General Medicine Lecture 2 Physical exam LA

May be the only available diagnostic due to financial or location constraints

1) Efficient
2) thorough
3) Minimal intrusion and stress
4) Minimize risk of personal injury

1) Previous illness, recurrent illness
2) Herd history
-others sick- contagious, nutrition, toxic
- new animals in herd
3) Management
- feed, pasture, water, housing, handling (stress)
4) Prior treatment
-response, adverse effects masks symptoms
5) Duration of signs
6) Early signs
7) Vaccinations
8) Deworming

1) Presenting problem?
2) Appetite
3) Thirst
4) Chew cud? (ruminant or camelid)
5) Defecation
-frequency, amount, consistency
6) Urination
7) Parturition
-Post parturient disease, stage of location
8) Pregnancy
-Disease of pregnancy
-Don't abort/induce!!!
9) Present use
-Endurance, breeding, racing, showing

Classic presentation for Vitamin E & selenium deficiency- get muscle necrosis in neck so don't want to life neck and can present w/ dysphagia

Neck trauma

Otitis media- they are very prone to that

Observe from a distance
-general appearance

1) Posture
2) Temperament, mental attitude
3) Gait, manner or locomotion
4) Condition: fat or skinny
5) Conformation, shape

1) Behavioral change
2) Depression
3) Head shaking, tossing, pressing
4) Frenzy or mania
5) Spooky, excitable
6) Stereotypic behavior
7) Moribund

Position of body parts in relation to each other
-Abnormal head placement
-Abnormal positioning of limbs

Polioencephalomalacia- classic presentation
-should check sulfate contents of water or could be thiamine deficiency (bracken fern, equisetum)

1) Continual standing
2) Restless
3) Continual walking
4) Getting up & down
5) Stiff, reluctant to move

Foundered horse (chronic laminitis)-they are trying to get the weight off their heels

No, they should cush, they will sit like this when there's lots of fluid to try and improve respiration

-Manner of locomotion
-Evaluate while moving
-ataxia, incoordination, lameness

May be significant to disease
-Fat animal is more likely to have an acute disease
-Thin animal is usually something that's chronic but treatable

Wooly animals because can be deceiving when you look at them

Cow: 1-5
Horse: 1-9

Abnormal shape of an animal or part of the animal
-Acquired or congenital
-Enlargements
-Atrophy
-Asmmetry

Apple top and pear bottom

All physical senses
-Look
-Listen
-Feel (shape, size, heat, crepitance, thrills)
-Small (putrefaction, ketosis)

Temperature: 99-101.5
Pulse rate: 32-52
Resp rate: 8-16

Temperature: 98-102.4
Pulse rate: 40-80
Resp rate: 18-28

Temperature; 100.9-103.8
Pulse rate: 70-80
Resp rate: 12-20

Temperature: 101.7-104.5
Pulse rate: 70-80
Resp rate: 12-20

Neonate ranges are often higher than adults

Regional

1) Cardiovascular
2) Respiratory
3) GI
4) Urinary
5) Integument

- front of horse
-head (get to know horse)
-right side to left side
-Rear (+ rectal exam)
-Special systems examination, ancillary tests

-Rear of cow
-Left side
-Right side
-Udder
-Rectal exam
-Head (this annoys cows so wait for last)
-Special systems examination, ancillary tests

Make sure restraint is adequate
-Horse: halter and lead rope
-Cow: head gate usually enough, halter can be a useful addition, may need to dairy man to hold head

-Attitude
-Symmetry
-Discharge

Discharge, smell, lesions, air flow

-Horn/dehorning sites
-Swellings of mandible
-Lymph nodes

Open and closed mouth

1) View
2) Nostrils
3) Swellings
4) Percuss sinuses
5) Feel pulse
6) Jugular veins

1) Mucous membranes
2) Color
-pink, pale, blue/gray, yellow, red
3) Capillary refill time
4) Use interdental space to open mouth
-Speculum ideal for thorough exam
-ulcers, vesicles, other lesions
5) Examine tongue
6) Teeth

1) Are eyes sunken?
-Hydration, loss of fat pad
2) Pupil response
3) Swelling, discharge
4) Conjunctiva and sclera
-Sclera often affected by systemic disease
5) Nictitans
-push on upper eyelid to push eye into orbit
6) Tent upper eyelid for hydration status

Submandibular nodes

1) Submandibular
2) Parotid
3) Medial retropharyngeal
-Have to dig into jaw to feel
4) Prescapular
5) Subiliac/ prefemoral
-easy to find when enlarged
6) Mammary
7) Iliofemoral (via rectal palpation)
8) Lymph nodes of the aortic bifurcation

1) Auscultate the heart
2) Auscultate lungs
-Start at rest, then if concerned using rebreathing bag
3) Thoracic percussion
-Identifies consolidation
-Pleural fluid
-Expanded lung field
4) Auscultate GI tract
5) Legs and DPs

Bc its just audible in adults
-Also listen before and after exercise and intestinal sounds

Young and thin animals

Consolidation

Rebreathing air--> increased CO2
- CO2 drives respiratory centers so increased CO2 leads to deeper more rapid breaths

Rebreathe until distress
Observe recovery- normally 3-4 breaths
CONTINUE TO LISTEN

Horses have a much larger lung field

Short, explosive, non-musical sounds
-Explosive equalization of pressure following the reopening of airways

Musical sounds of variable pitch and duration
-Caused by vibration of airway walls

Resembles creaking or rubbing of new leather

Inflamed parietal and visceral pleura rubbing together
-rarely hear bc occur early in disease such as pleuritis

4 quadrants

Small intestinal sounds
Cecal and colonic sounds

1) Auscultate the heart
2) Auscultate the lungs
3) Thoracic percussion
4) Auscultate GI tract
5) Legs and digital pulses

1) Palpate subiliac lymph node
2) Listen to the rumen in the paralumbar fossa
-Feel strength of excursion as the rumen contracts with your hand
3) Ballottement of the rumen
-Fiber mat dorsally
-Fluid ventrally
4) "ping" the side
-simultaneous ausculatation and percussion
5) Flick skin in a semicircle around the head of the stethoscope
6) Methodically cover left side, focusing on a line from the tuber coxa to the elbow

Put hand on one side of animal and tap other side of abdomen and can feel wave that bounces off fingers on the other side

Left displaced abomasum
Rumen gas under tension
Pneumo-peritoneum

1) Listen to the heart
-Bury stethescope deep under elbow and watch chest
2) Listen to the lung field
-Limited in cattle
-Listen over trachea
-Watch chest while you listen
3) Check pre-scapular lymph node and left leg
4) Skin tent to check hydration status

1) Smooth hand over the skin on the top line
-SQ emphysema
-Warbles (Hypoderma bovis)
2) Check for ventral abdominal pain
-Withers pinch
-Pressure on xyphoid
3) Examine brisket for lesions & edema
4) Digital pulses

1) Listen for gut sounds
2) Ping
3) Ballottement
4) Examine right hind leg
5) Palpate pre-femoral lymph node
6) Digital pulses
7) Listen to heart
8) Listen to lungs
9) Examine right front leg
10) Examine right neck and brisket
11) Feel the top line skin
*right is pretty much same as left

1) Right displaced abomasum/torsion
-central ping
2) Cecal dilation/ torsion
-cecal ping is more caudal
3) Trapped intestinal gas
4) Pneumo-peritoneum

Rear- get to know the horse first

Look for swellings, discharges, trauma
-Evidence of diarrhea
-Lift tail, feel strength
-Take temperature

Look for: Swellings, discharges, trauma
Look at abdominal shape
-bloat, gaunt, distention

Metritis

Stroke under vulva to stimulate urination
-try to get urine before upsetting cow
-observe urine
-ketone test strip
Examine vulvar mucous membranes

Ventral coccygeal artery

By looking down the cow's side
Normal= 20-40 /minute

Supramammary nodes
-often not palpable
-also look at back of udder and hind legs

1) Palpate bland, quarter by quarter
-often cannot perform adequately from one side
2) Examine each teat, especially the tip
3) Strip milk from each teat into a strip cup
-Flakes, clots, blood
-California Mastitis test plates

1) Use adequate lubrication
2) Pull a sample of feces and examine it
-color, small, consistency, presence of grain, blood, melena

false, just in cows, unless horse is presenting for weight loss
-Especially important in male horses

Left kidney, uterus, bladder, rumen, ovaries, internal nodes, inguinal rings

Rumen

1) Spleen
2) Medial cecal band
3) Small colon
4) Nephrosplenic ligament