genprin prelim.pdf

General Principles of VetMed Clinical Examination one of fundamentals for diagnosing animals which are presented to clinic. relies on knowledge of Anatomy, Physiology, Pathology, and animal behavior. History Taking A.k.a Anamnesis process of obtaining information on the a...

General Principles of VetMed Clinical Examination one of fundamentals for diagnosing animals which are presented to clinic. relies on knowledge of Anatomy, Physiology, Pathology, and animal behavior. History Taking A.k.a Anamnesis process of obtaining information on the animal patient about its illness, onset of illness and feeding practice through careful questioning of the owner. quality of information gained from the interview can be enhanced through several communication techniques. Five (5) Core Skills in Obtaining Effective History 1. open- and closes-ended questioning 2. reflective listening 3. pausing 4. positive nonverbal communcation 5. empathy General History Objective Data Subjective Data > signalment > primary complaint (age, species, breed, gender, > Historical Overview of the reproductive status) patient’s health > Environment > owners do not realize how (free roaming, fenced/encaged, unimportant observation may geographic origin) be related to the primary > Dietary History problem. > Medical History (previous disease/surgery, vaccination, preventatives, lab test results) > Length of ownership  Step-by-step History Taking Step 1 > begin interview by asking open-eneded questions. > encourage owner to actively particpate in the interview process. > as interview progresses, gradually transition to more specific, close-ended questions. SAMPLE OPEN- & CLOSED-ENDED QUESTIONS Example Question Type "Tell me about..." Open "What happened next?" Open "Describe the " Open "When did you first notice the problem?" Closed "How many times per day did it happen?" Closed "Can you show me which leg was affected?" Closed *avoid questions begin with “WHY”. It may cause the owner to feel defensive. Step 2 > Chief complaint Step 3 > develop chief complaint through further open- and close-ended questioning to encourage owner to elaborate details. Onset Location Severity Duration Frequency Factors that increase/decrease CS Progression Treatment Attempts  Step 4 > obtain body systems review to help identify localizing or non-localizing clinical signs, which may be related to the chief complaint. Head (nose, oral cavity, eyes, and ears) Neck Cardiopulmonary Digestive Urogenital Skin (mass or growths) Musculoskeletal Nervous attitude, activity, and behavior appetite and body condition water intake and urination presence of abnormalities (seizures, dyspnea, vomiting, diarrhea, coughing, & sneezing) skin, hair coat, and masses discharge (eyes, nose, vulva/prepuce) gait or lameness duration of chief complaint Step 5 > perform general overview to identify any risk factors > check for ther potential risk factors. Step 6 > at the end, ask owner to express any other concerns about the patient.  Physical Examination main aim is to apply general inspection, palpation, pecussion, and ausculation methods used to detect clinical signs of abnormalities. General Observation > physical exam begins when a vet enters the exam room. > general observation includes assessment of body condition, posture, gait, and behavior. Body Score Condition Vital Signs Normal parameters & - - 4. 8 & - & & & 38 5. 38 5.  & lowest & Highest & & > Facial & & & Sheep goat sal I pisht , , & - , dog call , & & pig Gogp best & 68 20 - 68-go [ & cattle so-g 90 - 130 16 - 138 Highest &  & M Body Systems Approach Needs: ⑨ > stethoscope > lubricating gel > thermometer > disposable digital oral thermometer sheats > latex glove > penlight > otoscope > watch > scale Head and Neck > shape and symmetry of skull. > examine eye separately (eye position, movement, vision, eyelids, conjunctiva, pupillary respone to penlight, palpebral and menace response, and lens position and clarity. eye twitching > look for ocular discharge or & blepharospasm. > fundic exam (pupils are adeqautely dilated). > examine ears. > external pinnae should move in response to sound and light touch. > examine ear canals (discharge), use otoscope for internal canal and tympanic membrane. > examine nose > bridge of external nose (shape, symmetry, color, and erosions). > nare discharge and patency. > examine mouth. > open (evaluate oral cavity) by grasping maxilla with 1 hand and the mandible with the other hand. > examine mucous membrane (color, dryness, moistness). > push gently on the gums to blanch capillaries and observe CRT (>2sec. = poor peripheral perfusion) > check gums, hard and soft palate (color and integrity). > check teeth and palpate (pain or looseness). > check for inflamed tonsils. > examine tounge. topside (color and movement) and underside (string or foreign bodies). = frenulum ·& · Skin > run both hand over the entire surface of the body to assess condition of skin and haircoat. > check for cutaneous and subcutaneous masses, alopecia, ectoparasites, pustules, papules, scale, ecthyma, dermatitis, petechiae, and ecchymoses. > use flea comb. > assess hydration status. > palpate each mammary gland. Thorax > observe and palpate thoracic cage. > palpate both sides for symmetry. > palpate spine (apply gentle downward pressure to spinous process and then along the transverse process; progressively increase degree of pressure. > auscultate thorax while palpating pulse to identify normal vs abnormal heart and pulmonary sounds and to assess heart rhythm and rate. Abdomen * External Genitalia > examine external vulva, prepuce, scrotum (discharge, swelling, and redness). > testicles should be symmetric and descended. > exteriorize penis to examine. > assess anus and perineal skin (swelling, masses, or fistulas). Rectal Exam rectal tem. with lubricated thermo. for large animals, gently insert gloved and well-lubricated finger into the rectum; evaluate rectal wall thickness, glands, pelvic urethra, prostrate gland, and vaginal tract. normal prostrate should be small, symmetric, and nonpainful on palpation. anal glands normal location is 4 and 8 o’clock positions. palpation along dorsal rectum may detect sublumbar lymphadenopathy. examine feces for color and consistency. Musculoskeletal System > examine each thoracic limb (digits to scapula). > palpate muscles, joints, and long bones (joint effusion, swelling, pain, or heat). > palpate prescapular lymph nodes (size and shape). axillary lymph nodes are palpable. > examine tail for movement, masses, and hair loss. > apply gentle pressure to the base of tail by pulling in a craniodorsal direction to detect lumbosacral pain. n > palpate popliteal lymph nodes behind stifles to evaluate size and shape.  Functional Anatomy of Nervous System Brain Spinal Cord Forebrain (Cerebrum, Thalamus, & > extends from brainstem caudally Hypothalamus) through vertebral canal. > sensory information (vision, > info from brain travels through hearing, touch, pain, body spinal cord to the rest of the body. position). > four (4) regions: > voluntary movement and critical ; C1-C5 for learning, behavior, and ; C6-T2 memory. ; T3-L3 Cerebellum ; L4-S3 > controls force and range of movement, muscle activity, Peripheral Nerves associated with vestibular system, > arise from brainstem and spinal body’s equilibrium, and balance. cord and innervate muscles, glands, Brainstem and organs. > connects spinal to the forebrain & > receives sensory input to CNS. relays info bt. two. > regulates autonomic functions (respiratory rate, blood pressure, & heart rate). Purpose of Neurologic Exam > confirm existence of neurologic condition. > localize the lesion. Neurologic Exam Preparation > best perform in quiet environment w/ nonslippery surface. > assistant by patient’s head prevents patient from leaning or turning. > needed: ; reflex hammer ; hemostat ; cotton-tip applicator ; cotton ball ; transilluminator ; lens Neurologic Examination 1. Mentation 2. Posture and gait 3. Cranial nerves 4. Postural reactions 5. Spinal reflexes 6. Pain on spinal palpation 7. Pain perception Mentation > conciousness is produced by appropriate function of both forebrain and ascending reticular activating system in brainstem. > dysfunction of either of these areas, or both, results in clinical observation of abnormal mental state. > other changes may be described, including compulsive behavior, agitation, aggression, and dementia / Posture and Gait > posture describes the animal at rest: > Gait eval. allows observation of lameness, ; kyphosis (dorsal curvature of spine) ataxia, or paresis. ; lordosis (ventral curvtature of spine) ; ambulation - ability of patient to walk ; head tilt using all limbs w/o support or assistanece. ; head and neck turn ; lameness - shortened stride of 1 or ; wide-based stance more limbs, often the result of orthopedic > rare posture but can help in lesion injury; neurlogic conditions (peripheral localization: nerve sheat tumor). ; decerebrate posture (extension of all ; ataxia - incoordination of gait that limbs) indicates disease in area of nervous system. ; decerebellate posture (extension of thoracic limbs;flexion of pelvic limbs) ; opisthotonus (dorsoflexion of head and neck) ; schiff-sherrington posture (increased tone in forelimbs; paralysis in hindlimbs) General History Objective Data Subjective Data > signalment > primary complaint (age, species, breed, gender, > Historical Overview of the reproductive status) patient’s health > Environment > owners do not realize how (free roaming, fenced/encaged, unimportant observation may geographic origin) be related to the primary > Dietary History problem. > Medical History (previous disease/surgery, vaccination, preventatives, lab test results) > Length of ownership  Step-by-step History Taking Step 1 > begin interview by asking open-eneded questions. > encourage owner to actively particpate in the interview process. > as interview progresses, gradually transition to more specific, close-ended questions. SAMPLE OPEN- & CLOSED-ENDED QUESTIONS Example Question Type "Tell me about..." Open "What happened next?" Open "Describe the " Open "When did you first notice the problem?" Closed "How many times per day did it happen?" Closed "Can you show me which leg was affected?" Closed *avoid questions begin with “WHY”. It may cause the owner to feel defensive. Step 2 > Chief complaint Step 3 > develop chief complaint through further open- and close-ended questioning to encourage owner to elaborate details. Onset Location Severity Duration Frequency Factors that increase/decrease CS Progression Treatment Attempts  Step 4 > obtain body systems review to help identify localizing or non-localizing clinical signs, which may be related to the chief complaint. Head (nose, oral cavity, eyes, and ears) Neck Cardiopulmonary Digestive Urogenital Skin (mass or growths) Musculoskeletal Nervous attitude, activity, and behavior appetite and body condition water intake and urination presence of abnormalities (seizures, dyspnea, vomiting, diarrhea, coughing, & sneezing) skin, hair coat, and masses discharge (eyes, nose, vulva/prepuce) gait or lameness duration of chief complaint Step 5 > perform general overview to identify any risk factors > check for ther potential risk factors. Step 6 > at the end, ask owner to express any other concerns about the patient.  Physical Examination main aim is to apply general inspection, palpation, pecussion, and ausculation methods used to detect clinical signs of abnormalities. General Observation > physical exam begins when a vet enters the exam room. > general observation includes assessment of body condition, posture, gait, and behavior. Body Score Condition Vital Signs Normal parameters Body Systems Approach Needs: > stethoscope > lubricating gel > thermometer > disposable digital oral thermometer sheats > latex glove > penlight > otoscope > watch > scale Head and Neck > shape and symmetry of skull. > examine eye separately (eye position, movement, vision, eyelids, conjunctiva, pupillary respone to penlight, palpebral and menace response, and lens position and clarity. > look for ocular discharge or blepharospasm. > fundic exam (pupils are adeqautely dilated). > examine ears. > external pinnae should move in response to sound and light touch. > examine ear canals (discharge), use otoscope for internal canal and tympanic membrane. > examine nose > bridge of external nose (shape, symmetry, color, and erosions). > nare discharge and patency. > examine mouth. > open (evaluate oral cavity) by grasping maxilla with 1 hand and the mandible with the other hand. > examine mucous membrane (color, dryness, moistness). > push gently on the gums to blanch capillaries and observe CRT (>2sec. = poor peripheral perfusion) > check gums, hard and soft palate (color and integrity). > check teeth and palpate (pain or looseness). > check for inflamed tonsils. > examine tounge. topside (color and movement) and underside (string or foreign bodies). Skin > run both hand over the entire surface of the body to assess condition of skin and haircoat. > check for cutaneous and subcutaneous masses, alopecia, ectoparasites, pustules, papules, scale, ecthyma, dermatitis, petechiae, and ecchymoses. > use flea comb. > assess hydration status. > palpate each mammary gland. Thorax > observe and palpate thoracic cage. > palpate both sides for symmetry. > palpate spine (apply gentle downward pressure to spinous process and then along the transverse process; progressively increase degree of pressure. > auscultate thorax while palpating pulse to identify normal vs abnormal heart and pulmonary sounds and to assess heart rhythm and rate. Abdomen External Genitalia > examine external vulva, prepuce, scrotum (discharge, swelling, and redness). > testicles should be symmetric and descended. > exteriorize penis to examine. > assess anus and perineal skin (swelling, masses, or fistulas). Rectal Exam rectal tem. with lubricated thermo. for large animals, gently insert gloved and well-lubricated finger into the rectum; evaluate rectal wall thickness, glands, pelvic urethra, prostrate gland, and vaginal tract. normal prostrate should be small, symmetric, and nonpainful on palpation. anal glands normal location is 4 and 8 o’clock positions. palpation along dorsal rectum may detect sublumbar lymphadenopathy. examine feces for color and consistency. Musculoskeletal System > examine each thoracic limb (digits to scapula). > palpate muscles, joints, and long bones (joint effusion, swelling, pain, or heat). > palpate prescapular lymph nodes (size and shape). axillary lymph nodes are palpable. > examine tail for movement, masses, and hair loss. > apply gentle pressure to the base of tail by pulling in a craniodorsal direction to detect lumbosacral pain. > palpate popliteal lymph nodes behind stifles to evaluate size and shape.  Functional Anatomy of Nervous System Brain Spinal Cord Forebrain (Cerebrum, Thalamus, & > extends from brainstem caudally Hypothalamus) through vertebral canal. > sensory information (vision, > info from brain travels through hearing, touch, pain, body spinal cord to the rest of the body. position). > four (4) regions: > voluntary movement and critical ; C1-C5 for learning, behavior, and ; C6-T2 memory. ; T3-L3 Cerebellum ; L4-S3 > controls force and range of movement, muscle activity, Peripheral Nerves associated with vestibular system, > arise from brainstem and spinal body’s equilibrium, and balance. cord and innervate muscles, glands, Brainstem and organs. > connects spinal to the forebrain & > receives sensory input to CNS. relays info bt. two. > regulates autonomic functions (respiratory rate, blood pressure, & heart rate). Purpose of Neurologic Exam > confirm existence of neurologic condition. > localize the lesion. Neurologic Exam Preparation > best perform in quiet environment w/ nonslippery surface. > assistant by patient’s head prevents patient from leaning or turning. > needed: ; reflex hammer ; hemostat ; cotton-tip applicator ; cotton ball ; transilluminator ; lens Neurologic Examination 1. Mentation 2. Posture and gait 3. Cranial nerves 4. Postural reactions 5. Spinal reflexes 6. Pain on spinal palpation 7. Pain perception Mentation > conciousness is produced by appropriate function of both forebrain and ascending reticular activating system in brainstem. > dysfunction of either of these areas, or both, results in clinical observation of abnormal mental state. > other changes may be described, including compulsive behavior, agitation, aggression, and dementia / Posture and Gait > posture describes the animal at rest: > Gait eval. allows observation of lameness, ; kyphosis (dorsal curvature of spine) ataxia, or paresis. ; lordosis (ventral curvtature of spine) ; ambulation - ability of patient to walk ; head tilt using all limbs w/o support or assistanece. ; head and neck turn ; lameness - shortened stride of 1 or ; wide-based stance more limbs, often the result of orthopedic > rare posture but can help in lesion injury; neurlogic conditions (peripheral localization: nerve sheat tumor). ; decerebrate posture (extension of all ; ataxia - incoordination of gait that limbs) indicates disease in area of nervous system. ; decerebellate posture (extension of thoracic limbs;flexion of pelvic limbs) ; opisthotonus (dorsoflexion of head and neck) ; schiff-sherrington posture (increased tone in forelimbs; paralysis in hindlimbs)