - The stethoscope can also detect if there is any fluid or inflammation in the lungs. - In addition to these two systems, the stethoscope is used to evaluate the digestive system. - Gut sounds can be helpful in determining intestinal motility. The veterinarian may also palpate the abdomen of small animals for signs of sensitivity or the presence of any abnormal masses. - Consistency of the feces is determined as being normal, hard, or loose. - The musculoskeletal and nervous systems can be partially evaluated during the observation part of the physical exam. - Watch for lameness, abnormal posture, and/or incoordination. - The veterinarian will palpate the muscles, bones, and joints to determine firmness and symmetry in these systems. - Palpation is also important in evaluating the reproductive and urinary systems. - A thorough record of an animal's medical history is crucial for proper evaluation of these two systems. - Also, note any fluctuation, increases or decreases in the frequency of urination. - Next, the veterinarian will examine the external genitalia for abnormalities. - The veterinarian will evaluate the circulatory system by looking for edema or abnormal fluid accumulation in any of the body systems. - A swelling in any area of the body or fluid in the thoracic or abdominal cavities are all signs of possible lymphatic or circulatory disorders. - A thorough physical examination is required for the accurate diagnosis and proper treatment of a disorder and can lead to the identification and prevention of potential problems. - For these reasons, the physical exam is one of the most important aspects in evaluating and maintaining an animal's health. ### Physical Examination of Large Animals - A thorough physical exam is the first step a veterinarian performs to diagnose illnesses in large animals, such as horses, cattle, and other farm animals. - As with small animals, the veterinarian must obtain complete medical records for the patient. - Once the veterinarian has carefully reviewed the records, he/she observes the animal prior to restraint. - After initial observation, the veterinary assistant should take horses from their owner and lead them. - This allows the veterinarian to observe the horse's gait and posture, which is important in assessing neurologic and musculoskeletal functions and mental state. - Mental state is important because a sick animal often will be depressed and lethargic, even in a strange environment. - Food animals such as cattle must be observed in a pen because most are not halter broken. Some horses may also need to be observed in a pen if they are wild or unbroken. - If a horse is lame, the veterinarian may want to perform flexion tests to determine the cause of lameness. - When performing flexion tests, the veterinarian will grasp one of the horse's legs and flex a particular joint for a few minutes. - The veterinarian may then have the veterinary assistant quickly trot the horse off while watching for a limp. - This procedure aids in determining the site of the problem. - After observation, the animal should be restrained either in stocks (for horses) or a chute (for cattle and other livestock) for further examination. - The veterinary assistant should take the animal's rectal temperature and respiration rate. - A stethoscope may be used to determine the heart rate. - When examining horses, the mandibular artery can be palpated below the jaw to determine the pulse. - As with small animals, the veterinarian can examine the eyes using an ophthalmoscope. - Ears are not usually examined unless there is a specific problem. - Other systems such as the lymphatic, cardiovascular, respiratory, and integumentary systems in large animals are evaluated similarly to those of small animals. - The veterinarian evaluates the digestive system of large animals by listening to gut sounds with a stethoscope. - A thorough history will help rule out many possible problems with the digestive tract. - Evaluation of the reproductive system of large animals requires observation and palpation. - The male genitalia can be observed and palpated for symmetry and abnormalities. - Rectal palpation of the male accessory sex organs, as well as palpation of the entire female reproductive tract in horses and cattle can diagnose abnormalities, and in females, pregnancy. - As with small animals, the physical exam is a veterinarian's key method of diagnosing and treating medical problems in large animals. - Each body system should be thoroughly evaluated to identify and prevent potential problems. ## Lesson 2- First Aid ### Introduction - First aid is the initial care or treatment of sick or injured animals before the complete medical evaluation and treatment. - Prompt action in rendering first aid may reduce the effects of an injury, reduce or stop severe bleeding, or prevent the death of an animal. - It should be emphasized that emergency measures must be carried out with sound judgment. - Cases requiring immediate attention or first aid involve both small and large animals. ### Handling and Restraint - Proper handling and restraint of the animal is very important to prevent injury to the animal and the handler during first aid care. - Injured animals may be in a state of shock, unconscious, and/or hemorrhaging. - Because of the possibility of bone fractures, the animal should be carefully handled when moved or restrained. ### Shock and Internal Hemorrhage - Mucous membranes (gums, conjunctiva) that are pale, gray, or blue in color, rather than a healthy pink color, and a pulse rate elevated 1 1/2 to 2 times above normal may indicate a state of shock, internal hemorrhage, pain, or respiratory distress. - An animal in shock should be kept very still and quiet without distractions that will make the animal move around. - Overheating should be avoided in warm weather, but it is well to cover the animal with some type of blanket so that the body temperature will be maintained. ### Wounds and External Hemorrhage - To properly control the flow of blood from a wound, determine if the blood is from an artery or a vein. - Blood from an artery will be bright red and will emerge in spurts as the heart beats, while blood from a vein will be darker and will flow steadily. - The bleeding should also be evaluated for severity and to determine whether or not it is clotting. - Non-bleeding wounds should be cleaned thoroughly with warm water and antiseptic or antibiotic medication applied. - A support-protective bandage applied to wounds below the knee or hock of large animals may be necessary. - Severe bleeding of wounds may be controlled by applying pressure with the hand of the handler at a specific point on the body, by use of pressure bandages, or by applying a tourniquet. - If a pressure bandage directly on the wound does not control the bleeding, pressure should be applied, above the wound for an artery and below the wound for a vein, with a hand or a tourniquet. - If a tourniquet is required, it must be applied tightly enough to stop the bleeding, and it should be loosened every 10 to 15 minutes. - Most bleeding can and should be controlled with a pressure bandage or by hand pressure. - An arterial tourniquet is generally contraindicated in a horse because it may cause a total shut down of circulation. - Also, clotting time is slow in horses. - Use of padding under a tight bandage over a wound for all animals is preferred. Examples of padding for pressure bandages are: cloth sheet, cloth towel, cotton, and diaper. - Top bandages include stretch wrap, roll gauze, white tape, and duct tape. - Once compression bandages become soaked with blood, additional dressings are placed over the previous applied bandages rather than removing them. - Later, bleeding vessels are ligated or cauterized. ### Pain and Fractures - An injured animal exhibiting labored breathing, depression, reluctance to move or stand should be examined for pain and fractures. - An animal not bearing weight on a leg indicates the possibility of pain, an open joint, or a fracture. - An animal with a broken bone should be kept very still to reduce pain and to reduce the possibility of a broken bone cutting important vessels. - To prevent movement of a broken leg, a temporary splint may be applied. - Incorporation of the joint above and below the fracture is necessary to stabilize the fracture. - Two thin, stiff pieces of wood, metal, PVC pipe, or other material may be used. - The leg should be padded and one splint piece placed in front and the other on the side of the leg as bandage material is wrapped around the leg extending above and below the fracture. ### Respiratory Distress - An injured small animal exhibiting respiratory distress from apparent drowning, trauma, circulatory shock, anaphylactic shock, or electrical shock should be given artificial respiration. - This is accomplished by laying the animal on its side, pressing straight down on the thorax with the palm of the hand and releasing the pressure quickly. - After the pressure forces the air out of the animal's lungs, the release of the pressure will allow the normal expansion of the chest to draw air back into the lungs. - Repeat the cycle every 4 or 5 seconds until the animal is breathing normally. - When the breathing is abnormal, administration of oxygen by means of a facial mask, nasal tube, or oxygen cage will be necessary to raise the oxygen level in the blood back to normal. - Artificial respiration should not be applied to animals with possible rib or thorax injuries. ### Colic - Colic of animals is abdominal pain related to gas, impaction, twist, or hypermotility of the large intestine, small intestine, or stomach. - Clinical signs of colic in a horse range from off feed to violent pawing, rolling, and sweating. - Vital signs are most often normal to slightly elevated body temperature; slightly elevated to very high pulse rate; pale, dark red, or blue mucous membranes; and capillary refill time (digital pressure on gums and release) may be greater than 3 seconds. - The initial treatment for colic is to walk the horse with intermittent jogging if the horse wants to lie down and roll. - If the horse is depressed and wants to lie quietly, it should be left alone and not walked. - A definitive diagnosis of the type of colic and treatment are based on the results of a physical examination. ## Lesson 3- Applying Bandages ### Introduction - Bandages are used on animals primarily as a means to apply pressure, maintain medication over a wound, and restrict movement. - Bandages also help to keep the wound free from contamination and irritations. - The most common areas to bandage are the lower limbs, such as the knee, hock or foot. - Some areas are difficult to bandage, such as the head and upper body. - However, almost any area of the animal's body may be covered with a bandage, if the individual patient will tolerate its presence. ### Wound Bandage - Types of bandages that cover wounds have a padding underneath and a top wrap. - The padding can be cotton with a gauze pad or a disposable diaper. - Top wraps are either roll gauze or elastic (stretch) wrap. - Tape may or may not be used for reinforcement. - To apply a bandage over a wound on the leg or foot of an animal, roll the gauze or elastic wrap over a pad, holding the roll and unrolling it as it is applied. - Depending on the contour of the area, the roll may need to be twisted half a turn occasionally to pull in the sides of the material for a "snug," neat bandage. - To secure, split the end of the gauze lengthwise, and use the strips to tie a knot. - Then, the strips (like the strings on the elastic wrap) are wrapped in opposite directions and tied. - Tape may be used to secure and protect the bandage more effectively. - The tape should be applied above and below the bandage to adhere to the animal and to keep the bandage in position. - The tape should not be placed tightly across tendons and blood vessels because it may interfere with circulation and cause pressure necrosis. ### Pressure Bandage - Pressure bandages are used to control bleeding, reduce or minimize swelling, and restrict movement. - The key to the safe application of pressure is to apply enough padding next to the limb or injured area. - Generally 1 to 2 inches of padding in the form of cotton, quilting, or any form of smooth, compressible material that can be easily contoured to the limb will suffice. The padding is covered with an elastic wrap. Excessive or uneven tightness is discouraged because it might prevent or restrict circulation. The term "snug" best describes a well-placed bandage. - Ideally the bandage should be "snuggest" at the lowest area and very gradually wrapped "less snug" as the bandage goes up the leg. ### Precautions - Bandages should not be applied too tightly. - If a bandage is improperly applied (too tight) the patient will often exhibit discomfort or even lameness within a short period of time. - Ideally, an animal that is bandaged should be confined and the bandage should be kept dry. - To protect foot and leg bandages from water, mud, and other contamination, various types of protectors are commercially available. - Bandaged wounds need to be rebandaged to clean and medicate infections and to promote healing. - Excessive movement of a bandage on a joint area of the leg may cause irritation which may produce tissue granulation in the wound. - Contaminated wounds bandaged in hot, humid weather are likely to develop infections due to the incubator-like environment under the bandage. - Unbandaged wounds of the lower limbs of horses can be irritated by grass, and wounds of the hock area can be irritated by the tail. - Wounds that are not bandaged may need to be protected with fly repellent because flies not only contaminate a wound but can irritate the tissue. ## Lesson 4- Handling & Administering Medications ### Understanding Labels - Drug labels, whether printed by the drug manufacturer or by the prescribing veterinarian or a pharmacist, contain important information. - They should be relied on for instructions on handling and on administering medications properly. - Over-the-counter (OTC) drugs are drugs that may be purchased directly by the user without a prescription from a veterinarian. - These drugs may be administered to the patient by either the veterinarian or owner. - Prescription or legend drugs are those that require a prescription from a licensed veterinarian and are dispensed by either the veterinarian or pharmacist and administered by the veterinarian or the animal owner. - Prescription drugs must contain a label (“legend”) that states: “Caution: Federal law restricts this drug to be used by or on the order of a licensed veterinarian”. - All prescription drugs must be dispensed by a licensed veterinarian within the confines of a valid veterinarian-client-patient relationship. - If a veterinarian does not have knowledge of the animal, he/she is not permitted to prescribed or dispense a drug for the animal. ### Handling Medications #### General Information - Hands should be cleaned prior to handling or administering medications to animals. This will ensure that the medication will not become contaminated, and it will help prevent exposures to medications that may be harmful to humans. #### Storage - Drugs, chemicals, biologicals, and feed additives must be properly stored to keep them effective and prevent them from deteriorating into useless or toxic compounds. - Every medication should have a label on it describing what it contains and how it should be used. - This label may be provided by the manufacturer, or it may be added by the veterinarian. - Never administer a compound from a container with no label! - The manufacturer's label will contain instructions for the proper environment for storing medications. - Most products should be stored at room temperature (60 to 80 °F) or at refrigeration temperature (35 to 45 °F) in a dry, dark environment, and this will be indicated on the label. - Pharmaceutical companies distribute certain products in dark non-transparent containers to allow them to remain stable for a longer period of time. - Products should remain in those containers until being administered to an animal or group of animals. - Such containers include paper cartons and bags, metal or plastic cans and tubes, and glass or plastic vials and bottles (opaque or amber). - Products should not be taken out of the original container and stored in another container unless directed on the package. - In particular, liquid products should be maintained in their original packaging. - As a general rule, all products should be stored away from direct or indirect sunlight. - Ultra-violet rays will destroy or reduce the effectiveness of most products. - Anthelmintics, insecticides, and vitamins are sensitive to sunlight, and these products are packaged in non-transparent containers for storage at room temperature. - Products labeled to store at room temperature do not need to be stored in the refrigerator. - In addition to proper temperature and in-dark storage requirements, store all products where they will stay clean and dry, away from dust and dirt, to prevent contamination. - Containers of drugs, chemicals, and biologicals contaminated with germs, hair, blood, dirt, or manure should not be used. - Contaminated products not only lose their effectiveness, but are sources of infection when administered to animals. - Always check the expiration date published on the label before administering the product. If it is expired, dispose of the product properly. - A dried product, such as a modified live vaccine or a hormone, is reconstituted with a diluent like sterile water. - After reconstitution, use the product immediately, as these products lose their potency after 1 hour. - Unused vials of biologicals (vaccines, bacterins, antisera) must not be stored for later use, as they will quickly lose their effectiveness. - Once the rubber stopper of a multi-dose biological vial is punctured with a needle to withdraw a dose, the seal is broken, the vacuum is lost, contamination is more likely, and the remaining contents will deteriorate during storage. ### Dispensing - All dispensed products should be properly labeled. - When an over-the-counter (OTC) product is sold by a non-veterinarian, the manufacturer's label is adequate. - A dispensed OTC product or a prescription (Rx) product prescribed by a veterinarian, either for on-label or extra-label use, must bear the veterinarian's label. - The Food and Drug Administration (FDA) and state boards of veterinary medical examiners require certain information be included on the label of every dispensed drug. ### Measuring - The body weight of the animal determines the dose of drugs and pesticides. - Vaccines (biologicals) usually require the same dose for all weights and ages of the same species of animal. - The product dose is published on the label. - The quantity of a product dose is measured in milligrams (mg), grams (gm) milliliters (ml), cubic centimeters (cc), ounces (oz), or pills, tablets (tab), or boluses. - Doses for liquids are measured in ounces or cubic centimeters (milliliters) and for solids in grams, milligrams, ounces, or pounds. - The animal's body weight is measured in kilograms (kg) or pounds (lb). - A kilogram is 2.2 pounds (2.2 lb per kg); a pound is 0.45 kilogram (0.45 kg per lb). ## Lesson 5- Rehabilitation ### Rehabilitation - In a broad sense, animal rehabilitation is repair of an injured animal and treatment for disabilities caused by a physical impairment. - Optimal physical rehabilitation is intended to enhance and aid in the recovery of animals with injuries, long-term degenerative conditions, or recovering from surgical procedures. - Patients at higher risk of complications or residual problems after injury or surgery may require rehabilitation. - Animal rehabilitation is a complex field of veterinary medicine that requires an accurate assessment of the patient's physical problems. - Physical therapy procedures promote health and fitness and enhance the quality of life. - The goal is to reduce and manage pain, to bring patients back to full health, and return them to their previous state. - The practice of rehabilitation in veterinary medicine requires the expertise of specialists in many disciplines of anatomy and physiology, including orthopedics (skeletal system), neurology (nervous system), mycology (muscular system), cardiology (cardiovascular system), biomechanics, and pain management. - Veterinary rehabilitation services provide treatment of various types of issues, such as: - Trauma (muscle, tendons, ligaments) - Orthopedic injury (bones, joints) - Neurological injury (peripheral nerves, spinal cord) - Osteoarthritis (aging) - Debilitating metabolic diseases (diabetes, hypothyroidism) - Obesity (overweight) - Postoperative care following orthopedic surgery. - The benefits of rehabilitation for animal patients are: - Patients become mobile after a severe orthopedic or neurologic injury. - Patients safely use a painful limb after an injury or surgery. - Improve and prolong the quality of life of geriatric and arthritic patients. - Achieve weight loss in overweight and obese animals. - Manage acute and chronic pain. - Increase fitness of athletic and working animals. - Provide ambulatory assistance to patients who need ambulation carts (mobile support), orthotic devices (splints), or prostheses (limbs). - Clinical services include: - Therapeutic exercise - Underwater treadmill - Land treadmill - Manual therapy - Theraball - Massage therapy - Stretch therapy - Cold pack therapy - Moist heat therapy - Acupuncture - Neuromuscular electrical stimulation - Low-level laser therapy - Therapeutic ultrasound - Focused shockwave therapy - Pulsed electromagnetic therapy - Hyperbaric oxygen therapy - Ambulation carts, orthotic devices, prostheses - Purposes of therapeutic exercises are: - Theraball - To help with balance and strength - Underwater treadmill - Low impact exercise - Reduces load on painful joints - Water pressure reduces swelling and edema (hydrotherapy) - Water resistance improves muscular and cardiovascular systems - Water float enables exercises - Land treadmill - Encourages use of limbs - Reduces stress and pain - Manual therapy - To mobilize joints - Low level laser therapy directs biostimulative energy to body cells. - In turn the body cells convert it into chemical energy that promotes natural healing and pain relief. - Pulsed neuromuscular electrical stimulation utilizes low-frequency currents to help relieve acute and chronic pain and help prevent muscle atrophy from orthopedic and neurological diseases. - Acupuncture is the insertion of needles into defined acupoints in the body to treat pain. - Ambulation carts are devices designed to support limbs of non-ambulatory animals. - Ambulation carts are custom fitted for patients to provide support during locomotion. - Splints are orthotic devices used to protect an injured or disabled limb. - Prostheses are internal or external devices used to replace missing limbs. - Surgical implantation of internal devices is known as osseointegration. - Patients and their caretakers must be trained to use these prosthetic devices to achieve the intended result.